Module 9: Special Populations

What are the three sides of the pediatric assessment triangle?

Appearance, breathing, circulation

If a newborn baby's heart rate is less than 100 beats/minute but greater than 60 beats/minute, what should first be done?

Artificial ventilations should be provided

Which two pulse points should be checked and compared when assessing the circulation of infant patients?

Brachial and femoral

When forming a general impression about a pediatric patient, which of the following is true of a "sick" child?

Unaware of your presence

First Stage of Labor

Uterine contractions and dilation of the cervix; Possible bloody show and rupture of membranes; Known as the dilation stage

To inspect for crowning, what should you do?

Visually inspect the vagina

At what point during assessment should the pediatric assessment triangle be used?

When forming the general impression

When should the umbilical cord be cut?

When local protocols permit When the cord stops pulsating When conditions are sterile All of the above

Why is it important to reassess elderly patients at regular intervals?

Elderly patients' conditions often decline slowly, which can give the false illusion that everything is fine.

Which statement about the emotional effects of aging is correct?

Emotional changes may lead elderly patients to feel frustrated, insecure, or depressed.

How should your suspicion of abuse affect patient assessment and care?

Provide assessment and care as you would any other patient

Which of the following is a form of abuse?

Psychological Financial Sexual Physical All of the above

If the amniotic sac is not broken when a baby's head delivers, what should you do?

Puncture or tear the amniotic sac

Age-related changes in the respiratory system put geriatric patients at a greater risk for which of the following?

Respiratory disease

What is the leaking of amniotic fluid known as?

Rupture of membranes

Hyperosmolar Hyperglycemic Nonketotic Syndrome is a diabetic complication in the elderly that can result in which of the following?

Severe dehydration

What is the most visible sign of aging?

Skin

When the afterbirth appears, it should be pulled from the mother's vagina. True or False

False

Why might an elderly patient feel fearful and anxious?

Feelings of abandonment Loneliness Financial insecurity Restrictions in daily activities All of the above

What is the cause of a febrile seizure in pediatric patients?

Fever

Heart rate is 90 bpm; Respiratory rate is 25 bpm; Systolic blood pressure is 80 mmHg; Temperature is 99 degrees F.

Troy, age 5 years

A child's head is proportionally larger in relation to the body than an adult's head. True or False

True

A newborn's respiratory rate is normally faster than any other pediatric age group. True or False

True

An infant's tongue is proportionally larger than an adult's tongue. True or False

True

Children have a larger body surface area than adults in relation to their body mass. True or False

True

Elderly patients may be reluctant to report abuse out of shame or fear of losing their caregiver or living situation. True or False

True

Elderly patients may not exhibit the signs and symptoms you would expect of an injury or illness. True or False

True

Following a SIDS incident, EMS providers should offer support to the family and caregivers. True or False

True

If crowning is present, delivery is imminent. True or False

True

If vaginal bleeding continues or is excessive after delivery, the mother should be treated for shock. True or False

True

In early respiratory distress, an increased respiratory rate is usually able to compensate for insufficient oxygen levels. True or False

True

Knowing the normal vital sign ranges for adults can help emergency medical providers determine if an adult has a medical emergency. True or False

True

Most children rely on their diaphragms for breathing. True or False

True

Neglect is a form of abuse. True or False

True

Pediatric patients have an increased risk of airway obstruction. True or False

True

Respiratory arrest often leads to cardiac arrest in pediatric patients. True or False

True

Under what circumstances can a foreign body airway obstruction be removed from a pediatric patient's airway with the finger sweep method?

When the object is visible

When can you expose, examine, and touch a woman's vaginal area?

When your partner is present

Which of the following questions should be asked to the caregiver of an injured child during scene size-up?

Why was EMS called? What is the chief complaint? Has the child been moved? All of the above

Signs of abuse are always obvious. True or False

False

Why should a newborn baby be wrapped in a blanket?

To protect the baby from heat loss

As the digestive system ages, peristalsis decreases and leads to which of the following?

Constipation

Which vital sign is likely to increase in late adulthood?

Blood pressure

When does the fetal stage of prenatal development occur?

9th week to birth

When does primary assessment for a pediatric patient begin?

"At the door"

A child in middle childhood or adolescence will have an average body temperature of ____.

98.6°F

Which of the following may be used to determine a child's level of consciousness?

AVPU check

What is a sign or symptom of gastrointestinal bleeding in a geriatric patient?

Acute abdominal pain Constipation Rapid, shallow respirations Vomiting blood All of the above

Which of the following is the correct response to a suspected SIDS infant who shows no signs of rigor mortis or lividity?

Aggressively attempt to resuscitate the infant through CPR.

During your assessment of an elderly patient, you notice that the patient seems confused. How can you determine the patient's baseline mental status?

Ask a caregiver about the patient's baseline mental status

Which of the following items is important during management of pediatric shock?

Assure airway and breathing Control bleeding Keep the patient warm Arrange for prompt transport All of the above

Which of the following is an example of a lower airway disease that may result in respiratory distress in children?

Asthma Bronchiolitis Pneumonia Pertussis All of the above

How does aging affect the reproductive system?

Atrophic changes in sexual organs

How is the heart affected by aging?

Blood pumping is less efficient

Which method may be used to administer oxygen to children who do not tolerate a face mask?

Blow by method

Why is a child's brain more prone to bleeding from an injury than an adult's brain?

Because a child's brain has less cushioning.

Why is it important for EMS providers to be able to recognize signs of respiratory distress in pediatric patients?

Because children with respiratory emergencies deteriorate quickly

Why are children able to compensate for shock for a long period of time?

Because their blood vessels constrict efficiently

What is the leading cause of death in elderly people?

Cardiovascular disease

Who are the most common targets of abuse?

Children and the elderly

Children generally have faster metabolisms than adults. What is one result of this faster metabolic rate?

Children use oxygen and glucose faster than adults.

Which of the following is true about children's rib cages?

Children's rib cages are more pliable than adults'.

Dementia results in the loss of what?

Cognitive and social function

You are treating a child who you suspect has been abused. The child's parent is reluctant to allow the child to be transported. What should you do?

Convince the parent that the child needs to go to the hospital for proper assessment and care

What happens to the endocrine system as it ages?

Decrease in production of hormones

What happens to the respiratory system as it ages?

Decrease in the exchange of oxygen and carbon dioxide

What is a state of temporary mental confusion?

Delirium

Third Stage of Birth

Delivery of the afterbirth; Known as the placental stage

Second Stage of Labor

Delivery of the baby; Known as the expulsion stage

Which predelivery emergency in the first trimester causes internal bleeding?

Ectopic pregnancy

What considerations should an emergency medical provider make when assessing an elderly patient?

Explain ahead of time what you are going to do

Children who are in respiratory distress because of an airway disease are given the same emergency care as those with airway obstructions. True or False

False

Children's skin is generally tougher and thicker than adults' skin. True or False

False

EMS providers should communicate with pediatric patients in the same way that they communicate with adult patients. True or False

False

Elderly patients are less likely to experience airway obstructions. True or False

False

Forms of abuse never occur in combination. True or False

False

If an elderly patient does not exhibit typical signs and symptoms, EMS providers should assume that the situation is not an emergency. True or False

False

If contractions last 60 seconds or more and occur less than five minutes apart, the mother has time to be transported to the hospital. True or False

False

Infants typically have a lower body temperature than all other pediatric age groups. True or False

False

It is important for EMS providers to diagnose SIDS on the field. True or False

False

It is safe to assume that the scene of a call involving a geriatric patient will not pose any danger to you or your partner. True or False

False

Most infants breathe through their mouths. True or False

False

Only unstable pediatric patients should be given ABC management. True or False

False

While performing an assessment on an elderly patient, you observe that the patient's pupils are slow to react and are not round in shape. What should you do?

Find out if your findings are typical for the patient

What should you do if you suspect that a patient may have been abused?

Follow laws and protocols for reporting your suspicions to the proper authorities

You are assessing an elderly patient who is pale, has a fever, and complains of abdominal pain. What might you suspect is wrong this patient?

Gastrointestinal bleeding

Which type of fracture is common in the extremities of children?

Greenstick fractures

What effect does the aging of the digestive system have on the elderly patient?

Gum disease Heartburn Incontinence Decreased ability to taste All of the above

What should an emergency medical provider do when assessing an elderly patient?

Handle the patient gently

Which vital sign condition is common in elderly patients and is not necessarily a significant finding?

High blood pressure Irregular pulse Dry skin All of the above

When should you inspect for crowning?

If contractions last 60 seconds or more and occur less than five minutes apart The mother feels as if she is having a bowel movement The mother has the urge to push All of the above

Why are the liver and spleen more prone to injury in children than in adults?

In children, these organs are not fully protected by the rib cage.

What happens to an elderly person as the urinary system ages?

Incontinence and nocturia

What might a bulging fontanelle on an infant's head indicate?

Increased intracranial pressure

Which of the following is a way in which a child might be exposed to a toxic substance?

Ingestion Inhalation Absorption Injection All of the above

Which of the following conditions are considered unstable in a child and require rapid transportation?

Isolated head injury Ingestion of a toxic substance Respiratory failure Shock All of the above

Why might abuse in the form of shaken baby syndrome be difficult to identify during a call?

It causes internal trauma that may not exhibit as an external injury

Which statement about obtaining a focused history for a geriatric patient is correct?

It typically takes more time than normal to obtain a history for a geriatric patient.

In what position should a pregnant woman in the third trimester of pregnancy be placed?

Left lateral

What effect does an aging immune system have on the elderly?

Makes them more vulnerable to infectious diseases

Which of the following is a possible sign of abuse?

Malnutrition and dehydration Unexplained genital infection Injuries in various stages of healing Patient reluctance to explain an injury All of the above

What is the process of the shedding of the uterine lining and the unfertilized ovum from the body?

Menstruation

Heart rate is 60 bpm; Respiratory rate is 12 bpm; Systolic blood pressure is 100 mmHg; Temperature is 98.6 degrees F.

Michael, age 16 years

Which of the following is an appropriate response to a child who is having a seizure?

Move unsafe items out of the child's way.

What can cause people to lose strength as they age?

Muscle atrophy

What reduces vaginal bleeding after delivery?

Nursing the baby Massaging the mother's uterus All of the above

You and your partner respond to an elderly man who lives alone. The patient is unable to share any information about his medical history. How might you obtain information about his history?

Observe his environment for clues

Which of the following is true about shock in children?

Once signs of shock appear, the child will deteriorate rapidly.

What causes the bones to become brittle and increases the risk of musculoskeletal injury?

Osteoporosis

If a newborn baby has central cyanosis with adequate breathing and heart rate, what should first be done?

Oxygen should be administered

Heart rate is 120 bpm; Respiratory rate is 35 bpm; Systolic blood pressure is 90 mmHg; Temperature is 99 degrees F.

Patrick, age 3 months

Which of the following is most likely to be a possible indication of abuse?

Pattern of injury that does not match the reported mechanism of injury

What should suspicions of abuse be based on?

Patterns of injury and behavior

Which of the following is true about pediatric vital signs?

Pediatric vital signs are different, according to the age of a child.

How does aging affect the sensory system?

Perception of pain diminishes

What predelivery emergency in the third trimester of pregnancy causes vaginal bleeding with no pain?

Placenta previa

Elderly patients with chronic diseases or compromised immune systems have a greater risk of which respiratory emergency?

Pneumonia

What may occur if too much force is used when ventilating a child?

Pneumothorax

The aging of the nervous system results in slower nerve conductions. These changes in nerve conductions lead to which of the following?

Slower reaction times and decreases in motor and sensory abilities

After the scene of an incident involving a child has been secured, which of the following is an appropriate manner for an EMS provider to enter the scene?

Take a moment to observe the big picture and look for clues.

During assessment and transport, how can you reassure a patient who may have been abused?

Tell the patient that there are people who can help

When delivering a baby, what should be suctioned first?

The baby's mouth

Why is a "trunk to head" evaluation sometimes recommended when performing a detailed physical exam on a small child who is not in critical condition?

The child may have less anxiety if the trunk of the body is examined before the head.

You are called to the scene of a bicycle accident involving a 10-year-old girl. She is alert and responsive. Her mother and several bystanders are also at the scene. To whom should you first direct your questions?

The girl

You respond to a call at the home of an elderly woman. Inside the home, you notice medication bottles neatly lined up next to the kitchen sink. The living room is clean and free of clutter. The temperature inside the home feels comfortable. What could this scene suggest about the patient?

The patient appears to be able to take care of herself.

You and your partner respond to a call at the home of an elderly man. Inside the home, you notice dirty dishes and food wrappers scattered around the kitchen. The living room is cluttered with magazines and medication bottles. The home feels cold. What could this scene suggest about the patient?

The patient is having difficulty taking care of himself.

Which of the following is true of decompensated respiratory failure?

The patient is no longer able to compensate for insufficient oxygen.

What is true of a pediatric patient who demonstrates stridor while in respiratory distress?

The patient probably has an upper airway obstruction.

What is the afterbirth?

The placenta

What are contractions the tightening and relaxing of?

The uterus

When evaluating contractions, what should be determined?

Their frequency Their duration All of the above

What is the cause of sudden infant death syndrome (SIDS)?

There is no known cause.

Which of the following is always true about the role of an EMR or EMT during a pediatric poisoning incident?

They must treat the effects of the poisoning in the patient.

Why should the head-tilt, chin-lift maneuver be used with caution in small children?

Tilting back the head may pinch and block the child's airway.

Why should a child suspected of being sexually abused be encouraged not to defecate urinate, or injest anything?

To preserve evidence