Question

You are caring for a 3-year-old with vomiting and diarrhea. You have established IV access. When you place an orogastric tube, the child begins gagging and continues to gag after the tube is placed. The child's color has deteriorated; pulses are palpable but faint, and the child is now lethargic. The rate is variable (44/min to 62/min range). You begin bag-mask ventilation with 100% oxygen. When the heart rate does not improve, you begin chest compressions. Which of the following would be the most appropriate therapy to consider next?

a) Administer a bolus of epinephrine
b) Continue chest compressions and reassess
c) Administer a fluid bolus
d) Consider advanced airway management

Answer 1

In a case of hypovolemic shock due to severe vomiting and diarrhea in a child, administering a fluid bolus is the appropriate next step in management after ventilation has been established and improved heart rate is not observed.

Step-by-step explanation:

The situation described suggests that the child is in a state of hypovolemic shock, which is common in young children with severe diarrhea or vomiting. The appropriate next step in therapy, after establishing an airway and ensuring proper ventilation but without improvement in heart rate, would be to administer a fluid bolus. Fluid resuscitation is crucial in treating hypovolemic shock to restore intravascular volume and improve circulation. Although chest compressions and reassessment, epinephrine, and advanced airway management are part of the resuscitation protocols, a fluid bolus is often a priority in cases of shock due to dehydration and fluid loss.