A 2 yo girl with history of a mitochondrial disorder presents after being found by parents to be hypoxic on her home pulse oximeter and in respiratory distress. She received supplemental oxygen via facemask and bag-valve mask ventilations while en route to the ED.
The patient is noted to be somnolent and minimally responsive with moderate retractions upon arrival.
Her T is 36.7, RR 20, HR 145, BP 107/60, p0x 71%. Oxygen saturations increase to 92% with airway repositioning, jaw thrust, shoulder roll and supplemental oxygen. Her extremities are warm and well perfused. Venous blood gas shows pH 7.08, pCO2 83, p02 51, HC03 31, Glu 106.
She is intubated with video laryngoscopy after administration of fentanyl, midazolam and rocuronium. The post-intubation chest x-ray is shown below.
Image courtesy of Ashley Keilman, MD
The next step in her management would be:
This question appears in Med-Challenger Pediatric Emergency Medicine Exam Review with CME - 3rd Edition.