For a lethargic child struck by an automobile, what is the preferred route of venous access?

In a lethargic child who has been struck by an automobile, venous access is crucial for fluid resuscitation and medication administration. The preferred route of venous access in this situation is via percutaneous peripheral veins in the upper extremities. This method is effective, relatively quick to perform, and generally provides sufficient access for ambulatory treatments.

One significant factor in choosing peripheral venous access is that it is less invasive than other methods, such as central access. Peripheral veins in the arms can usually accommodate the necessary flow rate for fluids and medications without the complications associated with central venous catheters, which may include increased risk of infection and complications from placement.

Using the upper extremities is also more suitable in children who may be unstable or lethargic, as approaching the upper extremities is generally easier and less painful, thus reducing the child's stress. In contrast, the lower extremities, while accessible (as indicated by the saphenous vein option), involve various risks, such as lower volume blood flow and proximity to the fetal positions, making them less ideal in emergency situations.

The intraosseous option, although rapid and effective in some emergency situations, typically applies when peripheral access is impossible, and central access techniques are not suitable