o**h
发帖数: 55 | 1 A 2 month old infant is brought to th emergency department by paramedics
after his mother found him not breathing in his crib. He is apneic and
cyanotic, no pulses are palpable but he is warm. After manually
stabilizing his neck and positioning the airway, which of the following is
the most appropriate next step in management?
a) Positive presure ventilation and oxygenation.
b) two chest thrusts followed by ches compressions.
c) Stabilishing vascular acces.
d) Administration of epinephrine.
e) E |
m*****5
发帖数: 438 | 2 Answer is B because most of the time the answer is the simplest intervention
. The baby is cyanotic and the first thing you should think of is foreign
body aspiration. Two chest thrusts can dislodge it and chest compression is
the first step you would do before oxygenation, vascular access, epinephrine
or defibrillation. |
r*****2
发帖数: 309 | 3 I think the answer is "a". The baby has SID, so ABC,ABC (airway, breath and circulation)...Ventilate with oxygen always has first priority. |
m*****5
发帖数: 438 | 4
and circulation)...Ventilate with oxygen always has first priority.
Common things first in any situation. I am telling you from experience. When
you do ACLS/PALS the first thing you do is look for a foreign body in a
child who is cyanotic. Positive pressure ventilation is never done in
resuscitation only umbobag is used in CPR so A is wrong in that sense too.
【在 r*****2 的大作中提到】
: I think the answer is "a". The baby has SID, so ABC,ABC (airway, breath and circulation)...Ventilate with oxygen always has first priority.
|
S******9
发帖数: 2837 | |
r*****2
发帖数: 309 | 6 Have you ever see 2 mo old with foreign body aspiration? The first pincer
grasp starts at 6 mo of age. If baby didn't put foreign body in his mouth,
then sb else put it in his mouth, which is highly impossible in common
practice (of course it may happen, but board or USMLE always test MOST
COMMON situation, but rare thing). The most common etiology for 2 mo old in
such scenario is SIDS(sudden infant death syndrome). Of course you can quick look at mouth for any foreign body (you may get this imp
【在 m*****5 的大作中提到】
:
: and circulation)...Ventilate with oxygen always has first priority.
: Common things first in any situation. I am telling you from experience. When
: you do ACLS/PALS the first thing you do is look for a foreign body in a
: child who is cyanotic. Positive pressure ventilation is never done in
: resuscitation only umbobag is used in CPR so A is wrong in that sense too.
|
m*****5
发帖数: 438 | 7 The idea behind is that if you miss a foreign body and start ventilating
then you could have missed a very common thing and you might cost a life.
You are right that this was meant to be a discussion. In fact I was not trying to be dogmatic since I don't have a lot of Peds experience. All I did in the previous post was to explain what I have thought about the case. If you think that I was doing so to 'trash' others' opinions, then you are way off. |
r*****2
发帖数: 309 | 8 Ok,maybe omyh should let us know the correct answer. You opinion is absolute
right in old children or adult patient, but infants have their unique
development milestone.
Checked CDC website and here is the link:
http://ephtracking.cdc.gov/showRbInfantMortalityEnv.action
SIDS is the most common reason caused death in early infancy and that is why
AAP so adopt the supine sleeping position in common primary pediatric
practice. |
|
s*****h
发帖数: 937 | 9 This is a SIDS case.
For babies, especially new borns, no pulses is most possibly 2ndary to
pulmonary problems, either low thrive from the CNS or troubled airway. If it
is in a delivery room, should be suction, stimulation, blow-by oxygen, then
chest compression et.al. Positive presure ventilation with room air is more
popular than pure O2 for new born. In this SIDS case, C/D/E is out because
they are steps after airway/ compression. If I saw this case in ER (
surprised that parameds didn't do i
【在 o**h 的大作中提到】
: A 2 month old infant is brought to th emergency department by paramedics
: after his mother found him not breathing in his crib. He is apneic and
: cyanotic, no pulses are palpable but he is warm. After manually
: stabilizing his neck and positioning the airway, which of the following is
: the most appropriate next step in management?
: a) Positive presure ventilation and oxygenation.
: b) two chest thrusts followed by ches compressions.
: c) Stabilishing vascular acces.
: d) Administration of epinephrine.
: e) E
|
p********g
发帖数: 372 | 10 B. SIDS baby, no pulse, you should do CPR firstly. Forget the ABC rule. |
|
|
n***8
发帖数: 634 | 11 I think "A" is correct.
it
then
more
because
not
【在 s*****h 的大作中提到】
: This is a SIDS case.
: For babies, especially new borns, no pulses is most possibly 2ndary to
: pulmonary problems, either low thrive from the CNS or troubled airway. If it
: is in a delivery room, should be suction, stimulation, blow-by oxygen, then
: chest compression et.al. Positive presure ventilation with room air is more
: popular than pure O2 for new born. In this SIDS case, C/D/E is out because
: they are steps after airway/ compression. If I saw this case in ER (
: surprised that parameds didn't do i
|
s*****h
发帖数: 937 | 12 ? The answer is ....
【在 o**h 的大作中提到】
: A 2 month old infant is brought to th emergency department by paramedics
: after his mother found him not breathing in his crib. He is apneic and
: cyanotic, no pulses are palpable but he is warm. After manually
: stabilizing his neck and positioning the airway, which of the following is
: the most appropriate next step in management?
: a) Positive presure ventilation and oxygenation.
: b) two chest thrusts followed by ches compressions.
: c) Stabilishing vascular acces.
: d) Administration of epinephrine.
: e) E
|
o**h
发帖数: 55 | 13 我以为大家都知道，这是NBME（CK）一道题。没有公布的答案。谢谢参与讨论的朋友。 |
l**********e
发帖数: 382 | |
s*****9
发帖数: 445 | |
c*******s
发帖数: 399 | 16 A
ACLS you don't do two chest thrusts,what is that for?
you do 5 back strock and the 5 chest comprssion if you susprect chocking,
but this case, there is no chocking
you remember ABC
【在 o**h 的大作中提到】
: A 2 month old infant is brought to th emergency department by paramedics
: after his mother found him not breathing in his crib. He is apneic and
: cyanotic, no pulses are palpable but he is warm. After manually
: stabilizing his neck and positioning the airway, which of the following is
: the most appropriate next step in management?
: a) Positive presure ventilation and oxygenation.
: b) two chest thrusts followed by ches compressions.
: c) Stabilishing vascular acces.
: d) Administration of epinephrine.
: e) E
|
