Guidelines recommend exclusive breastfeeding for infants for the first 6 months of life.Palivizumab, a monoclonal antibody against RSV, can be administered to prevent bronchiolitis to infants less than one year of age that were born very prematurely or that have underlying heart disease or chronic lung disease of prematurity. Passive immunization therapy requires monthly injections during winter. Otherwise healthy premature infants that were born after a gestational age of 29 weeks should not be administered palivizumab as the harms outweigh the benefits. Passive protection through the administration of other novel monoclonal antibodies is also under evaluation.Immunizations for RSV are being developed but none are available currently outside of clinical trials.Tobacco smoke exposure has been shown to increase both the rates of lower respiratory disease in infants, as well as the risk and severity of bronchiolitis. Tobacco smoke lingers in the environment for prolonged periods and on clothing even when smoking outside the home. Guidelines recommend that parents be fully educated on the risks of tobacco smoke exposure on children with bronchiolitis. Management
Treatment of bronchiolitis is usually focused on the hydration and symptoms instead of the infection itself since the infection will run its course and complications are typically from the symptoms themselves. Without active treatment, half of cases will go away in 13 days and 90% in three weeks. Children with severe symptoms, especially poor feeding or dehydration, may be considered for hospital admission. Oxygen saturation under 90%-92% as measured with pulse oximetry is also frequently used as an indicator of need for hospitalization.
black widow spider)
Malingering
Pneumoperitoneum secondary to abdominal trauma
Septic miscarriage (See Miscarriage)

Laboratory findings
Complete blood count (CBC)
Blood urea nitrogen (BUN)/creatinine
Liver function tests (LFTs)
Glucose
Amylase/lipase
Urine culture
Urinalysis
Beta-human chorionic gonadotropin (beta-hCG)
Cervical cultures are recommended to diagnose pelvic inflammatory disease

Electrolyte and biomarker studies
Electrolytes

MRI and CT
CT diagnoses:
Organ contusion
Organ laceration
Aneurysm
Diverticulitis
Appendicitis

Echocardiography or ultrasound
Pelvic, abdominal and/or transvaginal ultrasound diagnoses:
Peritonitis
Ectopic pregnancy
Ovarian cysts
Fluid/blood secondary to trauma
Appendicitis
Aneurysm

Other imaging findings
KUB x-ray imaging (kidney, ureter, bladder) could reveal nephrolithiasis and bowel gas pattern

Other diagnostic studies
Symptomatic relief may be provided by paracentesis, which may also diagnose spontaneous bacterial peritonitis (SBP)
Gastrointestinal endoscopy may be used or patients with suspected peptic ulcer disease
Helicobacter pylori testing may also be used
Trial medications may be beneficial for the diagnosis and treatment of:
GERD/dyspepsia: Proton pump inhibitors or H2 blockers
Abdominal wall strain: Nonsteriodal anti-inflammatory drugs (NSAIDs)
Anxiety: Lorazepam
Zoster: Acyclovir

Treatment
Specific conditions need direct treatment
Hemodynamic status and life-threatening disease require immediate attention
Volume replacement with a possible blood transfusion, and with normal saline
For obstruction and persistent vomiting, place nasogastric (NG) tube

Pharmacotherapy
If perforated viscus or intra-abdominal infection suspected, administer broad-spectrum empiric antibiotics

Surgery and device-based therapy
Early sepsis, or evidence of hemorrhage may require surgery (likely to be life-threatening emergency)

References
Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3