Question

A 3 year old boy is brought to the casualty by his mother with progressive shortness of breath for 1 day. The child has a history of bronchial asthma. On examination, the child is gasping and unresponsive. What will you do first?

• A. Intubate
• B. Administer 100% Oxygen by Mask
• C. Ventilate with Bag and Mask
• D. Administer Nebulized Salbutamol

Hint:

A gasping, unresponsive child cannot breathe in oxygen on their own, so assisted ventilation with bag and mask comes first.

Answer 1

The Correct Option is C

Step 1: Read the clinical picture carefully.
The child is gasping and unresponsive. Gasping is not effective breathing, it is a sign that the child is not moving enough air to keep oxygen and carbon dioxide levels normal. An unresponsive child with gasping breaths is in respiratory failure that is about to become respiratory arrest.

Step 2: Apply the basic emergency approach.
In any child who is not breathing effectively, the first priority is to support ventilation, not just to raise the oxygen percentage the child breathes in on their own. A child who is gasping cannot draw in enough of any oxygen concentration by themselves.

Step 3: Compare bag and mask ventilation with oxygen by mask.
Giving 100% oxygen through a simple face mask still depends on the child making their own breathing effort to pull that oxygen into the lungs. Since this child's own effort (gasping) is not enough, oxygen by mask alone will not fix the problem. Bag and mask ventilation actively pushes air and oxygen into the lungs, taking over the work of breathing that the child can no longer do adequately.

Step 4: Explain why the other options are not first.
Intubation may be needed soon after, but placing a tube takes time to prepare, bagging keeps the child oxygenated while the team gets ready for it. Nebulized salbutamol treats the underlying bronchospasm from asthma, but it does nothing for a child who is not moving enough air right now to even inhale the nebulized drug properly.

Note on the answer key:
The original key marks "100% oxygen by mask" with a question mark, showing doubt even at the time. Standard resuscitation teaching for a gasping, unresponsive child is to start assisted ventilation right away with bag and mask, so the answer has been updated to reflect this.

Final Answer:
\[ \boxed{\text{Ventilate with Bag and Mask}} \]