Question

You are treating a 10-year-old patient after a motor vehicle crash. The patient is unresponsive and flexes his arms at the elbow in response to a painful stimulus. An endotracheal tube is in place with position confirmed. You are ventilating using a resuscitation bag with oxygen, and the child has an Spot of 95% and good chest excursion bilaterally. Blood pressure is 130/70 mm Hg and heart rate is 90/min with good perfusion. You have established intravenous access. Which of the following actions would be most appropriate at this time?

a.Give an intravenous bolus of mannitol
b.Provide continuous positive airway pressure (CPAP)
c.Obtain a CT scan of the head and neck
d.Begin manual hyperventilation

Answer 1

Manual hyperventilation is not advisable for the patient; instead, maintain proper ventilation rates and prepare for additional interventions. Continue to monitor the patient closely and follow established medical protocols for further care.

Step-by-step explanation:

When treating an unresponsive 10-year-old patient post motor vehicle crash who is already intubated and being ventilated with a resuscitation bag with oxygen, showing an SPO2 of 95%, and a stable blood pressure and heart rate, the most appropriate next step would not be manual hyperventilation. Hyperventilation can lead to reduced cerebral blood flow and increased intracranial pressure, potentially worsening the patient's condition. Instead, it is essential to continue monitoring the vital signs, ensure the patient is adequately ventilated with the appropriate rate and volume, and prepare for further intervention by the medical team. Maintaining normoventilation is crucial unless specific indications for hyperventilation are present, which can be informed by the care guidelines or a physician's directive.

Given the scenario, medical providers must apply knowledge of resuscitation techniques, such as compressions in cardiopulmonary resuscitation (CPR) if the patient's heart stops. However, with good perfusion and heart function, as indicated by the normal blood pressure and heart rate, CPR is not indicated in this context. The use of ventilators, intubation, and potential use of additional supportive therapies should be executed according to established medical protocols and the specific needs of the patient.