›Initial stabilization workflow
›Triage triggers
›Apnea history
›Central cyanosis
›Severe retractions
›Monitoring
›Continuous pulse oximetry if moderate or severe distress
›Cardiorespiratory monitoring if severe or apnea risk
›Oxygen escalation
›Start oxygen if saturation below 90 percent on room air
›Escalate to high flow nasal cannula if persistent distress or hypoxemia
›Airway adjuncts
›Nasal suctioning
›Positioning upright
›Testing strategy
›Typical bronchiolitis with mild symptoms
›No routine imaging
›No routine labs
›Atypical or severe presentation
›Chest radiograph if focal findings or severe illness
›Blood gas if fatigue or rising oxygen requirement
›Supportive care
›Nasal suctioning with saline
›Hydration strategy
›Oral feeding if safe
›NG hydration if poor intake and stable respiratory effort
›IV fluids if unsafe oral intake or significant distress
›Bronchodilator approach
›Trial of inhaled salbutamol may be considered in selected infants
›Continue only if clear objective improvement
›Corticosteroids
›Not routine for bronchiolitis
›Consider systemic steroids if strong asthma phenotype or recurrent wheeze with bronchodilator response
›Anaphylaxis treatment if suspected
›IM epinephrine weight based local protocol
›Airway edema monitoring
Monitoring and reassessment loop
›Reassessment loop
›Recheck work of breathing every 30 to 60 minutes until stable
›Recheck feeding tolerance after interventions
›Escalate respiratory support if worsening retractions or rising oxygen need
›Consult triggers
›PICU for high flow escalation needs
›ENT for upper airway obstruction concern
›Pediatric surgery or pulmonology for foreign body concern