Respiratory distress

A 12 month old boy attends the emergency department overnight. He woke up at 03.00am with difficult breathing. He has had a cough and runny nose for 1 day. On assessment, he is saturating at 99% in air, respiratory rate is 36 breaths/minute, and temperature is 37.6 degrees. You hear an inspiratory breathing noise. This seems to get louder when he cries. He looks well, and drinks some milk while you see him. His parents report his cough sounds different to normal. Which would be the best management?

A two year old girl attends ED with ongoing fevers and difficulty breathing. She was seen in ED four days previously and started on Amoxicillin for a lower respiratory tract infection. She has ongoing fevers up to 39.5 degrees, and difficulty breathing. On assessment, she is saturating at 94% in air, respiratory rate is 50 breaths/minute, Heart rate is 145 beats/minute. She has tracheal tug and subcostal recession. Auscultation is very difficult as she screams whenever examined. What would be the next best step?

A 3 month old baby attends ED with difficulty breathing. They’ve had a cough and runny nose for 5 days. They normally feed 120ml every 3 hours, and the last day have only been managing 100ml. On assessment, heart rate 150 beats per minute, respiratory rate 45 breaths per minute, temperature 37.7^oC, oxygen saturations 94% in air. Smiling and active. Mild subcostal recession. Chest bilateral wheeze and few scattered crepitation’s. Which would be the best management?