A 4-year-old child is unresponsive after ingesting antihypertensive medication. He has poor perfusion and bradycardia (HR 50). The best initial action is to:

A 4-year-old child is unresponsive after ingesting antihypertensive medication. He has poor perfusion and bradycardia (HR 50). The best initial action is to:

• A. Begin immediate defibrillation.
• B. Initiate one-rescuer CPR while partner attempts to establish vascular access.
• C. Administer charcoal via NG tube.
• D. Transport immediately without intervention.

Answer: (B)

When a child is unresponsive with poor perfusion and bradycardia after a toxic ingestion, the priority is to restore circulation. Start high-quality CPR immediately to improve coronary and cerebral blood flow, while a second rescuer establishes IV/IO access for medications and potential antidotes. Defibrillation isn’t indicated because bradycardia is a non-shockable rhythm; you would address it with resuscitation and pharmacologic support rather than shocking the heart. In unstable poisoning, securing ventilation and circulation comes before decontamination or rapid transport without intervention.

When a child is unresponsive with poor perfusion and bradycardia after a toxic ingestion, the priority is to restore circulation. Start high-quality CPR immediately to improve coronary and cerebral blood flow, while a second rescuer establishes IV/IO access for medications and potential antidotes. Defibrillation isn’t indicated because bradycardia is a non-shockable rhythm; you would address it with resuscitation and pharmacologic support rather than shocking the heart. In unstable poisoning, securing ventilation and circulation comes before decontamination or rapid transport without intervention.