Bronchiolitis

HISTORY:

‍CoughWheezingShortness of breathFever for ‍ ‍hoursdays

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored

‍shortness of breath

‍wheezing

‍accessory muscle use

‍runny nose, ‍clearcolored

‍fever, up to ‍°, over ‍ ‍hoursdays

‍lethargy

‍irritability

‍rash

‍decrease in fluid intake

‍decrease in urine ouput

‍decrease in appetite

Treatments tried: ‍nonesaline nasal rinse, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: fontanelles ‍soft, ‍normocephalic

Eyes: -R: ‍normal, -L: ‍normal, ‍

Ears: -R: ‍normal, -L: ‍normal

Nose: ‍clear, ‍nasal flaring, discharge ‍clear, ‍

Throat: ‍normalrednessexudate

Mouth: ‍normal

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Extremities: ‍normal, ‍normal pulses, cap refill ‍< 3 sec> 3 sec

Skin: ‍no rash

Mental status: ‍alert, ‍, reactive to ‍



ASSESSMENT:

‍Bronchiolitis ‍likelysuspectedpossible

DDx: ‍



PLAN:

- RSV swab

- Chest X-ray

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍blood gas

- Admission to hospital with apnea monitoring if aged less than 3 months

- Nasal saline rinse

- Encourage oral hydration

- ‍Bronchodilators

- ‍Acetaminophen

- ‍Ibuprofen

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop

- Go to ER if severe shortness of breath, signs of dehydration, or high fever