Question

You are called to treat a 5-year-old with a 3-day history of worsening respiratory distress. The child responds only to pain. The heart rate is initially 45/min and regular with poor capillary refill. You provide bag-mask ventilation with high-flow oxygen, which produces good chest rise with full and clear bilateral breath sounds. The heart rate rises in response to ventilation, but after you suction the posterior pharynx, bradycardia recurs (40/min). Which of the following interventions would be most appropriate for you to do first?

a.Perform transcutaneous pacing
b.Resume bag-mask ventilation
c.Administer epinephrine IV
d.Administer atropine IV

Answer 1

The most appropriate first intervention is to resume bag-mask ventilation in a 5-year-old with respiratory distress and recurrent bradycardia after suctioning, aiming to correct hypoxia according to the ABC principles.

Step-by-step explanation:

You are treating a 5-year-old with a 3-day history of worsening respiratory distress who is now experiencing recurrent bradycardia after suctioning the posterior pharynx. Considering the child's initial heart rate was 45/min with poor capillary refill and improved upon bag-mask ventilation with high-flow oxygen, it is likely that the bradycardia is due to hypoxia. The most appropriate first action in this situation would be to resume bag-mask ventilation to address the hypoxia. This follows the ABC (Airway, Breathing, Circulation) approach of emergency pediatric care, prioritizing the restoration of adequate oxygenation and ventilation before proceeding to other interventions. If the heart rate does not improve following this intervention, it would be appropriate to consider administering epinephrine or atropine, and transcutaneous pacing would be a later consideration if pharmacological interventions failed to restore an adequate heart rate.