Question

Paramedics are called to the home of a 1-year-old child. Their initial assessment reveals a child who responds only to painful stimuli and has irregular breathing, faint central pulses, bruises over the abdomen, abdominal distention, and cyanosis. Bag-mask ventilation with 100% oxygen is initiated. The child's HR is 36 bpm. Peripheral pulses cannot be palpated, and central pulses are barely palpable. The cardiac monitor shows sinus bradycardia. Two-rescuer CPR is started. Upon arrival to the ED, the child is intubated and ventilated with 100% oxygen, and IV access is established. The HR is now 150 bpm with weak central pulses but no distal pulses. SBP is 74 mmHg. What intervention should be provided next?

Answer 1

The child, who presents with bradycardia and evidence of shock, needs immediate intravenous fluid resuscitation and possibly vasopressors to restore adequate circulation and tissue perfusion.

Step-by-step explanation:

The intervention that should be provided next for the child with a heart rate (HR) of 150 bpm but weak central pulses and no distal pulses, with an SBP of 74 mmHg, is intravenous fluid resuscitation and potential vasopressor support. Considering the child's unstable hemodynamic status and the symptoms that suggest possible internal bleeding or other causes of shock, it's important to restore circulating blood volume and improve tissue perfusion. The sustained bradycardia prior to intervention, as well as the bruises and abdominal distension, are concerning for trauma, possibly abusive, necessitating immediate fluid resuscitation to manage potential hemorrhagic shock. If there is no response to volume resuscitation, administration of vasopressors may be needed to support the heart's ability to generate adequate blood pressure and thus sustain vital organ perfusion.