Question

The nurse is caring for a 4-year-old male child who becomes unresponsive as his heart rate decreases to 40 beats/minute. His blood pressure is 88/70 mmHg, and his oxygen saturation is 70% while receiving 100% oxygen by non-rebreather face mask. In what sequence, from first to last, should the nurse implement these actions? (Place the first action on top and last action on the bottom.)

1.Start chest compressions with assisted manual ventilations
2.Administer epinephrine 0.01 mg/kg intraosseous (IO)
3.Apply pads and prepare for transthoracic pacing
4.Review the possible underlying causes for bradycardia

Answer 1

In a case of severe bradycardia in a child, the nurse should start chest compressions and ventilation, administer epinephrine, prepare for transthoracic pacing, and then review underlying causes, in that order.

Step-by-step explanation:

If a 4-year-old child becomes unresponsive with a heart rate of 40 beats/minute, a blood pressure of 88/70 mmHg, and an oxygen saturation of 70% while on 100% oxygen, the following steps should be taken in priority:

1. Start chest compressions with assisted manual ventilations. Due to the child's critical state with a strikingly low heart rate (bradycardia) and poor oxygen saturation, immediate action to circulate blood and provide oxygen to vital organs is necessary. This is in line with the urgent need for cardiopulmonary resuscitation (CPR).
2. Administer epinephrine 0.01 mg/kg intraosseous (IO). Epinephrine is given following the initiation of CPR to improve heart function and increase blood pressure.
3. Apply pads and prepare for transthoracic pacing. If available and the child's condition does not improve, this intervention is a consideration to help regulate the heart's rhythm.
4. Review the possible underlying causes for bradycardia. This step is crucial, although it comes after the immediate life-saving measures have been taken, to target the proper treatment specific to the cause.

The sequence starts with emergency resuscitation followed by medication, potential advanced cardiac life support, and a review of the etiology of the bradycardia. Understanding that rapid intervention is key in preventing irreversible brain damage or death, it is essential that the nurse acts quickly and efficiently.