Bronchiolitis Quiz: Ace Your Exams

A 3-month-old infant is brought to the emergency department by her parents for difficulty breathing and poor feeding. She has had rhinorrhea and a cough for three days with a maximum temperature of 37.8°C (100.0°F) at home. Starting this morning, she has been refusing to nurse for more than a few seconds at a time and has only had two wet diapers. That evening, at bedtime, her breathing became faster, and her abdomen appeared to be moving significantly when she was breathing. She was born at 35 weeks gestation and has no chronic medical conditions or prior wheezing episodes. Temperature is 37.3°C (99.1°F), pulse is 162/min, respiratory rate is 62/min, blood pressure is 84/40 mmHg, and oxygen saturation is 93% on room air. Weight is in the 62^nd percentile, height is in the 55^th percentile and head circumference is in the 61^st percentile. On physical examination, the child appears awake and alert with active movement of all extremities. The anterior fontanelle is sunken and there is poor skin turgor. Moderate intercostal retractions and abdominal breathing are noted. Lung examination reveals diffuse bilateral crackles with faint expiratory wheezes. Which of the following is the best next step in management?