A pediatric patient with breathing difficulty has a respiratory rate of 40/min and SpO2 88% on room air. What is the appropriate initial treatment?

• A. Oxygen with a Non-Rebreather Mask
• B. Nebulized albuterol
• C. IV fluids
• D. Intubation

Answer: (A)

Immediate elevation of oxygenation is the priority in pediatric respiratory distress with hypoxemia. With a respiratory rate of 40 and SpO2 of 88% on room air, this child needs high-concentration oxygen right away, and a non-rebreather mask delivers a high FiO2 quickly to improve saturation as the first step. Nebulized albuterol can help if there’s an accompanying bronchospasm, but it won’t correct low oxygen levels as rapidly or reliably as delivering high-concentration oxygen. IV fluids aren’t the primary treatment for hypoxemia, and intubation is reserved for airway/ventilation failure after noninvasive measures have been attempted or when the patient cannot be stabilized by other means.