Chapter 38 - Pediatrics
The mother of a 4-month-old boy awoke to find him in his crib and not breathing. On scene, you are providing resuscitative care while the parents watch on in disbelief. Which of the following would be most appropriate regarding their presence in the room?
a
Your partner informs you that the 3-year-old boy you have been called to care for is breathing 28 times per minute. As a knowledgeable EMT, you would recognize:
a normal rate
An Emergency Medical Responder asks you why you should not overextend the airway on a pediatric patient when performing a head-tilt, chin-lift. Your reply would be:
"The cartilage of the trachea is very soft and can 'kink' if the neck is extended too far."
The mother of a 3-year-old boy has called 911 because her son has a low-grade fever and difficulty breathing. On scene, you are suspicious that the boy is suffering from croup. Which of the following statements made by the mother would reinforce this suspicion?
"At night, he seems to get a barking-like cough."
Which of the following instructions would you provide to an EMT who is preparing to assess a stable 9-month-old boy who has a rash?
"Have the mother hold him as you do the assessment."
You must assess the pupils of a 5-year-old who fell off a bed while playing. Which of the following statements would be most appropriate prior to performing this assessment?
"I am going to use this light to look into your eyes."
You are assessing a 5-year-old boy who is complaining of arm pain after falling down three steps. As you physically assess the patient, he tries to bite your hands. His mother is at his side. Which of the following statements is appropriate to make regarding the behavior of biting?
"I know that you do not feel good, but biting is not okay."
Which of the following statements made by the EMT is most appropriate regarding dealing with caregivers and children during a medical emergency?
"I try to include the caregiver in all that I do with his or her child so that the child and caregiver are more comfortable."
After a 7 year-old boy's father who is complaining of chest pain is placed on a stretcher and taken from the house, the boy throws a temper tantrum. His mother is embarrassed and states that he has not done this since he was two years old. Given the situation, your response would be:
"I would not be concerned. This is a stressful event he doesn't understand, and he may just be having trouble coping with it."
A 5−year−old male is drooling with stridorous respirations and has a fever of 104degrees°F. What statement would concern the EMT most?
"It hurts to swallow."
You have been asked to speak to a group of new mothers regarding the emergency treatment of a fever. During your presentation, one of the mothers asks you what temperature would cause a child to seize. Your response would be:
"It is not the specific temperature that is of concern, but the rate at which the body temperature rises."
You are working with a new partner that was just hired. During the morning equipment check, he makes a comment about not feeling very comfortable with sick or injured children. Which of the following statements should the EMT respond with to help alleviate his fear?
"Remember that much of what you learned about adults also pertains to children."
When preparing to provide positive pressure ventilation to a child, what will be an acceptable tidal volume if the child weighs 22 kg?
154 mL
You are treating a 6-month-old patient who was accidently dropped down a flight of steps, when her mother stumbled at the top of the steps. The infant will only open her eyes and moan to deep painful stimuli, and tries to withdraw from the pain. Given these findings, you calculate her Glasgow Coma Score to be:
8
What would be the minimally acceptable blood pressure for a 9-year-old girl who is suffering from a significant bleed from broken glass?
88 mmHg
A co-worker is telling you about a recent run in which he provided care to a preschooler. Based on this description, you know that age of the patient would have been:
3-6 years.
A 1-year-old male is in respiratory distress and wheezing. His pulse is 156, respirations 32, and SpO2 95% on 5 liters of blow-by oxygen. His mother denies a medical history for him, but states that she suffers from asthma and uses an albuterol inhaler. Of the following, what would be appropriate in the care of this child?
Add humidity to the oxygen.
When possible, which of these guidelines should be observed regarding the caregiver of an ill or injured child?
Allow the caregiver to stay with the child, including transporting them in the ambulance.
You are assessing a 2 1/2-year-old who was involved in a minor car accident. She is currently alert and oriented. While you are assessing her for possible injuries, which of the following would be considered appropriate?
Allow the child to hold a favorite toy during the assessment.
The mother of a 4-month-old boy awoke to find him in his crib and not breathing. On scene, you are providing resuscitative care while the parents watch on in disbelief. Which of the following would be most appropriate regarding their presence in the room?
Allow them to observe the resuscitation if they wish.
You have been called for a 6-year-old girl who has vomited once and is complaining of abdominal pain. When you are performing the secondary assessment and obtaining a medical history, which action by you would be considered most appropriate?
Allowing the child to play with the stethoscope before listening to her lungs
You are assessing a 6-year-old girl with possible pneumonia. She has labored breathing and a fever of 102◦F. When you are assessing and classifying her respiratory status, which of the following signs would provide the strongest evidence that she is in decompensated or late respiratory failure?
Altered mental status
You are transporting a very sick 3-year-old with suspected septic shock. His airway is patent, respirations tachypneic, and radial pulse weak with skin that is hot to the touch. Vital signs are: pulse 152, respiration 32, blood pressure 94/64, and SpO2 96% on a nonrebreather face mask. He has a rectal temperature of 103.9degrees°F. Tylenol has been administered. During transport to the hospital, you should be most concerned with what clinical finding?
Blood pressure 84/32
You are treating a patient who presents with a slight fever, tachycardia, rapid breathing, respiratory distress, and audible wheezing on exhalation. The patient is about 14 months old, and the mother states that this has been developing over the past few days. What is this patient MOST likely to have?
Bronchiolitis
When he is assessing a 3-year-old child for possible injuries after the child fell down a flight of stairs, which of the following would raise the EMT's suspicion that the child may be a victim of physical abuse?
Bruises are found on his chest and abdomen.
When you are assessing a 3-year-old who is in respiratory distress, which of the following assessment findings would be most concerning to you?
Retractions observed above the clavicles
You are on scene for a 6-month-old pediatric patient who is unresponsive at home. The parents state that he suffers from a congenital heart defect, but they cannot pronounce its name. You find the patient to be cyanotic, with a weak carotid pulse. You note vomit in the airway, and breathing is labored. The closest ED is 25 minutes away from your location. What should you do first?
Clear the airway.
What disease or illness would you suspect when confronted with a pediatric patient exhibiting respiratory distress and audible inspiratory stridor but no cough?
Epiglottitis
Which of the following would be a primary concern for an 11-year-old female with a prolonged asthmatic episode and low-grade temperature?
Dehydration
You have been called to a lower-income housing complex for a 4-year-old who is short of breath and has a fever. When assessing this patient, what technique would be best?
Determining the respiratory rate before laying hands on the child
You are suspicious that a child is being physically abused and neglected. Which of the following best describes your best course of action in such a situation?
Documentation of the situation
Which of the following behaviors would the EMT recognize as uncharacteristic of a conscious and stable 2-year-old boy who fell and hurt his hand?
Does not cry or protest when taken from his mother
You have arrived at the Emergency Department with a young child who you believe is the victim of child abuse. To which person would it be best to report your suspicion?
Emergency physician
You have arrived on the scene to help a child who is short of breath. The mother is screaming hysterically that her 3-year-old boy cannot breathe, making assessment of the patient very difficult. What should be your initial action in managing this situation?
Have your partner talk to the mother while you assess the child.
Which of these is NOT a principle of family-centered care?
Health care providers remove children from unstable or abusive families as soon as such a family is identified.
You are treating a short of breath 9-year-old male with a history of asthma. On scene he presents in severe respiratory distress with noted intercostal retraction, lethargy, and expiratory wheezing. His pulse is 136, respirations 32, and SpO2 95%. You have assisted him with his albuterol MDI and are transporting emergently to the hospital. As you reassess the patient, what finding is most concerning?
Heart rate 88
A concerned parent asks you which vaccine will decrease the risk of her child getting epiglottitis. Which vaccine would you tell her?
Hib vaccine.
What is the best location for assessing breath sounds in the pediatric patient?
Midaxillary region of the lungs
An extremely high fever in a 2-month-old infant should be considered what medical emergency until known otherwise?
Meningitis
You have been called for a 2-week-old baby who is sick. Assessment reveals him to have a fever and rhonchi in the lungs. Which of the additional assessment findings would be most concerning to you given the age of this patient?
Nasal passages occluded by mucus
A 15-year-old male with a history of seizures presents as lethargic but oriented. He takes the anticonvulsant Keppra and has no other medical history according to his mother. Of the following, what action would you take first?
Obtain a full set of vital signs.
Which choice is a recommended technique when immobilizing a young child to a backboard?
Place padding beneath the neck and shoulders
An 8-year-old boy is unresponsive following the accidental ingestion of his father's high blood pressure medications. His airway is open and his breathing is labored and inadequate. The pulse rate is 56 beats per minute and his skin is cool and diaphoretic. Your partner states that his lungs have crackles in them and the blood pressure is 62/40 mmHg. Which of the following represents the most important care that you will provide to the patient?
Positive pressure ventilation
You have been called to an apartment for a child who is sick. As you approach the 4-year-old boy, you note that he is sitting upright in his mother's arms with his chin thrust forward. He has a sickly appearance and is drooling. His airway appears open and his breathing is adequate. His radial pulse is strong and his skin is hot to the touch. Which of the following interventions would be most appropriate in the care of this patient?
Provision of blow-by oxygen
With which of the following injury prevention programs would EMS providers be LEAST likely involved?
Road design and construction
An 8-year-old child was chasing his dog when he ran out into the street and was struck by a car. He is responsive to verbal stimuli and has an unstable pelvis and a bruise to the side of his face. His airway is open and his breathing is rapid and shallow. His radial pulse is rapid and weak and his skin is cool, moist, and diaphoretic. He also has burns and abrasions to his back after being thrown by the car onto the hot pavement. Based on these assessment findings, the EMT would treat the patient for what condition?
Shock
On the scene of a medical emergency, you are directed to a 5-month-old baby in his crib. He responds to painful stimuli by whimpering and he is breathing at a rate of 50 breaths per minute. His airway is open and his brachial pulse is fast, weak, and difficult to locate. Assessment of his skin reveals it to be cool and pale in color. According to the mother, he has had vomiting and diarrhea for four days. She also reports that the father of the baby is a diabetic. Based on this information, the EMT would recognize what condition?
Shock
After the unsuccessful resuscitation of a 3-year-old boy who was shot by his mother's boyfriend, you find yourself extremely stressed and anxious over the call. You are having trouble sleeping and the resultant anxiety is affecting your home life. Which of the following should be your initial action, given this situation?
Talk to a close friend about your feelings.
While in an apartment to provide care for a 52-year-old female with shortness of breath, you note a baby sleeping in a nearby crib. Which of the following observations related to the baby would prompt you to intervene and speak to the family?
The baby is sleeping on her abdomen.
When you are assessing a 9-month-old boy who had a fever for the past two days, which of the following assessment findings would most strongly suggest that the fever has caused dehydration?
The mother informs you that the baby is wetting very few diapers.
You note a 5-year-old seizing as you approach him. What observation or piece of information would be most alarming?
The patient has been seizing for 8 minutes.
Which of the following assessment findings related to the mental status of a 1-year-old would the EMT consider normal?
The patient is curious about your pen light.
Why are pediatric trauma patients at a greater risk of head injuries?
The child's head is proportionally larger than the adult's.
A 6-month-old has been stung on the tongue after putting a bottle in his mouth that had a bee on the nipple. In comparison to the same injury in an adult, why would the EMT be more concerned with this child?
The child's tongue is proportionally larger, increasing the chance of airway occlusion from minor swelling.
If you allow yourself to get frustrated or emotionally distraught at the scene of a pediatric trauma, what is likely to happen?
The parent's frustration or agitation level will rapidly escalate.
After you obtain a refusal at a residence in a neighborhood, a couple approaches the ambulance and inform you that they have concerns that a 6-year-old child may be being physically abused in a home two doors away. They state that they heard the child crying and what sounded like physical abuse occurring. In this situation, you would:
contact the police and wait in the ambulance until they arrive.
What is the ultimate goal of prevention programs?
To reduce pediatric injuries
Which choice is LEAST responsible for childhood injuries?
Unanticipated nature of accidents
If you do not have a small enough cervical collar to place on an infant during immobilization, what should you consider doing?
Using a rolled-up towel
The EMT is properly assessing the breathing of a 3-year-old when he:
counts the respiratory rate for 30 seconds and multiplies by 2.
You have been summoned to a grocery store for a 6-year-old girl who has collapsed. On scene, you find the girl lying unresponsive on the floor. Quickly you open the airway and determine that she is not breathing. When you try to ventilate her with the bag-valve mask, you are unable to do so. Repositioning the head and reattempting ventilation is not successful in passing air into the lungs. Your next action would be to:
administer 30 chest compressions
When providing care to the pediatric patient who has been injured or ill, the EMT must recognize that the most important aspect of care normally revolves around:
airway and respiratory support.
An infant is short of breath and has rhonchi in both lungs. He is alert with adequate respirations at a rate of 38 per minute. His skin color is pink but slightly cool to the touch. When you place a pediatric mask on his face, he becomes very upset and begins to physically struggle to remove it. In this situation you would:
allow the mother to hold the infant and provide blow-by oxygen
A 7-year-old child was riding a bike downhill and struck a parked car. He was thrown from the bike, impacting his head and back on the roadway. Presently, he is alert, oriented, and complaining of a headache. His airway is open and his breathing is adequate. A radial pulse is easily palpated and his skin is warm and dry. After taking manual in-line spinal immobilization, the EMT would:
apply oxygen via a non-rebreather face mask
You are transporting a child with a small laceration to his leg, sustained after cutting himself of a piece of broken glass. During transport, you observe a pulse oximeter reading of 87% on the frantic, crying, and actively moving child. The child is alert and oriented with a normal pulse and respiratory rate with pink skin that is warm to touch. Your immediate action would be to:
attempt to calm the child and obtain another SpO2 reading.
You are caring for an 8-month-old boy who is unresponsive after choking on a piece of hard candy he managed to find. As you look into his mouth, you can see the candy in the back of his oropharynx. Your next action would be to:
attempt to retrieve and remove it.
The EMT would recognize that pediatric patients range in age from:
birth to 18 years
A 2-year-old is awake and in respiratory distress with stridorous respirations. His airway is patent and pulses rapid. Vital signs are pulse 144, respirations 28, SpO2 93% on room air, and temperature 101°F. The patient has no medical history, although diabetes runs in the family. Appropriate care for this patient would include
blow−by oxygen that is humidified.
A 2-month-old presents with labored breathing, fever, and coughing. Auscultation of the lungs reveals significant wheezing bilaterally. Based on this presentation, an EMT would recognize that the patient is most likely suffering from:
bronchiolitis.
The increased pliability of the child's ribs makes him more prone to:
bruising of the lung.
Assessment of an alert and oriented 9-year-old child with a history of asthma reveals him to be breathing 20 times a minute with adequate chest rise and fall. You also note that he exhibits nasal flaring and has slight retractions of the intercostal muscles. His heart rate is 100 beats per minute and his blood pressure is 102/64 mmHg. On room air, he has a pulse oximeter reading of 98 percent. The EMT would recognize
compensated respiratory distress
You are by the side of a 2-year-old whose mother states he has had a cough for the past three days. His airway is patent and respirations labored. Intercostal retractions are accompanied by stridorous respirations. His skin is warm to hot and vital signs are as follows pulse 152, respirations 28, SpO2 97%, and temperature 100.3°F. Breath sounds are clear and equal. Based on this presentation, you would suspect and treat the patient for
croup.
On scene at a school cafeteria, you are presented with a 9-year-old boy who attempted to eat a small plum whole. He is conscious with stridorous respirations and unable to cough when instructed to do so. His skin color is gray and cyanotic. Your immediate action would be to:
deliver five abdominal thrusts
You have been called for a 2-year-old girl who has been sick for two days. In preparing to assess the patient, it is important that you recognize that patients in this age group generally:
do not like having clothing removed.
Croup is recognized as an illness that involves:
edema beneath the glottis.
When assessing the central pulse of a young child, the EMT would palpate the:
femoral pulse.
You have been called to a local day care for a sick child. On scene, panicked day care workers inform you that the 4-year-old child was lethargic all morning and wanted to sleep. After resting for several minutes, she began to "shake all over." This lasted for approximately 30 seconds. Your assessment reveals her to be responsive to painful stimuli and breathing adequately. Her airway is open and her radial pulse is strong and bounding. Her skin is hot and moist to the touch with no signs of cyanosis. You are told that she has no medical history. En route to the hospital, the patient's mental status improves. Based on this presentation and information, you assume that the seizure occurred secondary to:
fever.
"Soft spots" on the infant's skull are known as:
fontanelles.
A 5-year-old boy who is drooling has suspected epiglottitis. His pulse rate is 144, respirations 156, and blood pressure 110/52. He is noncompliant with the pulse oximeter, but his skin is normal colored. Which statement indicates proper care of this patient?
"Let's give him high-concentration oxygen through a mask."
You have been called for a 4-year-old female who is short of breath. Her mother informs you that she has had a fever and runny nose for two days and today began to have difficulty breathing. Furthermore, she is having a difficult time waking her up. Your assessment reveals her to be responsive to painful stimuli and breathing at 12 times a minute with minimal chest and abdominal rise and fall. Her skin is warm to the touch with cyanosis around the lips. Your partner informs you that her heart rate is 124 beats per minute. You find the girl lying in bed with snoring respirations despite use of the head tilt,-chin lift airway maneuver. Your immediate action in caring for this child next is:
insertion of a nasal airway.
When evaluating capillary refill time in a pediatric patient, the EMT must remember that:
it is considered very reliable.
The EMT is correctly assessing a child's apical pulse when he:
listens with a stethoscope to the child's left side of the chest.
A malnourished child would be an example of:
neglect.
A frantic mother has contacted EMS because she believes that her 4-year-old daughter got into her blood pressure medications and ate three or four pills. She presents as awake and confused with pale skin that is cool and diaphoretic. Her pulse is rapid and respirations adequate. Vital signs are pulse 116, respirations 22, blood pressure 82/44, and SpO2 99%. After completing the primary assessment, your immediate action would be to:
obtain the name and dosage of the medication.
You have arrived at a residence to find a 6-month-old girl in her crib in cardiac arrest. Quick assessment reveals no rigor mortis or lividity. The mother states that she put the baby to bed at 9 p.m. last night and awoke at 3 a.m. to find her in her present state. Your first action would be to:
open the airway and provide 2 ventilations.
A 6-year-old male has a decreased level of consciousness. His mother states that they do not have health insurance so they did not take him to the hospital last week when he started vomiting and had copious amounts of diarrhea. She continues by stating that he has not had anything to eat or drink since then. He has snoring respirations that are rapid and inadequate. His radial pulse cannot be located, and his carotid pulse is rapid and weak. His capillary refill is 5 seconds and his skin is cool to the touch. Your first intervention in caring for this child would be:
opening the airway using the head-tilt, chin-lift.
You are called to a home for a 7-year-old female with a suspected upper respiratory infection. As you assess the patient, you note a bruise to her right upper arm. As you care for this child, it is essential that you:
perform a head to toe assessment.
You have been called to a home by neighbors because they are concerned for the welfare of the children inside. On scene, you find two children left by themselves. They are playing in a filthy room with no light or heat. They are dirty and have insect bites all over their bodies. One is in a soiled diaper and has hard stool caked to the buttocks. The EMT would best recognize this situation as one of:
physical neglect.
A 7-year-old with a fever of 101.3°F and shortness of breath has a patent airway, but tachypneic respirations. His heart rate is 132, respirations 28, and blood pressure 94/60 with an SpO2 of 96% on room air. Crackles and wheezes are noted in the base of the right lung. Based on this presentation, you would suspect and treat the patient for
pneumonia
As you assess a very sick 3-year-old with a fever, rash, and sore neck, you suddenly suspect he might have meningitis. Your immediate action would be to:
put on a mask and gown.
The mother of a 2-year-old has called EMS because her son has an axillary temperature of 103.2degrees°F. On scene, your assessment reveals the boy to be confused and lethargic with a rectal temperature of 104.1degrees°F. When caring for this child, you would:
remove the child's clothes and sponge with tepid water.
While performing the reassessment of a 2-year-old male who is severely dyspneic, you note that he is now unresponsive and not breathing. He has a heart rate of 32 beats per minute and his skin is cool and diaphoretic. What instruction would you provide to another EMT who is helping you transport the patient?
"Let's start chest compressions and positive pressure ventilations."
You are assessing a 12-year-old female in respiratory distress and a history of asthma. What statement, made by her mother, would be most concerning?
"Two years ago she needed to have a breathing tube in her throat."
After placing a small rock in her mouth, a 7-month-old girl begins to choke. You are on scene within minutes and find her unresponsive in her mother's arms. You attempt to provide ventilation with the bag-valve mask, but are unsuccessful. Your next action would be to:
start cardiopulmonary resuscitation
Assessment of a 4-year-old reveals him to be unresponsive with no spontaneous respirations or pulse. Your immediate action would be to:
start chest compressions.
A 6-year-old female is in severe respiratory distress with inspiratory stridor and pale moist skin with cyanosis noted around his mouth. He is very lethargic and cannot hold his head up. His mother is panicked and reports that he has a history of asthma. Breath sounds are diminished and his vital signs are pulse 162, respirations 40, blood pressure 122/66, and SpO2 81%. Your immediate action would be to
start positive pressure ventilation.
You have been called to a preschool for a child in seizure activity. On your arrival, staff direct you to a bed in which a 4-year-old boy is lying. Staff state that the child began making "funny" noises in his sleep then began to seize for approximately 60 seconds. Your assessment indicates that the boy is responsive to painful stimuli and is breathing, but has gurgling sounds coming from the upper airway. His radial pulse is rapid and strong and his skin is cool and diaphoretic. Your immediate action in caring for this child would be to:
suction the airway.
While attempting resuscitation on a baby with a probable case of SIDS, which of the following questions would be appropriate for the EMT to ask the mother?
"Were there any problems with the pregnancy or his birth?"
A mother asks you what causes her son to get bronchiolitis. You would inform her that it is caused by:
the respiratory syncytial virus.
You have been called to care for a 21-month-old female who has been bitten by a dog. Given the patient's age, you would appropriately classify the patient as a(n):
toddler
A 3-year-old female has been accidentally struck in the chest with a baseball bat during a domestic altercation. Assessment indicates redness to the right lateral chest with no deformity, crepitus, or broken skin. Vital signs are pulse 124, respirations 22, blood pressure 108/62, and SpO2 99% on room air. Given these assessment findings, you would:
treat the child for suspected internal chest injury.
The EMT is correctly assessing breath sounds on a 3-year-old male when he:
understands that sounds from the left lung can be heard on the right side of the chest.
On scene, a 6-year-old male who is short of breath will not allow EMRs to place a nonrebreather face mask on his face. Assessment indicates moderate respiratory distress with the following vital signs: pulse 124, respirations 24, blood pressure 98/56, and SpO2 93%. At this time, you:
use a nasal cannula with 2 liters oxygen.
When involved with a pediatric patient, the EMT recognizes that patient assessment begins when:
you first lay eyes on the patient.
Which of the following would be the most appropriate instructions to give to another EMT concerning the ventilation of an unresponsive and apneic 3-year-old boy?
"Deliver one breath every 3 seconds."
You are concerned that a sick 5-year-old with lower abdominal pain and a temperature of 100.3degrees°F has appendicitis. He describes the pain as generalized and crampy and although complaining of nausea, he is not vomiting. His pulse, respirations, blood pressure, and SpO2 are normal and there are no immediate life−threatening conditions. Based on these assessment findings, his father informs you that he does not wish his son to be transported, and will call the pediatrician in the morning. How would you respond?
"I have to tell you, if he has appendicitis, it will only get worse and become a major situation."
Another EMT tells you that he had a call the previous shift in which he thinks a 5-year-old boy may be the victim of abuse since he had bruises on both upper legs. However, he did not communicate this to anyone nor transport the patient. Your best response would be:
"If you do not take steps to report this, you can be punished in a court of law."
Which of the following statements made by another EMT regarding treatment of the pediatric patient in the prehospital setting would you agree with?
"It is critical that the EMT be able to determine the respiratory status of the patient, as this commonly is the reason for acute deterioration."
