A 7-month-old boy is brought to the clinic in January by his parents due to a 3-day history of nasal congestion, clear rhinorrhea, and a low-grade fever. Over the last 24 hours, he has developed a harsh cough and rapid breathing. The patient was born at term and has received all age-appropriate vaccinations. His temperature is 37.9°C (100.2°F), heart rate is 135/min, respiratory rate is 58/min, and oxygen saturation is 95% on room air. Physical examination demonstrates nasal flaring, mild intercostal retractions, and diffuse bilateral wheezing with fine crackles. Which of the following is the most appropriate next step in management?
- Supportive care with nasal suctioning and hydrationCevap
- BAdministration of nebulized albuterol
- CPrescription of oral dexamethasone
- DPrescription of oral amoxicillin
- EPosteroanterior and lateral chest radiography
Cevap
Supportive care with nasal suctioning and hydration
The correct answer emphasizes that acute viral bronchiolitis is a self-limiting disease primarily caused by RSV. Because the airway narrowing is due to sloughed epithelial cells, mucus plugging, and submucosal edema, the mainstay of therapy is entirely supportive. Nasal suctioning helps relieve upper airway obstruction, which is crucial since infants are obligate nose breathers, and maintaining hydration prevents clinical deterioration. Since this patient is well-oxygenated (SpO2 > 90%) and in only mild distress, supportive management without medications or imaging is the standard of care.
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Anahtar Kavram
The primary management for mild to moderate acute viral bronchiolitis is supportive care, avoiding unnecessary pharmacologic interventions like bronchodilators or corticosteroids.