nbme 3 block 4 7q - drle

[ArchivalUser]

2mo old infant is brought to the emergency department by paramedics after his mother found him not breathing in his crib.He is apneic and cyanotic,no pulses are palpable ,he is warm.After manual stabilizing his neck and positioning the airway,which of the following is the most approriate next step in management?
a.positive pressure ventilation and oxygenation
b, two chest thrust followed by chest compressiopn
c.establishing vascular access
d.admistration of epinephrine
e.electrical defibrillation

what is the answer guys for this q?

[ArchivalUser]

not breathing ..
no pulses ..

B

[ArchivalUser]

but answer key say answert is a

[ArchivalUser]

I think the answer key is more acceptable

I searched and found the following link, may it helps

Reason for Cardiac Arrest in Children/Infants: Children and Infants suffer from cardiac arrest typically as a result of a respiratory event such as choking or respiratory arrest. Not from a cardiac condition - It is uncommon to hear of a child or infant having a heart attack. Children and Infants typically do not have a history of high blood pressure, smoking, or other conditions that are applicable to adults.

Due to children and infants likely going into cardiac arrest due to respiratory event, we must recognize that ***oxygenation and circulation need to be initiated ***as quickly as possible for these age groups.

Hypoxia (or lack of oxygen inside the body) is a reversible cause of cardiac arrest. If oxygenation and circulation are performed quickly and effectively the cardiac arrest may improve or allow the person to recover. - See more at:


http://www.cardiopulmonaryresuscitation....Nafcn.dpuf


Thank you

[ArchivalUser]

thanks us2015 for nice explanation.

[ArchivalUser]

answer key is not always right i think the correct answer is B
According to BLS first thing to do in any unresponsive patient with no pulse it position the patient and start CPR

anyone who has taken online can help

[ArchivalUser]

Agree with stranger, the correct answer if you apply PALS( Pediatric Advanced Life Support-AHA) is :
For any unresponsive child or infant, start CPR or chest compressions for 2 minutes first and then call for help 911 if outside hospital setting.
But in Emergency Department(ED) as in this case, it still remains chest compressions first, before intubation and setting up ventilation which takes time. The questions is asking what is the next best step in management when you get an unresponsive child in ED? So it is call for help to let someone get AED,and set up intubation and ventilation equipment, but start chest compressions/CPR straight away on child's arrival.

So, the correct answer is B

[ArchivalUser]

I think mouth to mouth resuscitation can be considered positive pressure ventilation in a way too.

[ArchivalUser]

was looking for this answer, almost went crazy!!
yes I agree that BLS algorythm has changed, however 2 chest thrusts are really not
how you start (thrusts doesnt sound a little too aggressive?), so I guess that leaves the next best answer A.

http://chemm.nlm.nih.gov/pals.htm

what do you guys think?