A conscious child comes with aspirations and gasping. HCP tried ventilation resuscitation but he did not succeed then what is the next action on priority?

1. A

   Start CPR

2. B

   Abdominal thrust

3. C

   High flow oxygen

4. D

   Back Flow between shoulder

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

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• The scenario describes a conscious child with a severe Foreign Body Airway Obstruction (FBAO), indicated by gasping and failed ventilation.
• According to pediatric emergency guidelines (AHA/PALS), the immediate and correct action for a conscious choking child (older than 1 year) is to perform abdominal thrusts (Heimlich maneuver).
• This maneuver is designed to create an artificial cough by forcefully expelling air from the lungs, which can dislodge the object blocking the airway.
• The goal is to relieve the obstruction before the child loses consciousness due to lack of oxygen.

Why Other Options Were Wrong

• Option A: CPR is indicated for a patient who is unconscious and not breathing or has no pulse. The child in this scenario is conscious.
• Option C: Providing oxygen is futile when the airway is physically blocked. The oxygen cannot bypass the obstruction to reach the lungs.
• Option D: The option 'Back Flow between shoulder' is interpreted as back blows. Back blows (in a series of 5) are the recommended intervention for a conscious choking infant (less than 1 year old), not a child.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of Foreign Body Airway Obstruction (FBAO) in a conscious child to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the signs of a severe airway obstruction (gasping, inability to speak or cough effectively, cyanosis) is a critical nursing skill.
• Immediate and correct intervention is vital, as brain damage can occur within minutes of oxygen deprivation.
• What if the child becomes unconscious? If the child loses consciousness during the rescue attempt, the nurse should immediately lower the child to the ground, call for help (activate emergency response), and begin CPR, starting with chest compressions. Before giving breaths, the airway should be checked for the foreign object.

How to Approach the Question

• First, analyze the patient's status: The question states the child is 'conscious'. This is a critical piece of information.
• Next, identify the core problem: The child has 'aspirations and gasping', and 'ventilation resuscitation... did not succeed'. This points directly to a severe Foreign Body Airway Obstruction (FBAO).
• Recall the age-specific algorithms for FBAO. For a conscious child (over 1 year), the correct procedure is abdominal thrusts.
• Evaluate the options based on this algorithm. Eliminate CPR because the child is conscious. Eliminate high-flow oxygen because the airway is blocked. Eliminate back blows as that is for infants.
• Select the option that matches the correct algorithm for a conscious choking child, which is abdominal thrusts.

Concept Tested & Keywords

• Concept Tested: Management of Foreign Body Airway Obstruction (FBAO) in a conscious child.
• Stem keywords: conscious child, aspiration, gasping, failed ventilation
• Lead-in keywords: next action, priority
• Clinical cues: The child is conscious, which dictates the specific choking response algorithm.
• Clinical cues: Failed ventilation attempts confirm a severe physical obstruction rather than a breathing problem like an asthma attack.

Question ID

Qd_e1Dclwbt7jLvqLMPajZ

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 602-604

E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 79-81