Question

A 4-year-old child is brought to the emergency department by the parents. Assessment reveals that the child has only gasping respirations and the pulse rate is 65 beats per minute. Which action would the provider initiate first?

Select the correct answer to this question.
A. Begin chest compressions.
B. Deliver 1 BVM ventilation every 2 to 3 seconds.
C. Check pulse and breathing every 2 minutes.
D. Prepare the manual defibrillator.

Answer 1

The provider should first begin chest compressions for the 4-year-old child with gasping respirations and a low pulse rate, as per the CPR guidelines.

Step-by-step explanation:

The provider would initiate chest compressions first in the situation where a 4-year-old exhibits only gasping respirations and has a weak pulse of 65 beats per minute. This aligns with current CPR guidelines prioritizing chest compressions to maintain blood circulation, particularly to the brain, to prevent irreversible damage or neuron death which can occur within minutes without blood flow.

Given the child's age, the normal respiratory rate should be around 18 to 30 breaths per minute; however, with only gasping respirations being present, this indicates inadequate respiration. The goal of chest compressions is to achieve a compression depth of at least 5 cm and at a rate of 100 compressions per minute, which can sustain the circulation of blood throughout the body, including the pulmonary and systemic circuits.

Since the priority is to maintain perfusion and oxygenation of vital organs, especially the brain, and breathing is inadequate with a critically low pulse rate, initiating CPR with chest compressions is crucial before advancing to other interventions such as artificial ventilation or checking for a pulse and breathing every 2 minutes.