A 6-year-old child is brought on board after being involved in a high-speed motor vehicle collision. The child is unresponsive, has a Glasgow Coma Scale (GCS) of 6, and shows signs of increased intracranial pressure (ICP). What is the MOST appropriate initial step?
Perform needle decompression of the chest.
Secure the airway with rapid sequence induction (RSI) and intubation.
Administer hypertonic saline to decrease intracranial pressure.
Administer mannitol to reduce intracranial pressure.
The best initial step in managing a pediatric patient with signs of increased intracranial pressure and a low GCS score is to secure the airway and ensure adequate oxygenation. A GCS of 6 indicates severe head trauma and potential airway compromise. Rapid sequence induction (RSI) and intubation will protect the airway, optimize oxygenation, and assist in controlling ICP. Administering mannitol or hypertonic saline can help reduce ICP, but they do not address the immediate need for airway protection and oxygenation. Performing needle decompression is indicated for tension pneumothorax, not for cases of increased ICP.
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