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In the case of respiratory arrest with a central pulse of ≤ 60 bpm and signs of poor perfusion, what action should Amy take?

  1. Start CPR immediately

  2. Check for responsiveness

  3. Call for emergency help

  4. Administer rescue breaths

The correct answer is: Start CPR immediately

In the scenario described, Amy should start CPR immediately because the presence of respiratory arrest combined with a central pulse of 60 beats per minute or less indicates a critical situation. This low heart rate, especially when accompanied by signs of poor perfusion, suggests that the body is not receiving adequate blood flow, which can lead to life-threatening consequences. Starting CPR is crucial because it helps maintain circulation and oxygen delivery to vital organs until advanced medical help arrives. The emphasis on immediate action aligns with the understanding that when a child has bradycardia (slow heart rate) and respiratory arrest, the priority is to initiate CPR to support the heart and improve perfusion. In this case, checking for responsiveness is not the most appropriate action since the signs of poor perfusion indicate that immediate intervention is needed. Similarly, while calling for emergency help is important, it should be done in conjunction with starting CPR rather than as the first step, particularly if Amy is alone. Administering rescue breaths alone would also be insufficient without chest compressions, especially since the heart rate is critically low and the patient is already in respiratory arrest. Overall, beginning CPR is the most effective way to address the life-threatening situation.