In pediatric stroke management, obtaining rapid, reliable IV access is essential to deliver fluids, medications, and any necessary imaging contrast. The antecubital fossa veins are the preferred peripheral IV site because they are usually larger and lie in a stable, easily accessible region of the elbow crease, allowing quick cannulation and a secure line. This minimizes the need for more invasive central venous access, which carries greater risk in children. Central sites like the jugular or femoral veins are reserved for when peripheral access fails or central access is specifically indicated. While the basilic vein can be used, the antecubital veins (median cubital or cephalic) are typically easier to cannulate in kids and provide faster, reliable access for urgent stroke management.

Immediate irrigation with normal saline is the best first step because it quickly dilutes and washes away any chemical or irritant from the eye, reducing surface damage and helping protect vision. Use a generous stream of isotonic saline or clean water, keeping the eye open and flushing for about 15–20 minutes to ensure the contaminant is removed from the entire ocular surface. If contact lenses are present and can be removed quickly without delaying irrigation, take them out to improve cleansing, but don’t delay the flushing. After irrigation, seek medical evaluation, especially if there’s ongoing pain, vision changes, or suspicion of caustic chemical exposure. Pain relief or wipes are not the primary immediate action.

Spinal motion restriction is important here because electrical injuries from electrocution or lightning can be accompanied by blunt trauma, including neck or spine injuries that aren’t immediately obvious. Protecting the spine during assessment and resuscitation helps prevent further injury while you check airway, breathing, and circulation. In practice, assume a possible cervical spine injury and keep the head and neck in a neutral, aligned position; use manual in-line stabilization and apply a collar if available, adding immobilization as you proceed with CPR or move the patient. Defibrillating immediately after a long delay isn’t appropriate; defibrillation should be guided by rhythm and delivered as soon as a shockable rhythm is present, not after a fixed 30-minute wait. High-dose aspirin isn’t indicated in this context, since the scenario is electrical injury with potential trauma rather than a typical myocardial infarction. And CPR should be performed when appropriate; withholding CPR contradicts basic resuscitation principles.

When a seizure in an adult does not respond to two doses of a benzodiazepine, you’re dealing with refractory status epilepticus and need a rapid-acting non-benzodiazepine agent to stop the seizure quickly. Ketamine fits this role because it blocks NMDA receptors involved in sustaining seizures and acts fast. It can be given IV, IO, or IM, and is often diluted for a controlled bolus delivery. This option is preferred in many protocols because ketamine tends to preserve airway reflexes and maintain blood pressure better than some other sedatives, which helps in emergency settings where airway management can be challenging. The suggested dose of 100 mg provides a rapid, sufficiently high concentration to terminate seizures promptly and can be administered via multiple routes if IV access isn’t immediately available. Other choices, like repeating a benzodiazepine or using propofol or other anticonvulsants, may be used in different contexts, but for immediate control after two benzodiazepine doses, a ketamine bolus is a common next step.