Bronchiolitis Quiz: Ace Your Exams

A 2-month-old infant is brought to the emergency department by his parents for difficulty breathing. He has had rhinorrhea and cough for the last two days, but no fever. He was fussy before bed and only drank half of his bottle, then awakened several times with progressively faster breathing. He was born at 36 weeks gestation and has no ongoing medical issues. Temperature is 37.8°C (100.1°F), pulse is 174/min, respiratory rate is 64/min, blood pressure is 92/48 mmHg, and oxygen saturation is 88% on room air. Weight is in the 53^rd percentile, height is in the 51^st percentile, and head circumference is in the 50^th percentile. On physical examination, he is awake with good tone and active movement of all extremities, crying weakly between breaths. Nasal flaring is observed. Breathing is labored with moderate suprasternal, intercostal, and subcostal retractions. Diffuse bilateral expiratory wheezing is noted on lung exam. Nasal respiratory viral panel swab is positive for respiratory syncytial virus. Which of the following is the best next step in management?