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.

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

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.

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: Select one: A. croup. B. epiglottitis. C. bronchitis. D. asthma.

A. croup.

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.

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.

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 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.

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.

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.

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.

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.

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 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: 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.

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.

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

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?

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.

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.

________ 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.

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.

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.

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