In the management of any potentially toxic exposure in a child, the initial step is to:

• A. Ensure a patent airway
• B. Administer activated charcoal
• C. Stabilize the patient with IV fluids
• D. Administer antidote

Answer: (A)

Securing a patent airway is the first priority because without oxygenation and ventilation, nothing else you do will help the child. Toxic exposures can rapidly compromise the airway or level of consciousness, leading to aspiration or respiratory failure. If the airway isn’t open and breathing isn’t adequate, you can’t safely administer decontamination, IV fluids, or antidotes. Once the airway is protected and the child is breathing reliably, you then proceed to other measures as indicated—stabilizing circulation, providing oxygen, and considering decontamination or antidotal therapy based on the toxin and time since exposure. Activated charcoal, for example, may be used later if appropriate and only after airway protection; IV fluids and antidotes are targeted to the specific situation and are not universal first steps.