Question

An 18-month-old child has a 1-week history of cough and runny nose. The child has diffuse cyanosis and is responsive only to painful stimulation with slow respirations and rapid central pulses. The child's RR has decreased from 65 bpm to 10 bpm, severe inspiratory intercostal retractions are present, HR is 160 bpm, SpO2 is 65% on room air, and capillary refill is <2secs. What is the most appropriate immediate interventions for this toddler?

Answer 1

Immediate interventions for a toddler with severe respiratory distress include establishing an airway, providing supplemental oxygen, and potentially advanced airway management with intubation and mechanical ventilation, and in some cases, administration of pulmonary surfactant.

Step-by-step explanation:

The 18-month-old child presents signs of severe respiratory distress, characterized by cyanosis, reduced responsiveness, a dangerously low respiratory rate (RR), rapid central pulses, severe intercostal retractions, and SpO2 well below normal levels. Given the urgency, the most immediate intervention would be to establish an airway and provide adequate ventilation. Interventions such as initiating supplemental oxygen and considering advanced airway management, like intubation and mechanical ventilation, are crucial. Actions should be performed in a rapid response scenario, with the medical team prepared to begin resuscitation measures, possibly including CPR if the situation deteriorates further and the child's heart rate drops or stops. The administration of pulmonary surfactant may also be indicated if the child has Respiratory Distress Syndrome (RDS), although at 18 months old RDS would be less common than in premature infants. However, immediate treatment focused on stabilizing the child's breathing and heart rate is imperative.