EMT Chapter 38

You suspect a very sick child to be in shock. His skin is dry, radial pulse weak, and blood pressure low. Which statement made by the parents would reinforce this suspicion?

"He has had diarrhea for three days."

You are assessing the pupils of a 5-year-old who fell off a bed while playing. Which of the statement would be most appropriate prior to performing this assessment?

"I am going to use this light to look into your eyes."

Another EMT tells you that he had a call the previous shift in which he thought a 5-year-old boy might be the victim of abuse, since he had bruises on both upper legs and chest. However, the EMT did not communicate this suspicion to anyone or transport the patient. What would your best response be?

"If you do not take steps to report this suspicion, you can be punished in a court of law."

Which statement made by another EMT during a continuing education session, regarding treatment of the pediatric patient in the prehospital setting, is correct?

"It is critical that the EMT be able to determine the adequacy of the airway and respiratory status of the patient, as these are commonly the reason for acute deterioration."

A 5-year-old boy who is drooling has suspected epiglottitis. His pulse rate is 144 beats/min, respirations are 46 breaths/min, and blood pressure is 110/52 mmHg. The patient is noncompliant with the pulse oximeter, but his skin is normal colored. Which statement made by the EMT indicates proper care of this patient?

"Let's give him some supplemental oxygen."

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. Which instruction would you provide to another EMT who is helping you transport the patient?

"Let's start chest compressions and positive pressure ventilations."

An Emergency Medical Responder asks you why you should not overextend the airway on a pediatric patient when performing a head-tilt, chin-lift maneuver. Your reply would be:

"The cartilage of the trachea is very soft and can 'kink' if the neck is extended too far."

You are assessing a 12-year-old female in respiratory distress and with a history of asthma. Which statement, made by her mother, would be most concerning?

"Two years ago she needed to have a breathing tube inserted into her throat."

While attempting resuscitation of a baby with possible SIDS, which question would be appropriate for the EMT to ask the mother?

"Were there any problems with the pregnancy or his birth?"

You are determining the PGCS score for a 28-month-old female who was stung by a bee while playing in the backyard. You note that the patient is alert. When asked, she tells you that she was stung on the bottom of her foot. At this point in time her GCS score would be:

15

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

A coworker is telling you about a recent EMS call in which he provided care to a preschooler. Based on this description, you know that age of the patient would have been:

3-5 years old

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. You quickly open the patient's 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. What would your next action be?

Administer 30 chest compressions

When providing care to the pediatric patient who has been injured or ill, the most important aspect of care normally revolves around:

Airway and respiratory support

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. You should consider:

Attempting to calm the child and obtain another SpO2 reading

When assessing a 3-year-old child for possible injuries after the child fell down a flight of stairs, which finding would raise the EMT's suspicion that the child may be a victim of physical abuse?

Bruises are found on his chest and abdomen

The increased pliability of the child's ribs makes him more prone to:

Bruising or other injury to the lungs

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 are suspicious that a child is being physically abused and neglected. What would be your best course of action in such a situation?

Document the situation

As you assess a very sick 3-year-old patient with a fever, rash, and sore neck, you suddenly suspect he might have meningitis. Your immediate action would be to:

Don additional BSI precautions of a mask and gown

Croup is recognized as an illness that involves:

Edema beneath the glottis

The need for a comprehensive understanding of normal growth and development, which enables the EMS provider to better anticipate the physiologic and emotional needs of the child who is affected by illness or injury, is a principle of:

Family-centered care

BRUE evaluations are typically performed on infants who:

Had a medical episode that concerned their caregiver

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. Your initial action in the management of this situation would be to:

Have your partner talk to the mother while you assess the child

You are treating a 9-year-old male who is short of breath and has a history of asthma. At the scene, he presents in severe respiratory distress, with intercostal retractions, lethargy, and expiratory wheezing. His pulse is 136 beats/min, respirations are 32 breaths/min, and SpO2 is 95%. You have assisted the patient with his albuterol MDI and are transporting him emergently to the hospital. As you reassess the patient, which finding is most concerning?

Heart rate of 68 beats/min

Which statement regarding pediatric injury prevention is most accurate?

Injury prevention and accident prevention are not the same

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, the mother is having a difficult time waking her daughter up. You find the girl lying in bed with snoring respirations despite use of the head-tilt, chin-lift airway maneuver. Your assessment reveals her to be responsive to painful stimuli and breathing at 12 times per 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. What is your immediate action in caring for this child?

Insertion of a nasal airway

When evaluating capillary refill time in a pediatric patient, the EMT must remember that:

It is considered more reliable than in an adult

What is the best location for assessing breath sounds in the pediatric patient?

Midaxillary region of the lungs

You have been called for a 2-week-old baby who is sick. Assessment reveals him to have a fever and rhonchi that is audible with a stethoscope over 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

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:

Neglect

A 15-year-old male with a history of seizures presents as oriented. He takes the anticonvulsant Keppra and has no other medical history according to his mother. The mother called EMS because the patient missed taking his medicine and she wants you to "check him out." Which action would be most appropriate for the EMT to take at this time?

Obtain a full set of vital signs

The EMT is correctly assessing a child's BRUE when he:

Obtains a thorough history

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 48 beats per minute and his skin is cool and diaphoretic. Your partner states that the patient's lungs have crackles in them and the blood pressure is 60/40 mmHg. Which intervention represents the most important care that you will provide to the patient next?

Positive pressure ventilation

An 8-year-old child was chasing his dog when the boy 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. The patient also has abrasions to his back after being thrown by the car onto the pavement. Based on these assessment findings, the EMT would treat the patient for which life-threatening condition?

Shock

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 ventilations with the bag-valve mask, but are unsuccessful after two attempts. What would your next action be?

Start cardiopulmonary resuscitation

A 6-year-old male is in severe respiratory distress with inspiratory stridor. He has pale, moist skin, with cyanosis noted around his mouth. The patient 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 beats/min; respirations, 40 breaths/min; blood pressure, 122/66 mmHg; and SpO2, 81%. What would your immediate action be?

Start positive pressure ventilation

You have been called to a preschool for a seizing child. On arrival, staff directs 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. What is your immediate action in caring for this child?

Suction the airway

After the unsuccessful resuscitation of a 3-year-old boy who was shot by his mother's boyfriend during a domestic dispute, you find yourself extremely stressed and anxious over the call. You are having trouble sleeping and the resultant anxiety is affecting your home life. What should be your initial action, given this situation?

Talk to a close friend or fellow EMS provider about your feelings

You are on scene of an MVC in which a 3-year-old female was in a car seat in the backseat. The child appears not to be injured, but the mother would like her taken to the hospital for an evaluation. Since the patient will need a car seat for transport, which criteria would indicate that the car seat she is currently sitting in cannot be used to safely transport the patient?

The car seat appears to have a crack in the side when impacted by the door handle

A 6-month-old male was outside with his parents and was 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

Ensuring that all children and adolescents, no matter where they live, attend school, or travel, have access to and receive appropriate care in a health emergency is the purpose of:

The federal Emergency Medical Services for Children (EMSC) program

You are assessing a 9-month-old boy who has had a fever for the past two days. What would be a likely finding if the fever has caused dehydration?

The mother informs you that the baby is wetting very few diapers daily

Which assessment findings related to the mental status of a 1-year-old would the EMT consider normal?

The patient is curious about your penlight

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 beats/min; respirations, 24 breaths/min; blood pressure, 98/56 mmHg; and SpO2, 92%. At this time, you try:

Using a nasal cannula with 2 lpm oxygen