The infant on 2 litres

A 4-month-old with bronchiolitis, day 3, admitted this afternoon on low-flow oxygen. The night shift has started. Setting: Pediatric ward, room 5.

1. 22:00

   Took 70 mL of a 120 mL bottle at 21:00, came off twice to breathe.

   HR156RR58BP86/50SpO294% (1 L nasal cannula)T37.8

   Mental status

   Awake, watching the mobile, cries at the saturation probe.

   Respiratory effort

   Nasal flaring, moderate subcostal retractions, no grunting.

   Perfusion

   Refill 2 seconds, warm.

   Urine

   Wet diaper at 20:00.

   Read the 22:00 frame for a 4-month-old on 1 L.

   Improving; wean the oxygen to 0.5 L overnight and trial room air before the morning feedModerate distress on 1 L, feeding around half: expected for day 3; watch the oxygen, the feeds, the effort and any pausesGive salbutamol via a spacer, since she is wheezy and it may reduce the work of breathingSevere distress for a 4-month-old at this respiratory rate; call intensive care now for high-flow

Educational simulation of a fictitious child. Vital sign reads come from the platform’s age-band reference layer (PALS 2020 teaching ranges) and are never a substitute for institutional early-warning scores or clinical judgement.