Clinical indications of respiratory distress/bronchiolitis include:

  1. Preceding upper respiratory illness and/or rhinorrhea
  2. Signs of respiratory illness:Tachypnea
    1. Retractions
    2. Shortness of breath
    3. Low O2 saturation
    4. Color change
    5. Nasal flaring
    6. Wheezing


  1. Place patient on the monitor, recording HR, RR, BP and oxygen saturation.
  2. Apply oxygen to keep oxygen saturation >90%
  3. NPO and IV hydration at maintenance.
  4. Fluid bolus 10-20 ml/kg (NS) if prolonged capillary refill time. Reassess and repeat if needed. (see Vascular Access)
  5. Intubation for impending respiratory failure. Placement of cuffed ETT is preferred. (see Intubation and Rapid Sequence Induction)
  6. Medications:




  1. Albuterol

Infants < 1 year:    2.5 mg

Children > 1 year: 5 mg, if there is clinical improvement in respiratory status, switch to pediatric asthma protocol.

AAP recommended against the routine use of Albuterol.

If concern for reactive airway disease, may consider albuterol trial.

  1. Racemic Epinephrine

0.5 ml, for only one dose, repeat ONLY for measured clinical improvement.

AAP recommended against the routine use of Albuterol


  1. AAP Updates Recommendations on Treating Bronchiolitis in Young Children: 201