This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Pediatrics
[{'content': 'A 10 year old boy, unconscious with 2 days h/o fever, comes to pediatric ICU with R.R. 46/min, B.P. 110/ 80 and E1 V1 M3 on Glasgow coma scale, next step of Mx includes –a) Intubate and ventilateb) Give 0.9% NaClc) Start dopamine at the rate of 1–2 g /min/kgd) Dopamine at the rate of 1–g/min/kg & furosemidee) Start antibiotic and order for CT Scan \nSelect and explain. \nA. ae, B. b, C. ab, D. ad', 'role': 'user'}, {'content': 'Answer: A \nExplanation: Management of unconscious child \n\nUnconsciousness (coma) is usually graded according to a standard scale so that changes in the level of consciousness can be evaluated accurately.\nGlasgow coma scale is commonly used evaluation system. In this scale : -\n\nTotal score = Eye opening + motor response + verbal response\n\nThe best response is scored. The lowest score is 3, and the highest is 15 (fully conscious child). A score of 8 or less suggests severe brain dysfunction, a score of 9-12 moderate brain dysfunction and a score of 13-15 minor brain dysfunction.\n\nInvestigations\n\nIf the cause of coma is unknown, following investigations may be required : -\n\n\nLumbar puncture\nECG\nSkull radiography/CT/MRI\nCervical spine imaging\n\n\nBlood is drawn for a CBC, electrolyte determination, toxicology tests, blood gas analysis, BUN and cross matching. Management\nCare of the child in coma is directed towards maintaining body function in optimal state until the child regains consciousness. Management includes : -\n\n1) Airway\n\nAs a general rule, place the child on his/her side to reduce the risk of aspiration. Oral suctioning to remove mucus from the mouth and pharynx may be necessary.\n\n\nIf Glassgow score is 8 or less and clinical circumstances do not suggests improvement then intubation is indicated to secure airway.\n\n2) reathing\n\nOxygen is given especially when oxygen saturation is low.\n\n3) Circulation\n\nVenous access is obtained.\n\n\nSigns of shock are assessed and treated as indicated.\n\n4\xa0 rugs and specific therapy\n\nAfter maintenance of breathing and circulation, specific therapy is given e.g., antibiotics for infection, dextrose in hypoglycemia, naloxone in opiates poisoning etc.', 'role': 'assistant'}]