Posted by jua from IP 132.170.234.116 on March 31, 2006 at 14:08:14:
An 8-year-old child was struck by a car. He arrives in the Emergency Department alert, anxious, and in respiratory distress. His cervical spine is immobilized, and he is receiving a 10 L/min flow of 100% oxygen by face mask. Respirations are 60 breaths/min, heart rate is 150 bpm, and systolic blood pressure is 60 mm Hg. No breath sounds are heard over the right chest, and the trachea is clearly deviated to the left. Pulse oximetry reveals an oxyhemoglobin saturation of 84%. Which of the following is the most appropriate immediate intervention for this child?
perform tracheal intubation and call for a STAT chest x-ray
obtain a chest x-ray and provide bag-mask ventilation until the x-ray is read
establish IV access and administer a 20 mL/kg bolus of normal saline
perform needle decompression of the right chest and assist ventilation with a bag and mask if necessary