A 9-mo-old boy is brought to the emergency room in a limp and unresponsive state. Initial examination shows a pulse rate of 35/min and occasional irregular breaths. After initiation of CPR (including tracheal intubation), delivery of oxygen positive-pressure breaths, and chest compressions, multiple attempts to inse an IV line fail. The most appropriate next step in management should be to:
Intraosseous (IO) lines should be placed if venous access is not obtained within 1-2 min of an arrest. The anterior tibia is the most common site utilized. Chemistries and other laboratory analyses can be obtained, including a blood culture, while intravenous fluids and medications can be delivered through an IO line. The risk of infection is very low. Once perfusion improves, venous access is usually attainable, and the IO line can be removed.
Obtain an aerial blood gas sample
Place an intraosseous needle and administer fluids andinotropic agents
Obtain a "stat" head CT study to evaluate reasons for unresponsiveness
Place a transthoracic cardiac pacemaker