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A 10 year-old boy presents to the emergency department following a 20 foot
fall from the balcony of a house. The boy was unresponsive at the scene and
arrives with a GCS of 5. Initial vital signs include a BP of 140/65, HR of 60, RR
16, and SpO2 of 97% in 100% oxygen via facemask. The decision to immediately
intubate in the trauma room is made. Which of the following best describes the
most appropriate management for this patient?

a) The patient’s hypertension should be treated with a direct acting vasodilator

b) Succinylcholine may be administered to ensure the airway is intubated quickly
and efficiently

c) Following intubation, the patient may be ventilated at a rate to achieve
normocapnia

d) Fluid resuscitation should be limited due to concern for worsening cerebral
edema and increasing intracranial hypertension with fluid overload

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==Answer==
Answer b. The patient presents with clinical findings suggesting acute
intracranial hypertension that require immediate surgical intervention to prevent
neurologic catastrophe. The mechanism of injury necessitates cervical spinal
immobilization with a rigid collar, which may make intubation more challenging
by inexperienced providers, especially if there is accompanying facial trauma
obscuring the airway. Succinylcholine is an appropriate paralyzing agent to use
to facilitate intubation, and immediate hyperventilation to a goal end-tidal CO2 of
30 mmHg is indicated. Fluid resuscitation is often also required due to volume
depletion that may be due to underlying trauma. Anti-hypertensive drugs are not
indicated, as CPP will be compromised by lowering the MAP.
==Notes==
<references />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
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TYK257 - Revision history

WikiSysop: 1 revision imported

metawikimedia>TymK at 21:55, 16 September 2018