Nokea
You are managing a 10-month-old infant who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. You have initiated supplemental oxygen therapy and elevated the lower extremities. En route to the hospital, you note that the child's work of breathing has increased. What must you do first?
Correct Answer: A
Rationale: In this scenario, the infant is showing signs of shock with increased work of breathing. Lowering the extremities helps improve venous return to the heart, cardiac output, and oxygenation by reducing the pressure on the diaphragm. This action can alleviate the respiratory distress and is a critical step to take in a child with signs of shock. Beginning positive pressure ventilations (Choice B) should be considered if the infant's respiratory distress worsens despite lowering the extremities. Placing a nasopharyngeal airway and increasing oxygen flow (Choice C) may not directly address the increased work of breathing or the underlying shock condition. Listening to the lungs with a stethoscope (Choice D) may provide information on lung sounds but does not address the immediate need to improve breathing in a child with signs of shock.