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Pediatric ED Bronchiolitis Algorithm

Pediatric ED Bronchiolitis Algorithm - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Respiratory, Related


Respiratory Care Protocol - Bronchiolitis
NON-Pharmacological Management
Obtain history and
perform physical exam
Meets
criteria?
Inclusion Criteria
ξ Age 28 days to < 24 months
Exclusion Criteria
ξ Intubation or ventilator
ξ Cystic fibrosis, bronchopulmonary
dysplasia (BPD), spinal muscular
atrophy (SMA)
ξ Immunodeficiencies
ξ Chronic Lung Disease
ξ Hemodynamically significant heart
disease
ξ Prematurity with gestational < 35 weeks
ξ Pediatric Intensive Care Unit (PICU)
ξ Severe respiratory distress
Pediatric Emergency Dept. Bronchiolitis Treatment Algorithm
Outside scope.
- Consider PICU consult or
High Flow Nasal Canula
MD activates “Respiratory Care Protocol - Bronchiolitis”
*ED – Bronchiolitis – Pediatric [5798]
ξ RT performs initial assessment including use of Bronchiolitis
Scoring Tool (WARM)
ξ RT suctions nasal passages
ξ RT reassesses when patient calm using WARM tool
WARM
score > 4?
RT order and give single trial of albuterol (2.5 mg, once) via nebulizer.
RT reassess using WARM tool 30 minutes post-
treatment
WARM score
improved by
> 2 points?
Management without inhaled medications:
A)

RN assess and record using WARM tool with Intermittent vitals
B) Perform nasal suction
C) RN reassess and record using WARM tool when patient calm
WARM
score > 4?
Did patient
receive trial
albuterol
dose?
Yes
Yes
Yes
Contact Attending
Yes
No
1. RT notify Resident
2. RT to do the following every 4 hours:
A)

assess using WARM tool
B) nasal suction
C) order and give albuterol via nebulizer (2.5 mg, PRN –
Bronchiolitis Score (WARM) > 4
)
D) reassess (WARM) 30 minutes post treatment*
*If score is < 3, patient to be managed via “NON-pharmacological
Management.” RT to notify Resident/Attending.
No
ξ RN performs initial assessment using Bronchiolitis
Scoring Tool (WARM)
ξ RN perform nasal suction

ξ RN reassess when patient calm using WARM tool
WARM
score > 4?
Proceed to
NON-
Pharmacological
Management
No
Yes
No
No
Proceed to
Respiratory
Care Protocol
- Bronchiolitis
No
Yes
Bronchiolitis – Pediatric – ED/Inpatient Clinical Practice Guideline | Last revised: 01/2016 | Contact CCKM for revisions.
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:CCKM@uwhealth.org 01/2016