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An 11-year- old, 40 kg female is transported to your emergency via ambulance. The patient is unresponsive. BP = 88/40, pulse 108, respiratory frequency is 12/minute. Her core body temperature is 36.0 C. A distinct odor of alcohol is present. The paramedics state they were called to a middle-school where the patient was found in a school bathroom.
Based on the history and present observations, acute alcohol toxicity seems likely. The patient was placed on her side (recovery position). Due to the severely obtunded, depressed condition of the patient, a cuffed endotracheal tube is inserted primarily to provide airway protection. Breath sounds can be heard bilaterally and are clear. A large-bore peripheral I.V. is inserted, and blood drawn and sent for glucose and electrolytes. An arterial sample is drawn for blood gas analysis to assess the adequacy of ventilation. A warm blanket is placed around the patient to assist in maintaining body temperature.
The blood glucose is reported at 49 mg/dl and electrolytes within normal limits. The ABG results: pH = 7.33, paC02 = 30 mm/Hg, pa02 = 113 mm/Hg, sa02 = .97 (Fi02 = .209). Based on these results, 2ml/kg of D25 is administered slowly followed by a D5 maintenance infusion. The patient is admitted to the pediatric ICU for further care and observation.
By the next morning, the patient had extubated herself and was verbally and physically responsive. She was discharged later in the morning and will be followed up by her pediatrician and school social services.
1. Which of the following could be causes of decreased levels of consciousness in children?
A. Head injury
B. Drug and/or alcohol ingestion
C. Shock
D. All of the above
2. Which one of the following provides the best protection against aspiration of gastric contents?
A. An oral/pharyngeal airway
B. A nasopharyngeal airway
C. A cuffed endotracheal tube
D. Inserting an orogastric tube and evacuating the stomach contents
3. Which of the following should be assessed, monitored and corrected if need when treating the seriously alcohol-intoxicated patient?
A. Blood glucose
B. Serum electrolytes
C.Respiratory status
D. All of the above
