A nasogastric tube should be inserted to aid ventilation by decompressing the stomach. A urinary catheter for monitoring urine output is valuable aiming for 1-2ml/kg/hr.
Ammonia is a time critical investigation and blood sugar should always be checked. Abnormalities of both can cause long lasting and irreversible neurological injury.
An ECG and chest xray are both valuable.
Dinoprostone is increased to 100ng/kg/min after 15 minutes and signs of shock improve. The patient is retrieved by the paediatric critical care team and an echocardiogram is performed by a paediatric cardiologist on arrival in PICU. A diagnosis of severe aortic coarctation is made. Surgery is performed the following day.
