Volume 5 Chapter 4

Documenting a suspected child abuse case in your patient care report​ should:

follow a discussion with legal counsel regarding what you are allowed to document.

Evaluation of breathing adequacy in the pediatric patient includes assessment of all of the following conditions except ______________

heart rate.

Your patient is a​ 10-year-old boy who was struck by a car traveling 35 miles per hour as he crossed a street. He responds to verbal stimuli and has​ pale, cool skin. He has a heart rate of​ 142, respirations of​ 32, and a capillary refill time of greater than 4 seconds. You estimate he weighs 65 lb. You have initiated oxygen and an IV of normal​ saline; if 65 lb is 29.5 kg that can be rounded to 30​ kg, then how many mL should your initial bolus​ be?

600

You should consider the heart rate of a​ 5-year-old patient to be bradycardic beginning at a rate below how many beats per​ minute?

70

Generally, adolescents:

are good historians.

Above what respiratory rate would a​ 10-year-old child be considered to be breathing abnormally​ fast?

​30/min

What is the proper dose of amiodarone for a pediatric patient?

5.0 mg/kg

What is the initial setting for asynchronous cardioversion in a pediatric cardiac arrest patient displaying ventricular tachycardia?

2 joules per kilogram

What should be the initial dosage of an isotonic crystaline solution for use in a 4-year-old hypovolemic shock patient?

20 mL/kg

What age should a pediatric patient be before blood pressures are routinely​ utilized?

3 years

You are on scene with a pediatric patient who is obtunded due to a congenital brain defect. As you are assessing the​ patient, you note that she has a gastric feeding tube and currently is hooked up to a machine that is delivering a feeding. You have not seen this type of pump before and have little experience with gastric tubes. What action should you​ take?

Ask the patient and caregivers about the device.

Which of the following is a sign specifically of respiratory​ arrest?

Absent chest wall motion

A​ 3-year-old child presents with a high​ fever, flushed​ cheeks, crying, and refusal to take food or fluids. He is sitting up and refuses to lie down. Lung sounds are clear and equal. Vital signs are HR​ 128, capillary refill less than 2​ seconds, RR​ 28, and SpO2 98 percent on room air. Which of the following treatment plans would be appropriate for this​ patient?

Administer humidified​ oxygen, transport in a position of​ comfort, and alert the receiving hospital.

Which of the following medications is not used in pediatric cardiac arrest?

Atropine

Children in which age group worry about their physical image more than those in any other pediatric age group?

Adolescents, ages 13-18 years

Which of the following is the most common cause of cardiac arrest in an infant or young​ child?

Airway and respiratory problems

You are providing care to a​ 2-year-old who you suspect is suffering from laryngotracheobronchitis. Medical command has recommended administration of racemic​ epinephrine, which you do not carry. What alternative may he recommend you​ administer?

Albuterol

Which of these is not a concern that Emergency Medical Services for Children​ (EMSC) has​ identifed?

An individualized approach to pediatric care

You are caring for a pediatric patient who relies on a home ventilator 24 hours a day. If you have any doubts whether the ventilator is​ working, which of the following should you immediately​ do?

Begin​ bag-valve mask​ ventilations, while you have the caregiver try to troubleshoot the ventilator.

You are caring for a​ 2-year-old child who has been sick with a​ fever, diarrhea, and vomiting for 24 hours. To assess​ perfusion, which of these would provide you with the least reliable information about​dehydration?

Blood pressure

What finding in a distressed infant or child may indicate hypoxia and is an ominous sign of cardiac arrest?

Bradycardia

Which of the following findings seems least consistent with child​ abuse?

Bruises on both knees of a​ 5-year-old

Which of these is the best description of​ asthma?

Inflammatory disease of the lower airways

Several large EMS systems have abandoned the practice of pediatric endotracheal intubation in favor of​ simple:

CPAP.

High winds blew down a tent at an outdoor high school graduation reception. A fire started from the fuel used for the hot buffet. Several people were injured by the tent​ collapse, and several patients have burns. The first patient you triage is a​ 3-year-old girl. She is not breathing. You open her​ airway, but she does not start breathing. What is the next​ action?

Check the​ patient's pulse.

You are caring for a lethargic infant following EMS notification by a babysitter. The babysitter tells you that the infant was like that when the parents left for a​ party, and she called 911 after they left. You notice that the infant is very small for his​ weight, appears very​ dirty, has dried urine in his​ diaper, and has bruises on both arms. Which of the following should you be concerned​ about?

Child abuse and neglect

What is not a routine challenge of pediatric care for the​ paramedic?

Children cannot receive care without a parent or guardian present.

While you are questioning a​ 4-year-old with abdominal​ pain, he tells you that his stomach started hurting last week. Which of the following should you do​ next?

Continue questioning the child but verify information with the parents.

A​ 12-year-old patient collided face first with another child while both were riding bikes. The patient bit his tongue when his jaw was struck and received a black right eye and bloody nose. He is alert and​ oriented, and after you suction some blood from his airway appears to have no respiratory​ compromise, with respirations clear bilaterally and​ 20/minute. Your index of suspicion should be high for what other​ injury?

Dental

What type of shock in the pediatric patient occurs when there is a marked decrease in peripheral vascular​ resistance?

Distributive

Which of these statements best describes why paramedics should be knowledgeable about pediatric patients who are dependent on medical​ technology?

EMS may be called when the medical condition worsens or a medical device fails.

The ______________ was formed for the express purpose of improving the health of pediatric patients who suffer potentially life-threatening illnesses or injuries.

EMSC

Which percentage of body surface area is correct according to the pediatric modifications for the rule of​nines?

Entire leg is 13.5 percent

What is the single most common cause of injury in children?

Falls

You are transporting a dehydrated​ 9-month-old who has had a​ fever, vomiting, and diarrhea for 12 hours. He is lethargic with​ pale, cool, mottled skin and capillary refill time of 4 seconds. His respiratory rate is​ 38, and you have initiated oxygen administration and have started an IO infusion followed by an initial bolus of fluid according to protocol. The​ patient's perfusion has not improved. Which of the following is the best choice with regard to fluid​ resuscitation?

Give a second bolus of 20​ mL/kg

You are at a racetrack where a racecar crashed into the fence separating the grandstands from the track. A large amount of​ debris, including tires and large pieces of the​ car, was propelled through and over the​fence, striking several spectators. As you approach the​ area, a man and a child run toward you. The man has a bleeding head​ wound, to which he has applied pressure with a piece of clothing. The child has an obvious deformity of his shoulder. What is the correct triage category for the​ child?

Green

You have arrived on the scene of a child with reported difficulty breathing. The patient is a​ 4-year-old male who is sitting on the​ floor, putting together a puzzle with his mother. One of the first things that you notice is that the child is grunting with every exhalation. Which of the following should you suspect as the cause of the​ grunting?

He is having difficulty keeping his lower airways open.

A​ 2-year-old child ingested some lamp oil intended for use in an​ old-fashioned kerosene lamp. The patient presents with a depressed respiratory​ rate, gastrointestinal​ irritation, and a diminished level of consciousness. What type of poisoning do you​ suspect?

Hydrocarbon

You are evaluating an​ 18-month-old child who presents with a history of​ fever, diarrhea, and vomiting. You notice that the child has very dry lips. Her skin is​ dry, mottled, and​ cool, and her radial pulse is weak in comparison with her carotid pulse. Her respirations are 30 with adequate depth. Her lung sounds are​ clear, and her pulse oximetry shows an SpO2 of 96 percent with a heart rate of​ 140/minute. Her blood glucose level is 60​ mg/dL. What is the primary problem for which you will treat this​ patient?

Hypoperfusion

Which of the following categories of pediatric shock is NOT considered a type of distributive​ shock?

Hypovolemic

What is the most common cause of pediatric bradyarrhythmias?

Hypoxia

Why is it important for the paramedic to observe the​ child's respiratory rate before beginning the​ examination?

If the child becomes distressed during the​ examination, then the respiratory rate will be impossible to determine.

Children in which age group should be examined in toe-to-head order?

Infants, ages 6-12 months

You are assessing a pediatric patient who has a rapid respiratory rate, absent alveolar breath sounds, a dropping pulse oximetry reading, and a spontaneous pulse of 102. What should you do next?

Initiate positive pressure ventilation.

Which of these terms should be used to convey the preventable nature of childhood​ trauma?

Injury

You note gastric distention in a​ 6-month-old patient experiencing respiratory failure you are attempting to ventilate but for whom you are not able to achieve adequate tidal volume. What do you​ do?

Insert an 8.0 French nasogastric tube.

Which stage of shock develops when the body can no longer compensate for decreased tissue perfusion and the patient enters cardiac arrest?

Irreversible

You are assessing a​ 20-month-old child with a history of fever for the past 36 hours along with coughing. He is upset and​ crying, but you do not notice any tears. What is the significance of the lack of​ tears?

It is a sign that the child is suffering from severe dehydration.

Which of the following airways can be used with a 4-year-old pediatric patient?

LMA

You are transporting a​ 4-year-old child who has burns on the forearms and hands consistent with cigarette burns. Which of the following should you avoid when documenting your patient care​ report?

Making a statement about who you suspect caused the abuse

Which of the following would arouse your suspicions of child​ neglect?

Malnutrition

Which of the following presentations is most consistent with​ bronchiolitis?

Mild upper respiratory infection signs and symptoms that progressively deteriorate over 1 to 2 days to respiratory distress with​ fever, cough,​ tachypnea, crackles in the​ lungs, and wheezing

What is a common complication of a tracheostomy tube that a mucus plug may​ cause?

Obstruction

The term neonate describes infants from birth to what age?

One month

A​ 13-year-old girl is having a sleepover at a​ friend's house and has been found unresponsive. She responds to painful stimuli by groaning. Her pupils are 3 mm PERRL. Her skin is​ cool, pale, and moist. Breath sounds are clear and​ equal, although breathing is shallow and she is snoring. Vital signs are HR​ 92, BP​ 96/70, RR​ 22, and SpO2 96 percent on room air. Which of the following should you do​ first?

Open the airway with a​ head-tilt/chin-lift maneuver.

In the secondary assessment of a​ 7-year-old child with difficulty breathing and a history of reactive airway​ disease, which of the following would give the paramedic the least amount of relevant information about the​ patient's ventilation and​ oxygenation?

Palpating the abdomen

Which information should raise the index of suspicion for​ abuse?

Parents of a child with multiple bruises and burns offer inconsistent explanations that are not consistent with the types of injuries.

Which of the following best identifies the age group of patients who should be triaged by using the JumpSTART​ system?

Patients who look younger than a young adult

Which of these modifications to care should you use when caring for pediatric​ patients?

Place padding behind the shoulders and neck of an infant or small child to maintain neutral alignment of the neck.

According to the pediatric assessment​ triangle, which of the following is used to assess the work of breathing when forming a general impression of the​ patient?

Presence of​ grunting, stridor,​ wheezing, crowing

Which of these terms is best applied to the majority of childhood​ injuries?

Preventable

If​ present, which of the following findings should alert the paramedic that a child is in respiratory​ failure?

Profound cyanosis

What term is used to describe the situation in which a child is regularly​ threatened, yelled​ at, or humiliated but not otherwise​ harmed?

Psychological abuse

Which of the following characterizes febrile​ seizures?

Recent onset of fever or cold symptoms

Which of the following actions should you take if you suspect that your pediatric patient is a victim of​abuse?

Report your findings to the appropriate​ authorities, including to the receiving hospital personnel.

The majority of childhood medical emergencies involve which body system?

Respiratory

You respond to a call for a​ 10-year-old patient who hit a road sign while traveling at high speed on a bicycle. The child is unconscious with no eye opening or motor or verbal response and has a severe contusion to the head. You note elevated blood pressure but a depressed heart rate with​ decreasing, deep respirations and an SpO2 of 92 percent. What do you assess as the problem and how do you manage this​ patient?

Severe traumatic brain injury with increasing intracranial​ pressure, to be managed with rapid sequence​ intubation, ventilation, supplemental​ oxygen, and rapid transport to a pediatric trauma facility

You are caring for a​ 5-year-old who was injured when his older brother accidentally stabbed him in the thigh with a pocketknife. The patient has lost about 350 mL of blood. He is​ pale, with​ cool, diaphoretic​skin, and is awake but very still. As part of your​ treatment, you have applied direct pressure to the​ wound, applied​ oxygen, and covered the patient with a blanket. The​ patient's mother is very upset and does not want to let go of the​ child's hand. How should you go about completing your​ treatment?

Show the mother where to sit so she can remain with the child while allowing you to work.

According to the pediatric assessment​ triangle, which of the following is used to assess circulation to the​ skin?

Skin color

What is the oxygenation goal for a pediatric patient receiving​ oxygen?

SpO2 of 94 percent or greater

Which of the following is an example of a commonly used neuromuscular blocking agent that can be used in a pediatric RSI procedure?

Succinylcholine

Which of the following statements is accurate regarding sudden infant death syndrome​ (SIDS)?

The cause of SIDS is not yet​ known; SIDS is a diagnosis that is given when other potential causes of death have been ruled out.

The combination of increased oxygen requirements and decreased oxygen reserves makes infants and children especially susceptible to ______________

hypoxia.

An​ 8-year-old male patient presents with​ pale, cool, clammy​ skin; tachycardia and​ tachypnea; a weak peripheral​ pulse; and a decreased level of consciousness. The parents say the patient has been sick and vomiting with diarrhea for several days. You respond​ with:

administration of supplemental oxygen and establishment of IV access for a 20​ mL/kg bolus of normal saline.

A​ seven-year-old female patient who was drowning in a pond was rescued and resuscitated prior to your arrival. It is a cold day and the water soaking the​ patient's clothing is very cold. What can you assume for this​ patient?

The low temperature of the water might have helped protect the child against brain injury.

A​ 4-year-old boy presents with a history of increasing respiratory difficulty over the previous 6​ hours, including grunting and​ wheezing, particularly with active play. His skin is warm and dry. There is no cyanosis of the lips or nail beds. On your​ arrival, the​ patient's respiratory rate is 27 per minute. You notice grunting on expiration and an occasional dry cough. Auscultation of the lungs reveals widespread wheezing throughout all lung fields. Vital signs are HR​ 116, capillary refill less than 2​ seconds, and SpO2 97 percent on room air. According to the​ parents, the child has suffered episodes similar to this one when visiting friends overnight but has had only one episode at home. The pediatrician has not prescribed medications for home use. What should you​ do?

Transport and administer albuterol 2.5 mg by​ small-volume nebulizer.

Which of these statements is​ true?

The paramedic always must report suspected sexual abuse to the appropriate authorities and the medical personnel who will be assuming care of the patient.

When does respiratory failure​ occur?

The respiratory system is unable to meet the​ body's demands for oxygen intake and carbon dioxide removal.

Which statement best describes the purpose of the JumpSTART triage​ method?

To do the most good for the greatest number of patients

When responding to a report of a patient with difficulty​ breathing, you find a pediatric male about 3 years old in a hospital bed at home. He is cared for 24 hours a day by his parents. You note a​ small, round tube that exits from the​ patient's neck, through which he is breathing. Given this​ finding, which of these devices does the patient most likely​ have?

Tracheostomy tube

You are called to a residence for a​ 7-year-old child in hypovolemic shock. You note evidence of severe dehydration as well as malnutrition. The child is wearing dirty clothes and appears to be unwashed. The​child's home is visibly unclean. What is your immediate​ priority?

Treat the child for​ shock, administering oxygen and establishing IV access for the replacement of fluids.

Which of these devices should you anticipate when responding to a pediatric patient who is dependent on medical​ technology?

Vascular access​ devices, urinary​ catheters, ventilators, and feeding tubes

During triage of a​ 6-year-old patient, you discover the​ following: The patient is​ awake, breathing 32 times/minute, has a palpable​ pulse, and responds to verbal stimuli. What is the correct triage category for this patient?

Yellow

You are caring for a​ 5-year-old who was found in her yard near a roadside crying with a scalp laceration causing some bleeding. In addition to assessing the head​ injury, controlling​ bleeding, and spinal​immobilization, what do you anticipate for this​ patient?

You will find evidence of other traumatic injuries.

The pediatric advanced life support​ (PALS) criteria for a physiologically unstable child does not​ include:

a heart rate of 100 beats per minute.

The most accurate method for determining the size of airway to use in pediatric resuscitation is​ touse:

a​ length-based resuscitation​ tape, such as a Broselow Tape.

During the management of a pediatric patient with a reactive airway disease and wheezing, you elect to provide a nebulized bronchodilator. Any of the following drugs could be used for this purpose in a pediatric patient except ______________

beclomethasone

A viral infection of the pediatric upper airway that results in inflammation of the subglottic region is known​as:

croup.

The mildest form of respiratory impairment is classified as respiratory ______________

distress.

An inflammation of an airway structure that is often due to a bacterial infection in children and is known to be potentially life threatening​ is:

epiglottitis.

A​ 7-year-old child following a drowning incident in a swimming pool is pulseless and apneic. Treatment for this patient should not​ include:

epinephrine administration every 5 to 15 minutes.

You respond to a shooting at a high​ school; the shooter has been​ apprehended, and law enforcement has certified the scene as safe. A​ 16-year-old patient presents with a​ small-caliber gunshot wound in the lower middle abdomen. The gunshot wound is small and not bleeding​ much, and there is no exit wound. This presentation suggests​ that:

internal bleeding and possible organ damage should be suspected.

Compared to an​ adult's, an​ infant's or​ child's:

lung tissues are more fragile.

The less frequently a paramedic uses a​ skill, the:

more likely that it is outside the scope of the​ paramedic's practice.

JumpSTART provides a framework for triage decisions that​ is:

objective.

When performing ventilation on an infant receiving​ CPR, it may likely be necessary​ to:

occlude the​ pop-off valve.

A​ four-year-old male patient presents with​ stridor, a​ cough, and hoarseness when speaking. The paramedic​ should:

place the patient in a position of comfort and transport immediately.

Conditions that place a pediatric patient at risk of cardiopulmonary arrest include all of the following except ______________.

respiratory rate greater than 40.

Shouting helps assess an​ infant's:

response to verbal stimuli.

Capillary refill time is considered reliable as a sign of perfusion primarily in children less than ______________ years of age.

six

You are suctioning a​ 10-year-old female​ patient's airway following the patient having vomited. The patient has a decreased level of consciousness. You​ should:

suction no deeper than you can see.

When an infant dies from an unknown​ cause, it is​ termed:

sudden infant death syndrome.

You are caring for a​ 6-year-old who was struck by a car on the street in front of her home in a very impoverished part of town. Her distraught father yells at you to hurry up and​ says, "If this was a kid on the other side of the​ tracks, you would be moving​ faster!" Which of the following is the most appropriate​ response?

​"I know this is upsetting. We are moving as fast as we can without making her condition worse. As long as I have your word that you​ won't yell at​ us, you can ride in the​ ambulance, and we will tell you everything we are​ doing."

You are caring for a​ 4-year-old male in hypovolemic shock. Which of the following statements would be most important to communicate to the receiving facility during the ED​ hand-off report?

​"Peripheral pulses are strong and equal bilaterally after the 1 liter IV bolus of 0.9%​ NS."