EMT - Chapter 34: Pediatric Emergencies

Pediatric Pulse Rate

0-3 Months: 85-205 3-24 Months: 100-190 2-10 Years: 60-140 10 and up: 60-100

A useful tool to determine blood pressure in children ages 1 to 10 years (lower limits) is:

70 + (2 × child's age in years) = Systolic Blood Pressure

toddler

A child age 1 to 3 years.

You are assessing a 6-year-old boy who has a fever of 102 and is showing signs of altered LOC. He is complaining of pain when he tries to turn his head. What condition should you suspect? Anaphylactic shock Febrile seizure Meningitis Spinal cord injury

A fever and pain in the neck are signs of meningitis.

Neisseria meningitidis

A form of bacterial meningitis characterized by rapid onset of symptoms, often leading to shock and death.

child abuse

A general term applying to all forms of child abuse and neglect of children.

You are using JumpSTART in a triage situation involving several children. How would you rate a patient who is breathing spontaneously, has a peripheral pulse, and is appropriately responsive to painful stimuli? Green tag Yellow tag Red tag Black tag

A pediatric patient who is breathing spontaneously, has a peripheral pulse, and is appropriately responsive to painful stimuli is a yellow tag. Treatment and transport can be delayed.

generalized tonic-clonic seizure

A seizure that features rhythmic back-and-forth motion of an extremity and body stiffness.

pediatrics

A specialized medical practice devoted to the care of the young.

Pediatric Assessment Triangle (PAT)

A structured assessment tool that allows you to rapidly form a general impression of the infant or child without touching him or her; consists of assessing appearance, work of breathing, and circulation to the skin.

shaken baby syndrome

A syndrome seen in abused infants and children; the patient has been subjected to violent, whiplash-type shaking injuries inflicted by the abusing individual that may cause coma, seizures, and increased intracranial pressure due to tearing of the cerebral veins with consequent bleeding into the brain.

length-based resuscitation tape

A tape used to estimate an infant or child's weight on the basis of length; appropriate drug doses and equipment sizes are listed on the tape.

After squeezing the end of a child's finger or toe for a few seconds, blood should return to the area within: A. 2 seconds. B. 3 seconds. C. 4 seconds. D. 5 seconds.

A. 2 seconds.

Blood pressure is usually not assessed in children younger than _____ years. A. 3 B. 4 C. 5 D. 6

A. 3

If the situation allows, a child should be transported in a car seat if he or she weighs less than _____ lb. A. 40 B. 50 C. 60 D. 70

A. 40

A child may begin to show signs of separation anxiety as early as: A. 6 months. B. 12 months. C. 18 months. D. 24 months.

A. 6 months.

Which of the following represents a low normal systolic blood pressure for a 6-year-old child? A. 82 mm Hg B. 88 mm Hg C. 90 mm Hg D. 98 mm Hg

A. 82 mm Hg

Which of the following findings is LEAST suggestive of child abuse? Select one: A. Consistency in the method of injury reported by the caregiver B. An unexplained delay in seeking medical care after the injury C. Burns to the hands or feet that involve a glove distribution D. Evidence of alcohol consumption or drug use at the scene

A. Consistency in the method of injury reported by the caregiver

Which of the following statements regarding the use of nasopharyngeal airways in children is correct? A. They are rarely used in infants younger than 1 year. B. It is the recommended adjunct for children with head trauma. C. They are usually not well tolerated in children with a gag reflex. D. Blanching of the nares after insertion indicates correct placement.

A. They are rarely used in infants younger than 1 year.

You are dispatched to a residence for a child with respiratory distress. The patient, an 18-month-old female, is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry, and her heart rate is 120 beats/min. The MOST appropriate treatment for this child includes: Select one: A. administering blow-by oxygen and transporting the child with her mother. B. requesting a paramedic ambulance to insert an advanced airway device. C. separating the child from her mother and providing ventilatory assistance. D. allowing the child to remain with her mother and applying a nasal cannula.

A. administering blow-by oxygen and transporting the child with her mother.

Submersion injuries in the adolescent age group are MOST commonly associated with: A. alcohol. B. child abuse. C. hyperthermia. D. swimming pools.

A. alcohol.

The components of the PAT are: A. appearance, work of breathing, and skin circulation. B. mental status, heart rate, and systolic blood pressure. C. skin condition, respiratory rate, and level of alertness. D. activity, respiratory quality, and level of consciousness.

A. appearance, work of breathing, and skin circulation.

Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler: A. at the feet. B. at the head. C. in the ambulance. D. en route to the hospital.

A. at the feet.

An 8-year-old female with a history of asthma continues to experience severe respiratory distress despite being given multiple doses of her prescribed albuterol by her mother. She is conscious, but clearly restless. Her heart rate is 130 beats/min and her respiratory rate is 30 breaths/min. She is receiving high-flow oxygen via a nonrebreathing mask. You should: A. be prepared to assist her ventilations, transport at once, and request an ALS intercept en route to the hospital. B. continue high-flow oxygen therapy, contact medical control, and request permission to administer more albuterol. C. begin immediate ventilation assistance and ensure that you squeeze the bag forcefully in order to open her bronchioles. D. begin chest compressions if she becomes unresponsive and her heart rate falls below 80 beats/min.

A. be prepared to assist her ventilations, transport at once, and request an ALS intercept en route to the hospital.

Death caused by shaken baby syndrome is usually the result of: A. bleeding in the brain. B. multiple open fractures. C. intra-abdominal hemorrhage. D. fracture of the cervical spine.

A. bleeding in the brain.

When ventilating a pediatric patient with a bag-mask device, the EMT should: A. block the pop-off valve if needed to achieve adequate chest rise. B. squeeze the bag 40 times/min when ventilating an infant. C. ensure that he or she uses a neonatal device for children younger than 12 months. D. ventilate the child with sharp, quick breaths at the appropriate rate.

A. block the pop-off valve if needed to achieve adequate chest rise.

Children with N meningitides would MOST likely present with: A. cherry-red spots or a purplish rash. B. a low-grade fever and tachycardia. C. hypothermia and an irregular pulse. D. a generalized rash with intense itching.

A. cherry-red spots or a purplish rash.

A 2-year-old female has experienced a seizure. When you arrive at the scene, the child is conscious, crying, and clinging to her mother. Her skin is hot and moist. The mother tells you that the seizure lasted approximately 5 minutes. She further tells you that her daughter has no history of seizures, but has had a recent ear infection. You should: Select one: A. cool the child with tepid water and transport to the hospital. B. suspect that the child has meningitis and transport at once. C. place the child in cold water to attempt to reduce her fever. D. allow the mother to drive her daughter to the hospital.

A. cool the child with tepid water and transport to the hospital.

A viral infection that may cause obstruction of the upper airway in a child is called: A. croup. B. asthma. C. bronchitis. D. epiglottitis.

A. croup.

A viral infection that may cause obstruction of the upper airway in a child is called: Select one: A. croup. B. epiglottitis. C. bronchitis. D. asthma.

A. croup.

Early signs of respiratory distress in the pediatric patient include all of the following, EXCEPT: A. cyanosis. B. tachypnea. C. retractions. D. abnormal airway noise.

A. cyanosis.

An infant or child with respiratory distress will attempt to keep his or her alveoli expanded at the end of inhalation by: A. grunting. B. wheezing. C. assuming a tripod position. D. retracting the intercostal muscles.

A. grunting.

When caring for a female child who has possibly been sexually abused, you should: Select one: A. have a female EMT remain with her if possible. B. encourage the child to urinate and take a shower. C. carefully examine the genitalia for signs of injury. D. immediately report your suspicions to the parents.

A. have a female EMT remain with her if possible.

When a child experiences a blunt injury to the abdomen: A. he or she can compensate for blood loss better than adults. B. his or her blood pressure falls with as little as 5% blood loss. C. your assessment will most often reveal bruising to the abdomen. D. delayed capillary refill indicates a state of decompensated shock.

A. he or she can compensate for blood loss better than adults.

Common causes of seizures in children include all of the following, EXCEPT: Select one: A. hyperglycemia. B. poisonings or ingestion. C. infection. D. electrolyte imbalances.

A. hyperglycemia.

Compared to an adult, the diaphragm dictates the amount of air that a child inspires because the: A. intercostal muscles are not well developed. B. rib cage is rigid and provides little flexibility. C. abdominal organs force the diaphragm upward. D. upper airway is smaller and easily collapsible.

A. intercostal muscles are not well developed.

The first month of life after birth is referred to as the: A. neonatal period. B. toddler period. C. start of infancy. D. premature phase.

A. neonatal period.

Padding underneath the torso when immobilizing an injured child is generally not necessary if he or she is: A. older than 8 to 10 years. B. complaining of severe back pain. C. immobilized on a long backboard. D. experiencing cardiopulmonary arrest.

A. older than 8 to 10 years.

A child who has no recent history of illness suddenly appears cyanotic and cannot speak after playing with a small toy. You should: A. perform abdominal thrusts. B. visualize the child's airway. C. perform a blind finger sweep. D. give oxygen and transport at once.

A. perform abdominal thrusts.

When administering oxygen to a frightened child, it would be MOST appropriate to: A. place oxygen tubing through a hole in a paper cup. B. tightly secure the oxygen mask straps to the face. C. have a parent restrain the child as you give oxygen. D. use a nasal cannula instead of a nonrebreathing mask.

A. place oxygen tubing through a hole in a paper cup.

Compared to adults, the liver and spleen of pediatric patients are more prone to injury and bleeding because they are: A. proportionately larger and situated more anteriorly. B. more vascular despite the fact that they are proportionately smaller. C. spaced further apart, which causes them to shift following trauma. D. lower in the abdominal cavity, where the muscles are not as strong.

A. proportionately larger and situated more anteriorly.

Which of the following inquiries should you make in private when obtaining a SAMPLE history from an adolescent patient? A. sexual activity B. past medical history C. change in bladder habits D. duration of symptoms

A. sexual activity

Bruising to the _________ is LEAST suggestive of child abuse. A. shins B. back C. face D. buttocks

A. shins

A high-pitched inspiratory sound that indicates a partial upper airway obstruction is called: A. stridor. B. rhonchi. C. grunting. D. wheezing.

A. stridor.

Signs and symptoms of meningitis in the infant or child include all of the following, EXCEPT: A. sunken fontanelles. B. headache and fever. C. a stiff or painful neck. D. an altered mental status.

A. sunken fontanelles.

The pediatric patient should be removed from his or her car seat and secured to an appropriate spinal immobilization device if: A. the car seat is visibly damaged. B. he or she has no visible injuries. C. his or her vital signs are stable. D. he or she even has a minor injury.

A. the car seat is visibly damaged.

When assessing or treating an adolescent patient, it is important to remember that: A. they usually do not wish to be observed during a procedure. B. it is generally not necessary to explain procedures in advance. C. they often request medication to help in the relief of severe pain. D. they cannot understand complex concepts and treatment options.

A. they usually do not wish to be observed during a procedure.

The signs and symptoms of poisoning in children: A. vary widely, depending on the child's age and weight. B. are more obvious than in the adult population. C. usually present within the first 10 minutes of ingestion. D. are most severe if the child ingested a poisonous substance.

A. vary widely, depending on the child's age and weight.

Signs of an upper airway obstruction in an infant or child include all of the following, EXCEPT: A. wheezing. B. a weak cough. C. a cough that resembles the bark of a seal. D. stridorous breathing.

A. wheezing.

grunting

An "uh" sound heard during exhalation; reflects the child's attempt to keep the alveoli open; a sign of increased work of breathing.

pertussis

An airborne bacterial infection that affects mostly children younger than 6 years, in which the patient is feverish and exhibits a "whoop" sound on inspiration after a coughing attack; highly contagious through droplet infection. Also called whooping cough.

apparent life-threatening event (ALTE)

An event that causes unresponsiveness, cyanosis, and apnea in an infant, who then resumes breathing with stimulation.

meningitis

An inflammation of the meningeal coverings of the brain and spinal cord; it is usually caused by a virus or a bacterium.

croup

An inflammatory disease of the upper respiratory system that may cause a partial airway obstruction and is characterized by a barking cough; usually seen in children.

tripod position

An upright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward.

sniffing position

An upright position in which the patient's head and chin are thrust slightly forward to keep the airway open; the optimum position for the uninjured child who requires airway management.

fontanelles

Areas where the neonate's or infant's skull has not fused together; usually disappear at approximately 18 months of age.

helpful mnemonic to remember is BLSCPR:

B Blood pressure L Level of consciousness S Skin color, temperature, moisture C Capillary refill time P Pulse rate, rhythm, strength R Respiratory rate, effort, pattern

Which of the following is the MOST appropriate dose of activated charcoal for a 20-kg child? A. 12.5 g B. 20 g C. 25 g D. 50 g

B. 20 g

Febrile seizures are MOST common in children between: A. 3 months and 4 years. B. 6 months and 6 years. C. 8 months and 8 years. D. 18 months and 10 years.

B. 6 months and 6 years.

Capillary refill time is MOST reliable as an indicator of end-organ perfusion in children younger than: A. 4 years. B. 6 years. C. 8 years. D. 10 years.

B. 6 years.

The normal respiratory rate for a newborn should not exceed ______ breaths/min. A. 50 B. 60 C. 70 D. 80

B. 60

Which of the following statements regarding sudden infant death syndrome (SIDS) is correct? Select one: A. SIDS is most commonly the result of an overwhelming infection. B. Death as a result of SIDS can occur at any time of the day or night. C. Certain cases of SIDS are predictable and therefore preventable. D. The cause of death following SIDS can be established by autopsy.

B. Death as a result of SIDS can occur at any time of the day or night.

With regard to the legal implications of child abuse: A. child abuse must be reported only if it can be proven. B. EMTs must report all suspected cases of child abuse. C. you should document your perceptions on the run form. D. a supervisor can forbid you from reporting possible abuse.

B. EMTs must report all suspected cases of child abuse.

The EMT should be MOST concerned when a child presents with fever and: A. chills. B. a rash. C. ear pain. D. a headache.

B. a rash.

During the attempted resuscitation of an infant with suspected SIDS: A. discourage the family from observing. B. allow the family to observe if they wish. C. a law enforcement officer must be present. D. give detailed updates to the infant's parents.

B. allow the family to observe if they wish.

The purpose of the pediatric assessment triangle (PAT) is to: A. determine if the child's vital signs are within the age-appropriate limits. B. allow you to rapidly and visually form a general impression of the child. C. facilitate a rapid head-to-toe assessment of the child by visualization only. D. gather critical data by performing a rapid hands-on assessment of the child.

B. allow you to rapidly and visually form a general impression of the child.

Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler: Select one: A. in the ambulance. B. at the feet. C. at the head. D. en route to the hospital.

B. at the feet.

A 2-year-old female has experienced a seizure. When you arrive at the scene, the child is conscious, crying, and clinging to her mother. Her skin is hot and moist. The mother tells you that the seizure lasted approximately 5 minutes. She further tells you that her daughter has no history of seizures, but has had a recent ear infection. You should: A. allow the mother to drive her daughter to the hospital. B. attempt cooling measures, offer oxygen, and transport. C. place the child in cold water to attempt to reduce her fever. D. suspect that the child has meningitis and transport at once.

B. attempt cooling measures, offer oxygen, and transport.

Which of the following is the LEAST reliable assessment parameter to evaluate when determining the presence of shock in infants and children? A. heart rate B. blood pressure C. skin condition D. capillary refill

B. blood pressure

An oropharyngeal airway should not be used in children who have ingested a caustic or petroleum-based product because it may: A. depress the gag reflex. B. cause the child to vomit. C. result in airway swelling. D. result in a soft-tissue injury.

B. cause the child to vomit.

A common cause of shock in an infant is: A. a cardiac arrhythmia. B. dehydration from vomiting and diarrhea. C. excessive tachycardia. D. cardiovascular disease.

B. dehydration from vomiting and diarrhea.

Infection should be considered a possible cause of an airway obstruction in an infant or child, especially if he or she presents with: A. extreme restlessness. B. drooling or congestion. C. skin that is cool and dry. D. acute respiratory distress.

B. drooling or congestion.

Infection should be considered a possible cause of an airway obstruction in an infant or child, especially if he or she presents with: Select one: A. extreme restlessness. B. drooling or congestion. C. skin that is cool and dry. D. acute respiratory distress.

B. drooling or congestion.

A 6-year-old male presents with acute respiratory distress. His mother states that she saw him put a small toy into his mouth shortly before the episode began. The child is conscious, obviously frightened, and is coughing forcefully. You should: A. carefully look into his mouth and remove the object if you see it. B. encourage him to cough, give oxygen as tolerated, and transport. C. deliver a series of five back blows and then reassess his condition. D. place the child in a supine position and perform abdominal thrusts.

B. encourage him to cough, give oxygen as tolerated, and transport.

When inserting an oropharyngeal airway in an infant or child, you should: A. place padding under the child's head. B. ensure that his or her neck is hyperextended. C. insert it until the flange rests on the teeth. D. depress the tongue with a tongue depressor.

B. ensure that his or her neck is hyperextended.

Before assessing the respiratory adequacy of an semiconscious infant or child, you must: A. routinely suction the mouth to remove oral secretions. B. ensure that the airway is patent and clear of obstructions. C. insert a nasopharyngeal or oropharyngeal airway adjunct. D. ensure that his or her head is in a hyperextended position.

B. ensure that the airway is patent and clear of obstructions.

Burns in children are commonly caused by all of the following, EXCEPT: Select one: A. exposure to caustic chemicals. B. entrapment in a structural fire. C. scalding water in a bathtub. D. hot items on a stovetop.

B. entrapment in a structural fire.

Which of the following groups of people is associated with the lowest risk of meningitis? A. newborns B. females C. geriatrics D. children with shunts

B. females

When caring for a female child who has possibly been sexually abused, you should: A. encourage the child to urinate and take a shower. B. have a female EMT remain with her if possible. C. carefully examine the genitalia for signs of injury. D. immediately report your suspicions to the parents.

B. have a female EMT remain with her if possible.

Use of a nonrebreathing mask or nasal cannula in a child is appropriate ONLY if: A. an oral airway has been inserted. B. his or her tidal volume is adequate. C. his or her respirations are shallow. D. he or she is breathing inadequately.

B. his or her tidal volume is adequate.

Common causes of seizures in children include all of the following, EXCEPT: A. infection. B. hyperglycemia. C. electrolyte imbalances. D. poisonings or ingestion.

B. hyperglycemia.

A 6-month-old male presents with 2 days of vomiting and diarrhea. He is conscious, but his level of activity is decreased. The infant's mother tells you that he has not had a soiled diaper in over 12 hours. The infant's heart rate is 140 beats/min and his anterior fontanelle appears to be slightly sunken. You should suspect: A. mild dehydration. B. moderate dehydration. C. severe dehydration. D. hypovolemic shock.

B. moderate dehydration.

A 4-year-old female ingested an unknown quantity of liquid drain cleaner. Your assessment reveals that she is conscious and alert, is breathing adequately, and has skin burns around her mouth. You should: A. place her supine and elevate her legs. B. monitor her airway and give oxygen. C. determine why the ingestion occurred. D. give 12.5 to 25 g of activated charcoal.

B. monitor her airway and give oxygen.

The first month of life after birth is referred to as the: Select one: A. premature phase. B. neonatal period. C. toddler period. D. start of infancy.

B. neonatal period.

After determining that an infant or child has strong central pulses, you should: A. assume the child is hypertensive. B. not rule out compensated shock. C. conclude that the child is stable. D. assess his or her respiratory effort.

B. not rule out compensated shock.

Critical burns in children include: A. any superficial or partial-thickness burn that involves the legs or arms. B. partial-thickness burns covering more than 20% of the body surface. C. second-degree burns covering more than 10% of the body surface. D. superficial burns covering more than 10% to 15% of the body surface.

B. partial-thickness burns covering more than 20% of the body surface.

To ensure that the airway of an infant or small child is correctly positioned, you may have to: A. place bulky padding behind his or her occiput. B. place a towel or folded sheet behind the shoulders. C. slightly flex the neck to prevent tracheal kinking. D. hyperextend the neck to ensure adequate alignment.

B. place a towel or folded sheet behind the shoulders.

Effective methods for providing pain relief to a child with an extremity injury include: A. separating the child from his or her parents. B. positioning, ice packs, and emotional support. C. avoiding the placement of a splint, if possible. D. heat compresses and lowering the injured extremity.

B. positioning, ice packs, and emotional support.

Cardiac arrest in the pediatric population is MOST commonly the result of: A. a complete airway obstruction. B. respiratory or circulatory failure. C. a congenital cardiovascular defect. D. lethal cardiac rhythm disturbances.

B. respiratory or circulatory failure.

Drawing in of the muscles between the ribs or of the sternum during inspiration is called: A. tenting. B. retracting. C. hyperpnea. D. accessory muscle use.

B. retracting.

When a child is struck by a car, the area of greatest injury depends MOSTLY on the: A. speed at which the car was traveling when impact occurred. B. size of the child and the height of the bumper upon impact. C. age of the child and the size of the car that struck him or her. D. height of the child and the speed at which the car was traveling.

B. size of the child and the height of the bumper upon impact.

When a child is struck by a car, the area of greatest injury depends MOSTLY on the: Select one: A. speed at which the car was traveling when impact occurred. B. size of the child and the height of the bumper upon impact. C. height of the child and the speed at which the car was traveling. D. age of the child and the size of the car that struck him or her.

B. size of the child and the height of the bumper upon impact. Chapter 34, page 1262, Pediatric Trauma Emergencies and Management

Signs of severe dehydration in an infant include all of the following, EXCEPT: A. profound tachycardia. B. slowed level of activity. C. delayed capillary refill. D. dry mucous membranes.

B. slowed level of activity.

You are dispatched to a local elementary school for an injured child. As you approach the child, you note that he is lying at the base of the monkey bars. He is unresponsive and there are no signs of breathing. You should: A. begin immediate rescue breathing. B. stabilize his head and check for a pulse. C. perform a head tilt-chin lift maneuver. D. open his airway and look in his mouth.

B. stabilize his head and check for a pulse.

Signs and symptoms of meningitis in the infant or child include all of the following, EXCEPT: Select one: A. altered mental status. B. sunken fontanelles. C. headache and fever. D. a stiff or painful neck.

B. sunken fontanelles.

When assessing an 8-year-old child, you should: A. refrain from taking a blood pressure. B. talk to the child, not just the caregiver. C. use a toe-to-head assessment approach. D. rely solely on the parent for information.

B. talk to the child, not just the caregiver.

When assessing an 8-year-old child, you should: Select one: A. refrain from taking a blood pressure. B. talk to the child, not just the caregiver. C. rely solely on the parent for information. D. use a toe-to-head assessment approach.

B. talk to the child, not just the caregiver.

When a child experiences a blunt chest injury: A. the flexible rib cage protects the vital thoracic organs. B. the flexible ribs can be compressed without breaking. C. the sudden force against the ribs causes them to fracture. D. there is usually obvious injury to the external chest wall.

B. the flexible ribs can be compressed without breaking.

The MOST efficient way to identify the appropriately sized equipment for a pediatric patient is to: A. estimate the child's weight based on age. B. use a length-based resuscitation tape measure. C. estimate the child's weight based on appearance. D. ask a relative if he or she knows the child's weight.

B. use a length-based resuscitation tape measure.

Signs of vasoconstriction in the infant or child include: A. warm, dry skin. B. weak distal pulses. C. a rapid heart rate. D. brisk capillary refill.

B. weak distal pulses.

Which of the following is true about a child's breathing? Older children experience intercostal muscle fatigue more quickly than younger children. A child's oxygen demand is about the same as that of an adult. Because less air is exchanged with each breath, detection of poor air movement or complete absence of breath sounds can be difficult. The trachea is proportionally larger in an infant, leading to a greater potential for choking.

Because less air is exchanged with each breath, detection of poor air movement or complete absence of breath sounds can be difficult.

What does respiratory syncytial virus (RSV) cause? Pneumonia Bronchiolitis Epiglottitis Pertussis

Bronchiolitis is a specific viral illness of newborns and toddlers, often caused by respiratory syncytial virus (RSV), that causes inflammation of the bronchioles.

Blood loss in a child exceeding _____ of his or her total blood volume significantly increases the risk of shock. A. 5% B. 15% C. 25% D. 35%

C. 25%

A 5-year-old child has had severe vomiting and diarrhea for 4 days. Which of the following assessment findings would be the MOST indicative of decompensated shock? Select one: A. Pulse rate greater than 120/min B. Respiratory rate of 30 breaths/min C. Blood pressure of 70/40 mm Hg D. Capillary refill time of 4 seconds

C. Blood pressure of 70/40 mm Hg

Which of the following statements regarding pediatric trauma is correct? A. Children are less likely than adults to be struck by a car. B. A child's head is less frequently injured than an adult's. C. Children are more likely to experience diving-related injuries. D. Inexperience and poor judgment are rare causes of pediatric trauma.

C. Children are more likely to experience diving-related injuries.

Which of the following statements regarding a pediatric patient's anatomy is correct? A. The tracheal rings of a child are more rigid than an adult's. B. A child's tongue is proportionately smaller than an adult's. C. Children have a larger, rounder occiput compared to adults. D. The child's epiglottis is less floppy and smaller than an adult's.

C. Children have a larger, rounder occiput compared to adults.

Which of the following statements regarding sudden infant death syndrome (SIDS) is correct? A. Certain cases of SIDS are predictable and therefore preventable. B. SIDS is most commonly the result of an overwhelming infection. C. Most cases of SIDS occur in infants younger than 6 months. D. The cause of death following SIDS can be established by autopsy.

C. Most cases of SIDS occur in infants younger than 6 months.

When questioning the parent of a child who ingested a poisonous substance, which of the following questions would be of LEAST pertinence? A. What time did the ingestion occur? B. Have you noticed any signs or symptoms? C. Why did your child ingest the poison? D. Do you know what substance was ingested?

C. Why did your child ingest the poison?

When questioning the parent of a child who ingested a poisonous substance, which of the following questions would be of LEAST pertinence initially? Select one: A. Have you noticed any signs or symptoms? B. What time did the ingestion occur? C. Why did your child ingest the poison? D. Do you know what substance was ingested?

C. Why did your child ingest the poison?

You are dispatched to a residence for a child with respiratory distress. The patient, an 18-month-old female, is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry, and her heart rate is 120 beats/min. The MOST appropriate treatment for this child includes: A. requesting a paramedic ambulance to insert an advanced airway device. B. separating the child from her mother and providing ventilatory assistance. C. administering blow-by oxygen and transporting the child with her mother. D. allowing the child to remain with her mother and applying a nasal cannula.

C. administering blow-by oxygen and transporting the child with her mother.

The purpose of the pediatric assessment triangle (PAT) is to: Select one: A. gather critical data by performing a rapid hands-on assessment of the child. B. determine if the child's vital signs are within the age-appropriate limits. C. allow you to rapidly and visually form a general impression of the child. D. facilitate a rapid head-to-toe assessment of the child by visualization only.

C. allow you to rapidly and visually form a general impression of the child.

Signs of a severe airway obstruction in an infant or child include: A. pink, dry skin. B. crying and anxiety. C. an ineffective cough. D. mild respiratory distress.

C. an ineffective cough.

Which of the following children would benefit the LEAST from a nonrebreathing mask? A. a conscious 4-year-old male with adequate tidal volume B. a responsive 6-year-old male who responds appropriately C. an unresponsive 5-year-old male with shallow respirations D. a semiconscious 7-year-old female with normal ventilation

C. an unresponsive 5-year-old male with shallow respirations

Pale skin in a child indicates that the: A. child is in severe decompensated shock. B. oxygen content in the blood is decreased. C. blood vessels near the skin are constricted. D. child's core body temperature is elevated.

C. blood vessels near the skin are constricted.

Pale skin in a child indicates that the: Select one: A. child is in severe decompensated shock. B. oxygen content in the blood is decreased. C. blood vessels near the skin are constricted. D. child's core body temperature is elevated.

C. blood vessels near the skin are constricted.

Which of the following findings is LEAST suggestive of child abuse? A. evidence of alcohol consumption or drug use at the scene B. burns to the hands or feet that involve a glove distribution C. consistency in the method of injury reported by the caregiver D. an unexplained delay in seeking medical care after the injury

C. consistency in the method of injury reported by the caregiver

When assessing the heart rate of a 6-month-old infant, you should palpate the brachial pulse or ________ pulse. A. radial B. carotid C. femoral D. popliteal

C. femoral

In most children, febrile seizures are characterized by: A. a blank stare, a duration of between 15 and 30 minutes, and a prolonged postictal phase. B. unresponsiveness, complete body relaxation, a fever greater than 105°F, and a short postictal phase. C. generalized tonic-clonic activity, a duration of less than 15 minutes, and a short or absent postictal phase. D. isolated tonic-clonic activity, a duration of greater than 15 minutes, and a short postictal phase.

C. generalized tonic-clonic activity, a duration of less than 15 minutes, and a short or absent postictal phase.

The secondary assessment of a sick or injured child: A. is a rapid head-to-toe exam to detect life threats. B. should be performed, regardless of the circumstances. C. may not be possible if the child's condition is critical. D. is most appropriate when your transport time is short.

C. may not be possible if the child's condition is critical.

When assessing an infant's ventilation status, you should: A. observe the chest for rise and fall. B. rule out hypoxia if cyanosis is absent. C. palpate the abdomen for rise and fall. D. give oxygen if the SpO2 is less than 90%.

C. palpate the abdomen for rise and fall.

After using the PAT to form your general impression of a sick or injured child, you should: A. evaluate the child's baseline vital signs. B. obtain a SAMPLE history from the parents. C. perform a hands-on assessment of the ABCs. D. assess the child's heart rate and skin condition.

C. perform a hands-on assessment of the ABCs.

Which of the following is NOT a known risk factor of SIDS? A. mother younger than 20 years B. low birth weight C. putting a baby to sleep on his or her back D. mother smoked during pregnancy

C. putting a baby to sleep on his or her back

Early signs of respiratory distress in the child include: A. cyanosis. B. bradycardia. C. restlessness. D. decreased LOC.

C. restlessness.

In contrast to adults, deterioration to cardiac arrest in infants and children is usually associated with: A. irritability of the left ventricle. B. a sudden ventricular arrhythmia. C. severe hypoxia and bradycardia. D. acute hypoxia and tachycardia.

C. severe hypoxia and bradycardia.

If a nasopharyngeal airway is too long, it may: A. result in tachycardia. B. push the tongue anteriorly. C. stimulate the vagus nerve. D. become obstructed by mucus.

C. stimulate the vagus nerve.

Greenstick fractures occur in infants and children because: A. the growth plate is commonly injured. B. their bones are more brittle than an adult's. C. their bones bend more easily than an adult's. D. twisting injuries are more common in children.

C. their bones bend more easily than an adult's.

The MOST common cause of dehydration in pediatric patients is: A. high fever. B. internal blood loss. C. vomiting and diarrhea. D. refusal to drink fluids.

C. vomiting and diarrhea.

________ is/are the recommended way to relieve a severe airway obstruction in an unconscious child. Abdominal thrusts Chest compressions Suctioning Sweeping

Chest compressions Correct. Chest compressions are recommended to relieve a severe airway obstruction in an unconscious child.

adolescents

Children between ages 12 to 18 years.

A ________ provides 24% to 44% oxygen concentration. Blow-by BVM Nasal cannula Nonrebreathing mask

Correct. A nasal cannula at 1 to 6 L/min provides 24% to 44% oxygen concentration.

The suture of the anterior fontanelle is typically closed by _____ months of age, and the suture of the posterior fontanelle is typically closed by _____ months of age. A. 2, 4 B. 6, 12 C. 12, 4 D. 18, 6

D. 18, 6

Which of the following statements regarding a 3-month-old infant is correct? A. The infant is unable to turn his or her head and focus. B. The infant should be aroused easily from a sleeping state. C. At this age, the infant typically sleeps for up to 8 hours a day. D. A 3-month-old infant can distinguish a parent from a stranger.

D. A 3-month-old infant can distinguish a parent from a stranger.

Which of the following statements regarding spinal injuries in pediatric patients is correct? A. Because of a child's proportionately large head, they are more prone to spinal cord injuries than adults. B. The majority of cervical spine injuries in children are partial transections of the spinal cord, resulting in partial paralysis. C. Most cervical spine fractures in infants and children occur between the first and second cervical vertebrae. D. If the cervical spine is injured, it is most likely to be an injury to the ligaments because of rapid movement of the head.

D. If the cervical spine is injured, it is most likely to be an injury to the ligaments because of rapid movement of the head.

Which of the following statements regarding preschool-age children is correct? A. They realize that injuries are not a form of punishment. B. Preschoolers are usually not fearful of pain or separation. C. The preschool age begins after the child turns 2 years old. D. They can usually identify painful areas when questioned.

D. They can usually identify painful areas when questioned.

An infant with severe dehydration would be expected to present with: A. excessive tearing. B. moist oral mucosa. C. bulging fontanelles. D. absent urine output.

D. absent urine output.

An infant with severe dehydration would be expected to present with: Select one: A. moist oral mucosa. B. excessive tearing. C. bulging fontanelles. D. absent urine output.

D. absent urine output.

A normal level of consciousness in an infant or child is characterized by: A. normal interactiveness, awareness to time, and pink skin color. B. awareness to place, pink and dry skin, and consistent eye contact. C. crying or combativeness, good muscle tone, and awareness to time. D. age-appropriate behavior, good muscle tone, and good eye contact.

D. age-appropriate behavior, good muscle tone, and good eye contact.

You respond to a skate park where a 10-year-old male fell from his skateboard and struck his head on the ground; he was not wearing a helmet. He is responsive to painful stimuli only and has a large hematoma to the back of his head. After your partner stabilizes his head and opens his airway, you assess his breathing and determine that it is slow and irregular. His pulse is slow and bounding. You should: A. apply high-flow oxygen via a nonrebreathing mask, perform an in-depth secondary assessment, apply full spinal precautions, and transport. B. insert an oral airway, hyperventilate him with a bag-mask device, apply full spinal precautions, and transport to the closest trauma center. C. apply high-flow oxygen via a nonrebreathing mask, obtain baseline vital signs, apply full spinal precautions, and perform a secondary assessment. D. assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center.

D. assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center.

The MOST ominous sign of impending cardiopulmonary arrest in infants and children is: A. pallor. B. retractions. C. nasal flaring. D. bradycardia.

D. bradycardia.

Hyperthermia differs from fever in that it is an increase in body temperature: A. of more than 2°F to 3°F per hour. B. secondary to a severe bacterial infection. C. caused by inflammation of the spinal cord. D. caused by the inability of the body to cool itself.

D. caused by the inability of the body to cool itself.

Burns in children are commonly caused by all of the following, EXCEPT: A. hot items on a stovetop. B. scalding water in a bathtub. C. exposure to caustic chemicals. D. entrapment in a structural fire.

D. entrapment in a structural fire.

Immediate transport is indicated for a child when he or she: A. is experiencing mild to moderate pain. B. falls from a height greater than 5′. C. has a possible closed fracture of the radius. D. has a history suggestive of a serious illness.

D. has a history suggestive of a serious illness.

All of the following are normal findings in an infant or child, EXCEPT: A. quiet breathing. B. fear or anxiety. C. belly breathing. D. head bobbing.

D. head bobbing.

Causes of infant death that may be mistaken for SIDS include all of the following, EXCEPT: A. child abuse. B. meningitis. C. severe infection. D. hyperglycemia.

D. hyperglycemia.

Febrile seizures in a child: A. typically last less than 30 minutes. B. occur after a week of a febrile illness. C. are usually caused by viral meningitis. D. may indicate a serious underlying illness.

D. may indicate a serious underlying illness.

Which of the following is MORE common in children than in adults following a head injury? A. spinal cord injury B. loss of consciousness C. seizures and hypoxia D. nausea and vomiting

D. nausea and vomiting

The MOST accurate method for determining if you are delivering adequate tidal volume to a child during bag-mask ventilations is to: A. monitor the child's heart rate. B. observe the child's skin color. C. monitor the pulse oximeter reading. D. observe the chest for adequate rise.

D. observe the chest for adequate rise.

While triaging patients at the scene of a motor-vehicle crash, you encounter a 5-year-old child who is unresponsive and apneic. After positioning his airway, you should: Select one: A. deliver 5 rescue breaths. B. categorize him as immediate. C. categorize him as deceased. D. palpate for a carotid pulse.

D. palpate for a carotid pulse.

Before positioning an infant or child's airway, you should: A. put padding behind his or her head. B. thoroughly suction his or her airway. C. rule out an injury to the spinal cord. D. place him or her on a firm surface.

D. place him or her on a firm surface.

When immobilizing an injured child in a pediatric immobilization device, you should: A. secure the head before the torso. B. slide the device under the child. C. pad underneath the child's head. D. secure the torso before the head.

D. secure the torso before the head.

sudden infant death syndrome (SIDS)

Death of an infant or young child that remains unexplained after a complete autopsy.

Use activated charcoal for pediatric patients who have ingested an acid, an alkali, or a petroleum product.TrueFalse

False Correct. The use of activated charcoal is NOT indicated for pediatric patients who have ingested an acid, an alkali, or a petroleum product.

The most common cause of dehydration in pediatric patients is sweating.TrueFalse

False Correct. The most common cause of dehydration in pediatric patients is vomiting and diarrhea.

Young children are more likely to experience ________ than adults. Cardiopulmonary arrest Femur fractures Greenstick fractures Sprains

Greenstick fractures Correct. Greenstick (incomplete) fractures are more common in pediatric patients.

In a normal adult, greater than 30% to 40% of blood volume loss significantly increases the risk of shock. What is the threshold of blood volume loss in children? 25% 30% 45% 50%

In children, any loss of blood volume greater than 25% significantly increases the risk of shock.

bronchiolitis

Inflammation of the bronchioles that usually occurs in children younger than 2 years and is often caused by the respiratory syncytial virus.

central pulses

Pulses that are closest to the core (central) part of the body where the vital organs are located; include the carotid, femoral, and apical pulses.

neglect

Refusal or failure on the part of the parent or caregiver to provide life necessities.

With which age group should you talk to the child, not just the parent, while taking the medical history? Toddler Preschooler School-age Adolescent

School-age School-age children (6-12 years) begin to act more like adults. Including them in the history-taking conversation helps build trust.

If a pediatric patient begins seizing again during your care, which of the following would be your treatment priority? Stopping the seizure Securing and clearing the airway Providing rapid transport Maintaining the patient's body temperature

Securing and protecting the airway are your priorities.

bradypnea

Slow respiratory rate; ominous sign in a child that indicates impending respiratory arrest.

What does the PAT assess? Airway, breathing, circulation Appearance, work of breathing, circulation Alert, responsive, unresponsive Tone, interactiveness, consolabiliy, look, speech/cry

The Pediatric Assessment Triangle (PAT) assesses appearance, work of breathing, and circulation.

What should you use the Wong-Baker FACES scale to determine? Motor response LOC Work of breathing Pain level

The Wong-Baker FACES scale uses pictures of facial expressions to help assess the level of pain in a child.

nares

The external openings of the nostrils. A single nostril opening is called a naris.

Which of the following are true about the pediatric airway? The pediatric airway is smaller in diameter and shorter in length. The tongue is proportionally the same but more posterior. Children have a funnel-shaped upper airway. Smaller lungs mean that the oxygen reserves are smaller.

The pediatric airway is smaller in diameter and shorter in length. Children have a funnel-shaped upper airway. Smaller lungs mean that the oxygen reserves are smaller.

You are responding to a 9-1-1 call where the mother reported finding her 3-month-old daughter cyanotic and unresponsive in her crib. When you stimulate the child, she responds. This is an example of what condition? Apparent life-threatening event SIDS Shaken baby syndrome Febrile seizure

This is an example of an apparent life-threatening event (ALTE), also called near-miss SIDS.

Mnemonic TICLS includes: Used When:

Tone Interactiveness Consolability Look or gaze Speech or cry - To tell if the pediatric patient is sick or not sick

Fever and altered LOC are common symptoms of meningitis in patients of all ages.TrueFalse

True Correct. Fever and altered LOC are common symptoms of meningitis in patients of all ages.

The postictal state begins once a seizure has stopped; the patient's muscles relax, becoming almost flaccid, and the breathing becomes labored.TrueFalse

True Correct. The postictal state begins once a seizure has stopped; the patient's muscles relax, becoming almost flaccid, and the breathing becomes labored.

epiglottisitis

a disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction

work of breathing

an indicator of oxygenation and ventilation; reflects the child's attempt to compensate for hypoxia

preschool-age

children between ages 3 to 6 years

school-age

children between ages 6 to 12 years

infancy

first year of life

Tachypnea

increased respiratory rate

tracheitis

inflammation of the trachea

blanch

to turn white