UMEM Educational Pearls

An 18-months old presents with classic symptoms of bronchiolitis.  A trial of Albuterol does not show any objective improvement. What are your other options?
- Nebulized epinephrine: 0.9mg/kg for racemic epi or 0.03 mL/kg of the 2.25% solution (diluted in 3mL) - improves oxygen saturation and respiratory rate, but does not affect admission rates
- Hypertonic saline (3%): decreases hospital length of stay and improves clinical scores, possibly by decreasing airway edema and mucus plugging
- Nasal CPAP: improves ventilation in children with bronchiolitis and hypercapnia
- Heliox: decreases respiratory distress, by reducing gaseous flow resistance and improving alveolar ventilation

Interventions that have shown no benefit and are not recommended:
- Anticholinergics
- oral and/or inhaled corticosteroids

Joesph, M. Evidence-Based Assessment and Management of Acute Bronchiolitis in the Emergency Department. Pediatric Emergency Medicine Practice 2011; 8(3)