Scenario

Response 1:

            I agree with your treatment because you treat the child with caution to avoid fear or even further complications. Using a non-rebreather mask for extra oxygen is also acceptable. The fact you noted the possibility of excessive mucus production and thus using 500 mcg nebulized atrovent is also acceptable. However, using Epi 1:10,000 mg/kg is questionable as the initial treatment. I think that this is very high for the asthmatic condition and would have been necessary for cardiopulmonary arrest. I think Epi 1:1,000 would have worked. I also agree with you that the child has Asthmaticus because of failure of past treatments.    

Response 2:

            I agree with your treatment because you started with stabling the breathing of the patient. Noting that the labored breathing and wheezing is of concern proves that your treatment is right. Further, noting that the child has crackles in the lung fields and the JVD and thus fluid bolus cannot be administered showing that you understand the sensitivity of the situation. Preparing the child by simple adjust using OPA with BVM supported by 15L O2  is also acceptable. Further, 1:10,000 mg/kg is also acceptable because the diagnosed condition is arrest and should be corrected with a strong shock. Continued support care is also necessary by educating the parents of what they should do.

Response 3:

            Giving extra oxygen to the patient using a non-rebreather mask or humidified high flow nasal cannula is acceptable. The fact that you note the importance of caution in regulating the oxygen dosage shows that you understand that a child is sensitive. However, Epi of 1:10,000 IV may not be important in this stage. The step of rendering 1.5 mg of Epinephrine 1:1,000 via ET tube would start. However, administering Amiodaroe 75 mg to treat the underlying causes is also acceptable. Starting with a shock of 30-J followed by a 60-J is also acceptable because a strong shock is only rendered if the situation does not change.  

      

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