Question

An 18-month-old child presents with a 1-week history of cough and runny nose. You perform an initial impression, which reveals a toddler responsive only to painful stimulation with slow respirations and diffuse cyanosis. You begin a primary assessment and find that the child's respiratory rate has fallen from 65/min to 10/min, severe inspiratory intercostal retractions are present, heart rate is 160/min, SpO₂ is 65% on room air, and capillary refill is less than 2 seconds. Which of the following is the most appropriate immediate treatment for this toddler?

a) Administer high-flow oxygen
b) Initiate cardiopulmonary resuscitation (CPR)
c) Administer epinephrine
d) Perform a head-to-toe physical examination

Answer 1

The immediate treatment required for a toddler in severe respiratory distress with low SpO₂ is to administer high-flow oxygen. Other interventions mentioned would follow or be required in different circumstances.

Step-by-step explanation:

The most appropriate immediate treatment for this toddler, who presents with severe respiratory distress, cyanosis, and a dangerously low SpO₂ of 65% on room air, is a) Administer high-flow oxygen. The child's symptoms, including a respiratory rate that has drastically fallen to 10/min from an initially high rate of 65/min, intercostal retractions, and a high heart rate of 160/min, are indicative of severe respiratory distress which could potentially lead to respiratory failure. Immediate oxygen therapy is critical to improving the child's saturation levels and to prevent further hypoxemia and its complications. Option b) Initiate cardiopulmonary resuscitation (CPR) would only be appropriate if the child's heart and breathing have stopped, which is not the current condition. Administering epinephrine or performing a head-to-toe physical examination, while important in specific circumstances, would not be the immediate interventions for a child in acute respiratory distress.