# Situation: A nurse works in the pediatric rehabilitation clinic and the emergency room of a regional hospital. A 2-year-old is brought to the emergency room 20 minutes after drinking kerosene stored in a soft-drink bottle. He is coughing and gagging, with a respiratory rate of 44/min. Which action is appropriate?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse works in the pediatric rehabilitation clinic and the emergency room of a regional hospital.

A 2-year-old is brought to the emergency room 20 minutes after drinking kerosene stored in a soft-drink bottle. He is coughing and gagging, with a respiratory rate of 44/min. Which action is appropriate?

## 보기

1. Perform gastric lavage to empty his stomach right now
2. Give activated charcoal 1 g/kg by mouth right away
3. Start an antibiotic to prevent pneumonia early
4. Monitor his breathing and oxygen saturation closely **✔ 정답**

**정답: 4**

## 해설

The main danger of hydrocarbons such as kerosene is aspiration pneumonitis. Coughing and gagging suggest aspiration, so respiratory status and oxygen saturation are monitored closely and oxygen is given as needed. Activated charcoal does not bind hydrocarbons and adds aspiration risk, gastric lavage is not routine, and early chemical pneumonitis is not an infection, so preventive antibiotics are not given routinely.

## 심화 해설

Clinical context

A 2-year-old who drank kerosene 20 minutes ago is now coughing, gagging, and tachypneic at 44/min. Kerosene is a low-viscosity, highly volatile hydrocarbon with low surface tension, so even a small amount can spread quickly across the airway and be aspirated [2]. The cough and gag reflex are not reassuring signs; they indicate the child may already be aspirating or is at immediate risk of aspiration pneumonitis.

Why the correct answer is monitoring

The priority is respiratory support and close observation. Hydrocarbon pneumonitis evolves over the first 6–8 hours, with fever, tachypnea, hypoxemia, and tachycardia, and symptoms typically peak within 48 hours [1]. Because deterioration can occur after a relatively stable early period, serial assessment of breathing effort, lung sounds, and oxygen saturation is the most appropriate immediate action. Oxygen is given only as needed for hypoxemia, and fluid balance is also monitored carefully [2].

| Intervention | Why it is not appropriate here |
| --- | --- |
| Gastric lavage | Not routine for hydrocarbons; it increases the risk of vomiting and further aspiration without removing the main danger, which is already in the airway. |
| Activated charcoal | Does not bind kerosene or other hydrocarbons well, and giving it by mouth adds aspiration risk and may obscure airway assessment. |
| Prophylactic antibiotics | Early chemical pneumonitis is an inflammatory injury, not a bacterial infection; antibiotics are reserved for confirmed secondary infection, not given routinely. |
| Close respiratory monitoring | Correct. Detects early hypoxemia and worsening pneumonitis so oxygen and advanced support can be started promptly. |

Watch out! A normal initial oxygen saturation does not rule out evolving pneumonitis. The inflammatory response develops over hours, so repeated reassessment is essential. Key point! The danger of kerosene is not the amount in the stomach but the amount that reaches the lungs. Management is supportive, not decontamination-focused.

In children with severe respiratory distress or hypoxemia that does not respond to supplemental oxygen, escalation to positive-pressure ventilation or intensive care may be needed [2]. Most children who aspirate hydrocarbons recover with supportive care, but late presentation and harmful home remedies can worsen outcomes . The emergency nurse’s role is to protect the airway, avoid any maneuver that could trigger vomiting, and monitor for the expected 6–8 hour window of symptom evolution [1].References (research sources)

- [1]Respiratory complications following hydrocarbon aspiration in children.Research articleMakrygianni EA, Palamidou F, Kaditis AG (2016) · DOI: 10.1002/ppul.23392

- [2]Kerosene, Camphor, and Naphthalene Poisoning in Children.Research articleKumar S, Kavitha TK, Angurana SK (2019) · DOI: 10.5005/jp-journals-10071-23316

## 임상 시나리오

Hydrocarbon Ingestion: Kerosene in a ToddlerPrioritize Airway and Breathing Over Decontamination
The main danger of kerosene ingestion is aspiration pneumonitis. Coughing, gagging, and tachypnea suggest aspiration, so monitor breathing effort, lung sounds, and oxygen saturation closely. Give oxygen only for hypoxemia.

Deterioration may occur after a stable early period. Hydrocarbon pneumonitis evolves over 6–8 hours and symptoms typically peak within 48 hours, so serial observation is essential.

CautionDo not perform gastric lavage or give activated charcoal; both increase aspiration risk. Prophylactic antibiotics are not indicated because early chemical pneumonitis is inflammatory, not infectious.

## 핵심 개념

- **Aspiration pneumonitis** — Chemical lung inflammation caused by inhalation of gastric contents or hydrocarbons, not primarily a bacterial infection.
- **Hydrocarbon** — Organic compound such as kerosene with low viscosity and surface tension, allowing rapid airway spread and aspiration.
- **Activated charcoal** — Adsorbent used in some poisonings but ineffective for hydrocarbons and increases aspiration risk.
- **Gastric lavage** — Stomach washing procedure that is not routine for hydrocarbon ingestion due to vomiting and aspiration risk.
- **Tachypnea** — Abnormally rapid breathing; here 44/min in a 2-year-old suggests respiratory distress or aspiration.

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