OB & Pediatrics

You are responding to a call for a 2-year-old child who fell from a second-story window. With the mechanism of injury and the age of the patient in mind, you should suspect that the primary injury occurred to the child's: A) head. B) chest. C) abdomen. D) lower extremities.

A Because a child's head is proportionately larger than the rest of the body when compared to an adult, the head commonly is the primary site of injury in pediatric patients. This is especially true in fall-related injuries, in which gravity causes the head to precede the rest of the body. Head injury is a leading cause of traumatic death in infants and small children.

General guidelines when assessing a 2-year-old child with abdominal pain and adequate perfusion include: A) examining the child in the parent's arms. B) palpating the painful area of the abdomen first. C) placing the child supine and palpating the abdomen. D) separating the child from the parent to ensure a reliable examination.

A If the child's condition is stable, the parent should be allowed to hold the child during the examination. This will minimize anxiety in the child and will make the assessment easier for you. In general, you should avoid separating the child and parents unless the child's condition warrants it. When assessing the abdomen of any patient, you should palpate the most painful area last.

A 5-year-old child experienced partial-thickness burns to his head, anterior chest, and both upper extremities. What percentage of his total body surface area has been burned? A) 0.45 B) 0.54 C) 0.63 D) 0.72

A According to the pediatric Rule of Nines, the child's head represents 18% of his or her total body surface area (TBSA), the anterior chest represents 9% (the entire anterior torso [chest and abdomen] represents 18%), and each entire upper extremity represents 9%. Therefore, burns to the head, anterior chest, and both upper extremities cover 45% of the child's TBSA. The Rule of Nines is modified for infants and children. The head accounts for 18% of the child's TBSA (9% in adults) because the head is proportionately larger than an adult's. The lower extremities account for 13.5% (some references cite 14%) of the child's TBSA (18% in adults) because the child's lower extremities are proportionately smaller than an adult's.

You receive a call for a 3-year-old girl with respiratory distress. When you enter her residence, you see the mother holding the child, who does not acknowledge your presence. This finding indicates that the child: A) has severe hypoxia. B) probably is sleeping. C) is afraid of your presence. D) is reacting normally for her age.

A A 3-year-old child typically is very attentive to his or her surroundings, especially when a stranger enters the environment. The fact that this child does not acknowledge your presence is an abnormal sign and indicates significant hypoxia. This child must therefore be managed aggressively to prevent respiratory arrest and subsequent cardiac arrest.

You are treating a 5-year-old child who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. You should: A) lower the extremities and reassess the child. B) begin positive-pressure ventilations and reassess the child. C) insert a nasopharyngeal airway and increase the oxygen flow. D) listen to the lungs with a stethoscope for abnormal breath sounds.

A Because infants and small children rely heavily on their diaphragm for breathing (as evidenced by belly breathing), elevating their lower extremities can cause the diaphragm to shift into the thoracic cavity and decrease the effectiveness of breathing. Therefore, in the case of this child, you should lower the lower extremities and reassess. In fact, you should elevate a shock patient's lower extremities only if allowed by local protocol.

Which of the following is the MOST common cause of shock in infants and children? A) Dehydration B) Cardiac failure C) Accidental poisoning D) Severe allergic reaction

A Common causes of shock in children include infections, dehydration (even from a few episodes of vomiting and/or diarrhea), and blood loss from trauma. Less common causes include severe allergic reactions (anaphylaxis) cardiac failure, and poisonings.

In contrast to the contractions associated with true labor, Braxton-Hicks contractions: A) do not increase in intensity and are alleviated by a change in position. B) may be intensified by activity and are accompanied by a pink discharge. C) generally follow rupture of the amniotic sac and occur with regularity. D) consistently become stronger and are not alleviated by changing position.

A During pregnancy, the mother may experience false labor, or Braxton-Hicks contractions, in which there are contractions but they do not represent true labor. Unlike true labor contractions, Braxton-Hicks contractions do not increase in intensity, are not regular, and are typically alleviated by activity or a change in position. The contractions associated with true labor, once they begin, consistently get stronger and closer together and are regular; a change in position does not relieve the contractions. True labor is also commonly followed by, or in some cases preceded by, a rupture of the amniotic sac (bag of waters) and a pink or red vaginal discharge that is generally accompanied by mucus (bloody show).

A woman who is 39 weeks pregnant is unresponsive, apneic, and pulseless. When treating her, the EMT should: A) manually displace her uterus to the left. B) ventilate her at a rate of 20 breaths/min. C) ensure that she is positioned on her left side. D) delay defibrillation until ALS is at the scene.

A During the later stages of pregnancy, a supine position should be avoided. The pregnant uterus can compress the aorta and inferior vena cava (IVC), thus impairing blood flow (aortocaval compression). In this case, however, the patient is in cardiac arrest; she must remain supine in order to perform effective CPR. Therefore, if the uterine fundus (top of the uterus) is above the level of the umbilicus (likely the case at 39 weeks), the EMT should manually displace her uterus to the left to relieve pressure off the IVC. The chest compression and ventilation rates are no different for pregnant patients than they are for non-pregnant patients. Do not delay defibrillation, if it is indicated.

When is it MOST appropriate to clamp and cut the umbilical cord? A) As soon as the cord has stopped pulsating B) After the placenta has completely delivered C) Before the newborn has taken its first breath D) Immediately following delivery of the newborn

A Generally, it is safe to clamp and cut the umbilical cord once it has stopped pulsating and the baby is breathing adequately. When blood flow through the umbilical cord ceases, it will stop pulsating; this indicates that the baby is oxygenating its own blood. If the cord does not stop pulsating and/or the baby is not breathing adequately, the cord should not be clamped and cut and the baby should be kept at the level of the mother's perineum and managed appropriately while en route to the hospital.

You are assessing a 26-year-old woman who is 38 weeks pregnant and is in labor. She tells you that she was pregnant once before, but had a miscarriage at 19 weeks. You should document her obstetric history as: A) gravida 2, para 0. B) gravida 1, para 1. C) gravida 0, para 2. D) gravida 2, para 1.

A Gravida is the term used to describe the number of times a woman has been pregnant, regardless of whether she carried the infant to term. Para is the term used to describe the number of times a woman has carried a fetus beyond 28 weeks, regardless of whether the infant was born dead or alive. Because your patient is currently pregnant and was pregnant once before, she is gravida 2. However, because she had a miscarriage with her first pregnancy (she did not carry beyond 28 weeks) and has not yet delivered the baby she is currently carrying, she is para 0. When she delivers, she will become gravida 2 and para 1.

Supplemental oxygen via the blow-by technique is MOST appropriate for a child who presents with respiratory difficulty and: A) is agitated, tachycardic, and clinging to his parent. B) is breathing with a significant reduction in tidal volume. C) has facial cyanosis and a decreased level of consciousness. D) has a heart rate of 70 beats/min and signs of physical exhaustion.

A If a child presents with respiratory difficulty, the method of oxygen delivery depends on his or her mental status, respiratory effort, and heart rate. A child with respiratory distress has an increased work of breathing, is agitated and tachycardic, and is clinging to his or her parent. Oxygen for a child with respiratory distress should be given by the least threatening method. You should avoid further agitation of the child, which may cause deterioration of his or her condition. Give the child oxygen via the blow-by technique; allow the parent to hold the mask or oxygen tubing near the child's face. By contrast, respiratory failure in the child is characterized by a decreased level of consciousness, signs of physical exhaustion, reduced tidal volume (shallow breathing), cyanosis, and bradycardia. Children with respiratory failure need assisted ventilation with a bag-valve-mask device and high-flow oxygen. Remember, respiratory failure is the most common cause of cardiac arrest in infants and children.

A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and is bleeding from her mouth and nose. You should: A) open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her ventilations. B) open her airway by carefully tilting her head back, suction her oropharynx, and administer high-flow oxygen via nonrebreathing mask. C) manually stabilize her head, open her airway with the jaw-thrust maneuver, insert a nasopharyngeal airway, and suction her oropharynx. D) suction her oropharynx, open her airway with the jaw-thrust maneuver, insert an oropharyngeal airway, and assist her ventilations.

A In any semiconscious or unconscious patient with a head injury, you should manually stabilize the head and open the airway with the jaw-thrust maneuver. If there are any secretions in the mouth, suction the oropharynx. If possible, insert a simple airway adjunct. The patient in this scenario is semiconscious and likely has an intact gag reflex; therefore, you should not attempt to insert an oropharyngeal airway. Conversely, you should not insert a nasopharyngeal airway in patients with a head injury, especially if there is fluid or blood draining from the nose (a sign of a skull fracture). After ensuring a patent airway, you should turn your attention to the patient's breathing. Slow, irregular breathing will not provide adequate minute volume and should be treated with ventilatory assistance.

A 34-year-old woman, who is 36 weeks pregnant, is having a seizure. After you protect her airway and ensure adequate ventilation, you should transport her: A) on her left side. B) in the prone position C) in the supine position. D) in a semisitting position.

A Initial care for any patient who is seizing--pregnant or otherwise--involves ensuring a patent airway, ensuring adequate ventilation, and administering high-flow oxygen. If the patient is breathing inadequately, ventilation assistance is indicated. Suction any secretions from the patient's mouth. The pregnant patient should be placed on her left side (lateral recumbent position); this will prevent supine hypotensive syndrome, a condition in which the pregnant uterus compresses the inferior vena cava and reduces cardiac output. A lateral recumbent position will also facilitate the draininge of oral secretions, thus minimizing the risk of aspiration.

Which of the following signs or symptoms is/are more common in children than in adults following an isolated head injury? A) Nausea and vomiting B) Altered mental status C) Tachycardia and diaphoresis D) Changes in pupillary reaction

A It is relatively common for children to vomit following a head injury such as a concussion. In adults, vomiting--though less common--is an ominous sign and indicates increased intracranial pressure. You must always be prepared for vomiting and have suctioning equipment readily available when managing the patient with a head injury. Altered mental status and pupillary changes following a head injury are equally as common in children and adults. Tachycardia and diaphoresis are signs of shock and are not commonly observed in patients with an isolated head injury.

A 29-year-old woman, who is 38 weeks pregnant, presents with heavy vaginal bleeding, a blood pressure of 70/50 mm Hg, and a heart rate of 130 beats/min. She is pale and diaphoretic, and denies abdominal cramping or pain. Her signs and symptoms are MOST consistent with a/an: A) placenta previa. B) abruptio placenta. C) ruptured ovarian cyst. D) ruptured ectopic pregnancy.

A Of the conditions listed, placenta previa would be the least likely to present with abdominal pain, although some patients may have pain or cramping. Placenta previa is a condition in which the placenta develops over and covers some or all of the cervix. As the cervix dilates, the vasculature that attaches the placenta to the uterine wall tears, resulting in vaginal bleeding that is often severe enough to cause shock. By contrast, abruptio placenta is a condition in which the placenta prematurely separates from the uterine wall; it is characterized by tearing abdominal pain, heavy vaginal bleeding, and shock. Placenta previa and abruptio placenta occur during the later stages of pregnancy. A ruptured ovarian cyst typically causes lower abdominal pain, often unilateral. Ectopic pregnancy, a condition in which the egg implants and grows outside the uterus (usually in a fallopian tube), is a first-trimester condition; it is typically discovered between 8 and 10 weeks of pregnancy. If the ectopic pregnancy ruptures, the patient often presents with a sudden stabbing pain in the lower abdomen and shock due to intra-abdominal hemorrhage.

Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What is the MOST appropriate initial management for this newborn? A) Initiate positive-pressure ventilations. B) Provide blow-by oxygen with oxygen tubing. C) Assess the newborn's skin condition and color. D) Start chest compressions and contact medical control.

A Positive-pressure ventilations are indicated in the newborn if he or she is apneic or has gasping respirations, if the heart rate is less than 100 beats/min, or if central cyanosis persists despite the delivery of blow-by oxygen. Chest compressions are indicated if the heart rate is less than 60 beats/min, despite 30 seconds of adequate positive-pressure ventilation. In many cases, the newborn's heart rate will increase to greater than 100 beats/min with adequately performed positive-pressure ventilation.

A 30-year-old woman is 22 weeks pregnant with her first child. She tells you that her rings are not fitting as loosely as they usually do and that her ankles are swollen. Her blood pressure is 150/86 mm Hg. She is MOST likely experiencing: A) preeclampsia. B) gestational diabetes. C) a hypertensive emergency. D) a condition unrelated to pregnancy.

A Preeclampsia typically develops after the twentieth week of gestation; it most commonly occurs in primigravida (first-time pregnancy) women. Preeclampsia is characterized by a headache, visual disturbances, edema to the hands and feet, anxiety, and persistent hypertension. Left untreated, preeclampsia can lead to seizures (eclampsia). Gestational diabetes, a condition in which the pregnancy hormones estrogen and progesterone impair the effects of insulin (insulin resistance), is characterized by an increase in the patient's blood glucose level (BGL); there is no mention of the patient's BGL in this scenario. A hypertensive emergency usually occurs when the systolic blood pressure acutely rises above 160 mm Hg.

Which of the following is an abnormal finding? A) Heart rate of 80 beats/min in a 3-month-old infant B) Rapid, irregular breathing in a newly born infant C) Systolic BP of 100 mm Hg in a 10-year-old child D) Respiratory rate of 26 breaths/min in a 2-year-old child

A The heart rate for an infant up to 3 months of age varies, depending on whether they are awake or asleep, but averages 140 beats/min. Therefore, a heart rate of 80 beats/min is grossly abnormal in this same age group and indicates bradycardia. Newborn infants normally have irregular breathing that ranges between 40 and 60 breaths/min. The systolic BP for a child between 6 and 12 years of age typically ranges between 90 and 115 mm Hg. The respiratory rate in a child between 1 and 3 years of age typically ranges between 24 and 40 breaths/min.

You are assessing a 5-year-old boy with major trauma. His blood pressure is 70/40 mm Hg and his pulse rate is 140 beats/min. and weak. The child's blood pressure: A) indicates decompensated shock. B) reflects adequate compensation. C) is appropriate based on his age. D) suggests increased intracranial pressure.

A The low normal systolic blood pressure (SBP) for a child between 1 and 10 years of age is calculated by multiplying his or her age (in years) by 2 and adding 70. Using this formula, the low normal SBP for a 5-year-old child is 80 mm Hg; anything less indicates hypotension. Therefore, a SBP of 70 mm Hg in a 5-year-old child, especially in the context of major trauma, indicates decompensated shock. Patients with increased intracranial pressure are typically hypertensive, not hypotensive.

Oxygen and other nutrients are transferred to the developing fetus via the: A) umbilical vein. B) amniotic fluid. C) umbilical arteries. D) mother's liver.

A The organ of oxygen and carbon dioxide exchange between the mother and the developing fetus is the placenta. The fetus is attached to the placenta by the umbilical cord, which contains two arteries and one vein. The fetus receives its supply of oxygen and other nutrients from the placenta via the umbilical vein. Carbon dioxide and other waste products are returned from the fetus to the placenta via the umbilical arteries. The amniotic sac acts as a cushion for the developing fetus and helps protect it from infection.

You and your partner are performing CPR on an infant with suspected sudden infant death syndrome (SIDS). An important aspect in dealing with such cases is: A) carefully inspecting the environment in which the infant was found. B) discouraging the presence of the parents during your resuscitation attempt. C) remembering that most infants with SIDS can be successfully resuscitated. D) focusing all of your attention on the infant, with little parental interaction.

A When managing an infant with suspected sudden infant death syndrome (SIDS), you will be faced with three tasks: assessment and management of the infant, communicating with and providing emotional support to the family, and assessing the scene. When assessing the scene, you should note the position in which the infant was found, any signs that suggest the infant was recently ill (eg, medications, humidifiers), and the general condition of the house (ie, clean or dirty). Because most infants die of SIDS during the night and are not discovered until the next morning, resuscitation is futile and is generally not indicated. In some cases, you may begin CPR as another member of your team discusses the situation with the parents. CPR is typically stopped after it is evident to the parents that the infant is dead and that resuscitation would be futile. If the parents want you to attempt resuscitation, encourage them to be present. Some parents wish to be present; others do not.

After an advanced airway device has been inserted in a 6-month-old infant in cardiopulmonary arrest, you should deliver ventilations at a rate of: A) 8 breaths/min. B) 10 breaths/min. C) 12 breaths/min. D) 20 breaths/min.

After an advanced airway device (eg, ET tube, multilumen airway, supraglottic airway) has been inserted during cardiac arrest, ventilate the patient at a rate of 10 breaths/min (one breath every 6 seconds). This ventilation rate applies to all age groups, except the newborn. Health care providers often deliver excessive ventilation, particularly when an advanced airway device is in place. Excessive ventilation (eg, hyperventilation) is detrimental because it causes an increase in intrathoracic pressure, which impedes blood flow back to the heart and decreases coronary perfusion. Hyperventilation also increases the risks of regurgitation and aspiration in the patient who does not have an advanced airway device in place. A ventilation rate of 12 to 20 breaths/min would be appropriate for an apneic infant or child who has a pulse.

A newborn is considered to be premature if it: A) weighs less than 6.5 pounds. B) is born before 37 weeks' gestation. C) is born to a heroin-addicted mother. D) has meconium in or around its mouth.

B A term gestation is between 37 and 42 weeks. A premature newborn is one that is born before 37 weeks' gestation or weighs less than 5.5 pounds (2.5 kg). Compared to women who do not abuse drugs, smoke, or drink alcohol during pregnancy, women who do are more likely to deliver prematurely or to deliver a low-birth-weight baby. The risk of the fetus voiding its first bowel movement (meconium) in utero increases any time the fetus is distressed, regardless of its gestational age or weight; the presence of meconium does not define a premature newborn.

After attaching the AED to a 7-year-old child in cardiac arrest, you push the analyze button and receive a shock advised message. After delivering the shock, you should: A) assess for a carotid pulse. B) immediately perform CPR. C) reanalyze the cardiac rhythm. D) open the airway and ventilate.

B After the AED delivers a shock, you should immediately begin or resume CPR, starting with chest compressions. Perform CPR for 2 minutes and then reanalyze the child's cardiac rhythm. If the AED states that a shock is advised, defibrillate without delay and then continue CPR. If the AED states no shock advised, resume CPR and reassess in 2 minutes. Do not check for a pulse after defibrillation or if the AED gives a no shock message; this merely causes an unecessary delay in performing chest compressions. Continue CPR and cardiac rhythm analysis and defibrillation (if indicated) every 2 minutes until ALS personnel arrive or the patient starts to move spontaneously.

A 30-year-old woman has severe lower abdominal pain and light vaginal bleeding. She tells you that her last menstrual period was 2 months ago. On the basis of these findings, you should suspect: A) a normal pregnancy. B) an ectopic pregnancy. C) a spontaneous abortion. D) a ruptured ovarian cyst.

B An ectopic pregnancy should be assumed, until proven otherwise, in any woman of childbearing age who presents with abdominal pain, with or without vaginal bleeding. The fact that the patient's last menstrual period was 2 months ago should make you that much more suspicious. The majority of women with an ectopic pregnancy are not aware they are pregnant, whereas women with a spontaneous abortion (miscarriage) typically are. Furthermore, a spontaneous abortion typically presents with abdominal pain and moderate to heavy vaginal bleeding; the passage of clots of blood are not uncommon.

Which of the following would MOST likely occur in conjunction with a breech presentation? A) Vertex presentation B) Prolapsed umbilical cord C) Maternal hypertension D) Premature rupture of the amniotic sac

B In most deliveries, the baby's head is the presenting part (vertex presentation). In a breech presentation, the baby's head is not the presenting part; the buttocks usually are. Breech presentations are associated with a higher incidence of prolapsed umbilical cord, a condition in which a part of the umbilical cord precedes the presenting part of the baby. Furthermore, breech presentations increase the risk of delivery-related trauma to the baby. Maternal hypertension and premature rupture of the amniotic sac (bag of waters) are not common concurrent findings in women with a breech presentation.

You arrive at the scene shortly after a 3-year-old female experienced a seizure. The child, who is being held by her mother, is conscious and crying. The mother tells you that her daughter has been ill recently and has a temperature of 102.5°F. What is the MOST appropriate treatment for this child? A) Oxygen via nonrebreathing mask, place the child in a tub of cold water to lower her body temperature, and transport. B) Oxygen via the blow-by technique, remove clothing to help reduce her fever, and transport with continuous monitoring. C) Oxygen via nonrebreathing mask, avoid any measures to lower the child's body temperature, and transport at once. D) Oxygen via the blow-by technique, transport, and request a paramedic intercept so an anticonvulsant drug can be given.

B As evidenced by her recent illness and fever (102.5ºF), this child has likely experienced a febrile seizure. Appropriate treatment for the child following a febrile seizure involves ensuring a patent airway, administering oxygen (the blow-by technique is generally better tolerated in children than a mask), removing the child's clothing to facilitate heat loss, and transporting to the hospital. Avoid cooling the child with water; doing so may cause the child to shiver--a mechanism that produces body heat--which may cause an abrupt rise in body temperature and another seizure. Since the child is no longer seizing, an anticonvulsant drug is not indicated.

While performing a visual inspection of a 30-year-old woman in labor, you can see the umbilical cord at the vaginal opening. After providing high-flow oxygen, you should: A) massage the uterus to facilitate delivery of the fetus. B) relieve pressure from the cord with your gloved fingers. C) place the mother on her left side and provide rapid transport. D) elevate the mother's lower extremities and provide rapid transport.

B Care for a prolapsed umbilical cord includes placing your gloved fingers into the vagina and lifting the presenting part of the baby off of the umbilical cord. Positioning the mother with her hips elevated may allow the baby to slide off of the umbilical cord. Continued pressure on the umbilical cord will cut off the baby's oxygen supply. In addition, you should keep the cord moist by covering it in saline-soaked dressings. Give the mother high-flow oxygen and provide rapid transport to the hospital.

A 5-year-old boy was struck by a car when he ran out into the street. When you arrive at the scene and approach the child, you see him lying supine approximately 15 feet from the car. Based on the child's age and mechanism of injury, which of the following should you suspect to be his PRIMARY injury? A) Head injury B) Pelvic injury C) Lower leg injury D) Upper thorax injury

B Children are smaller than adults; therefore, when they are injured by the same mechanism of injury as an adult, the location of their injuries may differ from those of an adult. For example, when an adult is struck by a vehicle, the primary injury typically occurs at or below the knees, depending on the height of the bumper at the time of impact. Because the child is shorter, initial impact typically occurs at or near the pelvis. Secondary injury occurs when child's chest collides with the vehicle's grille. Tertiary injury occurs when the child strikes the side of his or her head on the pavement after being propelled away from the vehicle. In some cases, the child is pulled underneath the vehicle and is dragged.

Which of the following statements regarding pediatric anatomy is correct? A) The child's trachea is more rigid and less prone to collapse. B) The occiput is proportionately larger when compared to an adult. C) Relative to the overall size of the airway, a child's epiglottis is smaller. D) Airway obstruction is common in children because of their large uvula.

B Compared to adults, infants and small children have a proportionately larger head, specifically the occiput (back of the head). Therefore, when positioning an infant's or child's airway, padding in between the shoulder blades is often needed to maintain neutral alignment of the head. Infants and children are at risk for an airway obstruction because their entire airway is smaller, not because their uvula is large. An infant's or child's trachea is less rigid than an adult's; therefore, it collapses more easily during respiratory distress. Relative to the overall size of an infant or a child's airway, the epiglottis is larger; it is also floppier

A 5-year-old child in compensated shock secondary to severe vomiting and diarrhea would be expected to have: A) slow, shallow respirations. B) a slow capillary refill time. C) strong, bounding radial pulses. D) a weakly palpable carotid pulse.

B Compensated shock in the infant or child is characterized by poor peripheral perfusion (eg, delayed [> 2 seconds] capillary refill time, weak peripheral pulses, pallor), tachycardia, and tachypnea. In compensated shock, the child's blood pressure is maintained and his or her mental status is adequate. In decompensated shock, the child's compensatory mechanisms have failed; blood pressure falls, central pulses become weak, and mental status begins to deteriorate. It is critical to recognize an infant or a child in compensated shock, begin immediate treatment, and transport without delay.

Which of the following statements regarding crowning is correct? A) Crowning represents the end of the second stage of labor. B) Gentle pressure should be applied to the baby's head during crowning. C) It is safe to transport the patient during crowning if the hospital is close. D) Crowning always occurs immediately after the amniotic sac has ruptured.

B Crowning occurs when the baby's head is visible at the vaginal opening; it is an obvious sign of delivery in progress. When crowning is observed, you should apply gentle pressure to the infant's head to prevent an explosive delivery. Care must be taken to avoid putting pressure on the fontanelles (the soft spots on the infant's head). Crowning represents the end of the first stage of labor and the beginning of the second stage; it does not always occur immediately after the amniotic sac has ruptured. If the infant's head is born and the amniotic sac is still intact, you need to pinch the thin membrane with your fingers, which will usually cause the sac to easily rupture, and then suction the infant's mouth and nose.

The MOST important initial steps of assessing and managing a newborn include: A) suctioning the airway and obtaining a heart rate. B) clearing the airway and keeping the infant warm. C) keeping the infant warm and counting respirations. D) drying and warming the infant and obtaining an Apgar score.

B In the initial steps of assessing and managing the newborn, the most important aspects include clearing the airway of amniotic fluid and making sure that the baby stays warm. The Apgar score should not be relied on as the initial indicator for resuscitation because it is not performed until the child is 1 minute old. Clearly, this is too long to wait before assessment and intervention. After the airway has been cleared and the newborn has been warmed, the respirations, heart rate, color, and oxygen saturation (SpO2) should be assessed and managed accordingly.

A 3-year-old female presents with respiratory distress. She is conscious, crying, and clinging to her mother. She has mild intercostal retractions and an oxygen saturation of 92%. The MOST effective way of delivering oxygen to her involves: A) gently restraining her and assisting her ventilations. B) asking the mother to hold an oxygen mask near her face. C) a nasal cannula with the flow rate set to at least 6 L/min. D) ventilations with a manually-triggered ventilation device.

B Do not assume that a child will simply allow you to administer oxygen to him or her as you would to an adult. The child in this scenario, who is in respiratory distress and is mildly hypoxemic (SpO2 of 92%), should receive supplemental oxygen; however, it should be given in a nonthreatening manner. Agitating a sick or injured child causes an increase in oxygen consumption and demand, which may cause the child's condition to deteriorate. In this scenario, ask the child's mother to hold an oxygen mask near the child's face (blow-by oxygen). Small children are not as likely to tolerate a nasal cannula as an adult would. Closely monitor the child's condition and be prepared to assist her ventilations with a bag-valve-mask device if she deteriorates. Do NOT use a manually-triggered ventilation device (ie, demand valve) on any child; doing so can cause severe gastric distention and pulmonary injury. Allow the child to assume a position of comfort and transport.

A 3-year-old child experienced a seizure that lasted about 10 minutes. He has a fever of 103.5°F, his skin is hot to the touch, and he has a rash on his trunk. The EMT should suspect: A) epilepsy. B) meningitis. C) an intracranial bleed. D) an allergic reaction.

B Febrile seizures and fever with seizures are not one in the same. Febrile seizures are caused by fever and fever alone. Conversely, fever with seizures could be something else. The rash on the child's trunk indicates possible sepsis, and should make the EMT suspect meningitis; a rash is not a common finding with simple febrile seizures. Rash and fever are not common findings with intracranial hemorrhage, and fever is not commonly associated with an allergic reaction.

Of the following, the MOST detrimental effect of gastric distention in infants and children is: A) tracheal rupture. B) decreased ventilatory volume. C) acute rupture of the diaphragm. D) less effective chest compressions.

B Gastric distention can be lethal if not detected and managed appropriately in any patient, but especially infants and children. As air insufflates the stomach, the diaphragm is pushed into the thoracic cavity, which decreases the amount of air that can fill the lungs. This results in decreased ventilatory volumes during artificial ventilation. Gastric distention also increases the risks of regurgitation and aspiration. You must be able to deliver adequate ventilations to the patient. Remember, respiratory failure is the most common cause of cardiopulmonary arrest in children.

A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and administer supplemental oxygen. En route to the hospital, you should be MOST alert for: A) hypotension. B) convulsions. C) combativeness. D) respiratory distress.

B High fever and an alerted mental status indicate sepsis (severe infection). A generalized rash should alert you to the possibility of meningitis, a condition caused by infection and inflammation of the meninges that protect the brain and spinal cord. Children with meningitis are at risk for seizures (convulsions), usually due to increased intracranial pressure (ICP) and/or high fever; therefore, you must continually monitor the child's condition en route to the hospital and be prepared to treat seizures if they occur. Remember that seizure deaths are caused by cerebral hypoxia. You should also be alert for vomiting, which can jeopardize the airway. Hypotension can occur in patients with sepsis and should also be of concern; however, seizures directly compromise adequate ventilation and oxygenation.

Treatment for a responsive 4-year-old child with a mild airway obstruction, who has respiratory distress, a strong cough, and normal skin color, includes: A) oxygen, back slaps, and transport. B) supplemental oxygen and transport. C) assisted ventilations, back slaps, and transport. D) subdiaphragmatic thrusts until the object is expelled.

B If a child (1 year of age to the onset of puberty [12 to 14 years of age]) with a mild airway obstruction is alert and has adequate air movement (ie, a strong cough, normal skin color), you should offer oxygen, avoid agitating the child, and provide transport to the hospital. Attempts to relieve a mild airway obstruction may result in a severe airway obstruction. If signs of a severe airway obstruction develop, you must take immediate action to remove the object (eg, back slaps and chest thrusts in a responsive infant; subdiaphragmatic [abdominal] thrusts in a responsive adult or child). Finger sweeps are indicated ONLY if the patient is unresponsive and you can see the object in his or her mouth.

During transport of a woman in labor, the patient tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. You should: A) allow the head to deliver and check for the location of the cord. B) advise your partner to stop the ambulance and assist with the delivery. C) ask the mother to take short, quick breaths until you arrive at the hospital. D) apply gentle pressure to the baby's head and notify the hospital immediately.

B If, during transport, the mother begins to deliver the infant, your first action should be to advise your partner to stop the ambulance and assist you with the delivery. Delivery of a baby should never be attempted in the back of a moving ambulance. During delivery, you should apply gentle pressure to the top of the baby's head (be careful of the fontanelles) to prevent an explosive delivery. After the head is delivered, you should quickly run your fingers around its neck to determine if the cord is wrapped around its neck (nuchal cord). If a nuchal cord is not present, suction the baby's mouth and nose and continue with the delivery.

Which of the following is a more reliable indicator of perfusion in children than it is in adults? A) Heart rate B) Capillary refill C) Blood pressure D) Respiratory rate

B In children younger than 6 years of age, capillary refill time (CRT) serves as an excellent indicator of perfusion; it assesses oxygen delivery to the capillaries. As a person gets older, however, CRT becomes less reliable. It is important to remember that factors such as cold temperature can affect CRT. Early in shock, the heart and respiratory rates increase in an attempt to compensate for decreases in oxygen; this occurs in both children and adults. When these compensatory mechanisms fail, the blood pressure falls, and the patient enters a state of decompensated shock. For this reason, you should not rely upon a patient's blood pressure to determine overall perfusion; the blood pressure may be maintained, despite inadequate perfusion.

The preferred method for inserting an oropharyngeal airway in a small child is to: A) insert the airway with the curvature toward the roof of the mouth and then rotate it 180 degrees. B) depress the tongue with a tongue blade and insert the airway with the downward curve facing the tongue. C) open the airway with the tongue-jaw lift maneuver and insert the airway until you meet slight resistance. D) insert the airway as you would in an adult, but use an airway that is one size smaller than you would normally use.

B Keeping in mind that a child's tongue is proportionately large, the preferred method for inserting an oropharyngeal (oral) airway is to use a tongue blade to depress the tongue and slide the airway straight in, with the downward curve of the airway facing the tongue, until it rests just beyond the curvature of the tongue. If you use an oral airway that is too small, it will not reach the curvature of the tongue and propel it forward. If you use an oral airway that is too large, it may obstruct the airway. If you meet resistance when inserting an oral airway, you are likely using an airway that is too large. Oral airways are rigid, and the hard palate of a child is rather fragile. An improperly inserted oral airway could lacerate or fracture a child's hard palate.

You will know that the third stage of labor has begun when: A) the placenta has delivered. B) the entire baby has delivered. C) the mother's contractions become regular. D) the baby's head is visible at the vaginal opening

B Labor is divided into three stages. The first stage begins with the onset of contractions and ends when the cervix is fully dilated. In the field, the EMT cannot determine the degree of cervical dilation, so the appearance of the baby's head at the vaginal opening (crowning) is used to mark the end of the first stage of labor. As the first stage of labor progresses, the mother's contractions become more frequent and regular. The second stage of labor begins with full cervical dilation (or in the field, crowning) and ends when the baby is completely delivered. The third stage of labor begins with the birth of the baby and ends when the placenta (afterbirth) has delivered.

Your assessment of a mother in labor reveals that a fetal limb is protruding from the vagina. Management of this situation should include: A) positioning the mother in semi-Fowler's position, administering oxygen, and providing transport. B) positioning the mother with her hips elevated, administering high-flow oxygen, and providing transport. C) applying gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord. D) giving the mother 100% oxygen and attempting to manipulate the protruding limb so that delivery can occur.

B Limb presentations represent a dire emergency for the newborn and do not spontaneously deliver in the field. You should position the mother in a manner so that her hips are elevated in an attempt to slide the infant slightly back into the birth canal and remove pressure from the umbilical cord. Administer high-flow oxygen to the mother, cover the protruding limb with a sterile sheet (or any clean sheet, if a sterile sheet is not available), and transport immediately. Do NOT pull on the protruding limb, as this may cause injury to the newborn.

A 4-year-old boy with a tracheostomy tube is experiencing respiratory distress. He has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should: A) ventilate through the tracheostomy tube. B) carefully suction the tracheostomy tube. C) remove the tracheostomy tube and clean it. D) place an oxygen mask over the tracheostomy tube.

B Obstruction of a tracheostomy tube with thick secretions is a common complication. You must first suction the tube to ensure that it is clear of secretions; this will usually improve the patient's condition. Do not vigorously suction the tube, however, as this may cause a further decrease in the child's heart rate. Placing an oxygen mask over an obstructed tracheostomy tube will be of little to no benefit. If the child's condition does not improve following suctioning (eg, he remains bradycardic, his oxygen saturation remains low), attach a bag-valve-mask device to the tracheostomy tube and begin ventilating him. Do not remove the tracheostomy tube; this is beyond the EMT's scope of practice, plus there is no guarantee that you will be able to replace it.

Which of the following techniques represents the MOST appropriate method of opening the airway of an infant with no suspected neck injury? A) Lift up the chin and hyperextend the neck. B) Tilt the head back without hyperextending the neck. C) Gently lift the chin while maintaining slight flexion of the neck. D) Perform the technique as you would for an older child or adult.

B Opening the airway in infants and small children involves keeping the head in a neutral or slightly extended position. Because the occipital region (back of the head) of the skull is proportionately larger in infants and small children as compared to an adult, hyperextension of the neck can result in a reverse flexion of the neck and subsequent airway blockage.

Following delivery of a newborn and placenta, you note that the mother has moderate vaginal bleeding. The mother is conscious and alert, and her vital signs are stable. Treatment for her should include: A) massaging the uterus if signs of shock develop. B) administering oxygen and massaging the uterus. C) carefully packing the vagina with sterile dressings. D) treating her for shock and providing rapid transport.

B Postpartum bleeding is most effectively controlled by massaging the fundus (top) of the uterus. Uterine massage stimulates the pituitary gland to secrete a hormone called oxytocin, which constricts the blood vessels in the uterus and helps stop the bleeding. Do not wait for signs of shock to develop before performing uterine massage. The goal is to control the postpartum bleeding and thereby prevent shock. Administer supplemental oxygen as needed, begin transport, and monitor the patient for signs of shock (ie, tachycardia, pallor, diaphoresis, tachypnea) en route. Vaginal bleeding is never treated by placing anything inside the vagina; this action increases the risk of maternal infection.

Following the initial steps of resuscitation, a newborn remains apneic and cyanotic. You should: A) immediately resuction its mouth and nose. B) begin ventilations with a bag-valve-mask. C) gently flick the soles of its feet for up to 60 seconds. D) start CPR if the heart rate is less than 80 beats/min.

B The initial steps of newborn resuscitation, which are performed on all newborns following delivery, include drying, warming, positioning, suctioning, and tactile stimulation. If the newborn remains apneic after the initial steps of resuscitation, or has a heart rate less than 100 beats/min, you should begin positive-pressure ventilations (PPV) with a bag-valve-mask device at a rate of 40 to 60 breaths/min. Continued tactile stimulation (eg, flicking the soles of the feet, rubbing the lateral thorax) of an apneic newborn wastes time; you must ventilate at once. If the newborn's heart rate is less than 60 beats/min despite effective PPV, you should begin chest compressions.

The function of the uterus is to: A) dilate and expel the baby from the cervix. B) house the fetus as it grows for 40 weeks. C) provide oxygen and other nutrients to the fetus. D) provide a cushion and protect the fetus from infection.

B The uterus is a muscular organ where the fetus grows for 37 to 42 weeks (average of 40 weeks). It is responsible for contracting during labor, which in conjunction with dilation of the cervix (the opening of the uterus), expels the baby from the uterus into the birth canal. The placenta is the organ of exchange that delivers oxygen and other nutrients from the mother to the fetus and returns metabolic waste products from the fetus to the mother. The amniotic sac, also called the bag of waters, provides a cushion for the developing fetus and helps protect it from infection.

Which of the following statements regarding the length-based resuscitation tape measure is correct? A) It is not a reliable tool in children who are younger than 5 years of age. B) The tape measure can be used in children who weigh up to 75 pounds. C) The resuscitation tape estimates a child's age based on his or her height. D) The red end of the tape measure is placed at the heel of the child's foot.

B There are a number of ways to identify the appropriate size of equipment for a pediatric patient; however, the length-based resuscitation tape measure is perhaps the most accurate. Pediatricians generally agree that length (height), not age, is the most reliable estimator of weight. The resuscitation tape estimates a child's weight based on his or her height; it is a reliable tool to use in children who weigh up to 75 pounds (34 kg). To use the resuscitation tape, lay it next to the child with the multicolored side up. Place the red end of the tape at the top (crown) of the child's head, and stretch the tape out the full length of the child, stopping at the heel of the foot. Place your free hand, side down, at the bottom of the child's heel. Note the color or letter and weight range on the edge of the tape where your hand is.

When assessing a 30-year-old female who was sexually assaulted, it is MOST important for you to: A) have a female EMT perform the assessment. B) ensure that all life-threatening injuries are treated. C) recognize that the patient is a walking crime scene. D) discourage her from showering or changing clothes.

B Victims of sexual assault can present a unique challenge for the EMT. The patient is a walking crime scene; potential evidence could be on or in him or her. Furthermore, many victims will not want to be assessed by a member of the opposite sex. As with any other patient, however, your first priority is to assess for and treat life-threatening injuries or conditions and begin immediate transport if indicated. If possible, an EMT of the opposite sex should assess the patient. To help preserve potential evidence, discourage the patient from showering, douching, going to the bathroom, or changing clothes.

You are called to a local park for a 7-year-old boy with respiratory distress. During your assessment, you find that the patient is wheezing and has widespread hives and facial edema. What should you suspect has occurred? A) Heat illness B) Allergic reaction C) Acute asthma attack D) Poison oak exposure

B Wheezing, hives, and edema are hallmark findings of an allergic reaction. In this case, the patient is having a severe reaction. Although wheezing occurs in patients with asthma, hives and facial edema do not. Wheezing is not associated with heat-related illnesses. Exposure to poison oak or poison ivy causes a local reaction, such as redness and itching or burning; it is not commonly associated with systemic symptoms.

A 6-year-old boy complains of pain to the right lower quadrant of his abdomen. Assessment of this child's abdomen should include: A) avoiding palpation of the abdomen. B) palpating the left upper quadrant first. C) auscultating bowel sounds for 2 minutes. D) palpating the right lower quadrant first.

B When assessing the abdomen of any patient, you should determine the location of the pain and palpate that area last. Begin by palpating the abdomen farthest away from the area of pain; in this case, the left upper quadrant is farthest away from the right lower quadrant. Palpating the painful area first will interfere with the rest of your assessment because the patient will be in significant pain and will likely not remain still during the remainder of the assessment. This is especially true in children. Auscultation of bowel sounds is generally not performed in the prehospital setting; little, if any, information will be gained from doing so.

Which of the following statements regarding two-rescuer child CPR is correct? A) The chest should not be allowed to fully recoil in between compressions, as this may impair venous return. B) Compress the chest with one or two hands to a depth that is equal to one-third the diameter of the chest. C) The chest should be compressed with one hand and a compression to ventilation ratio of 30:2 should be delivered. D) A compression to ventilation ratio of 15:2 should be delivered without pauses in compressions to deliver ventilations.

B When performing two-rescuer CPR on a child (1 year of age to the onset of puberty [12 to 14 years of age]), the chest should be compressed with one or two hands (depending on the size of the child), and a compression to ventilation ratio of 15:2 should be delivered. It is important to compress the chest to an adequate depth: one-third the anterior-posterior diameter of the chest (about 1½ inch in the child). The chest should be allowed to fully recoil in between compressions to maximize venous return to the heart. If an advanced airway device (ie, ET tube, multilumen airway, supraglottic airway) is not in place, two rescuers should deliver "cycles" of CPR; the compressor should pause briefly so the ventilator can deliver two breaths. A compression to ventilation ratio of 30:2 is used for one-rescuer child CPR. After an advanced airway device has been inserted, "cycles" of CPR should not be performed; compressions should be continuous at a rate of 100 to 120/min and ventilations should be delivered at a rate of 10 breaths/min (one breath every 6 seconds)

The appropriate technique for performing two-rescuer CPR on a 4-year-old child includes: A) 30 compressions to 2 ventilations, compressing the chest one-third the depth of the chest, and delivering each breath over 1 second. B) 15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs. C) 30 compressions to 2 ventilations, compressing the sternum with the heel of both hands, and delivering each breath over 1 to 2 seconds. D) 15 compressions to 2 ventilations, compressing the sternum with your thumbs, and delivering 100 to 120 compressions per minute.

B When performing two-rescuer CPR on an infant (less than 1 year of age) or a child (1 year of age to the onset of puberty [12 to 14 years of age]), use a compression to ventilation ratio of 15:2. Compress the chest by one-third the depth of the chest (about 1½ inches for infants; about 2 inches for children), at a rate of 100 to 120/min, and allow the chest to fully recoil in between compressions. Deliver each breath over 1 second, just enough to produce visible chest rise, and allow complete exhalation. For a child, use the heel of one or both hands to compress the chest, depending on the size of the child. For two-rescuer infant CPR, use the tips of your thumbs to compress the chest (two-thumb, encircling-hands technique); the two-finger technique may be used for one-rescuer infant CPR. A 30:2 compression to ventilation ratio is used for all adult and one-rescuer CPR.

You and your partner are performing CPR on a 2-year-old female in cardiac arrest. During your resuscitation attempt, you should: A) hyperventilate her because she is severely hypoxic. B) allow the chest to fully recoil in between compressions. C) perform compressions and ventilations at a ratio of 30:2. D) attach the AED pads after 5 minutes of high-quality CPR.

B When performing two-rescuer CPR on an infant or a child, use a compression to ventilation ratio of 15:2 (30:2 for one-rescuer infant or child CPR), compress the chest by one-third the depth of the chest (about 2 inches), and allow the chest to fully recoil between compressions. Full recoil of the chest is essential to high-quality CPR; it maximizes the amount of blood that returns to the heart, which maximizes the amount of blood ejected from the left ventricle during chest compressions. Do not hyperventilate any patient; deliver each breath over 1 second while observing the chest for visible rise. Hyperventilation causes gastric distention and increases the risk of aspiration if regurgitation occurs. Furthermore, hyperventilation causes a reduction in blood return to the heart because it hyperinflates the lungs and puts pressure on the heart. Attach pediatric AED pads as soon as possible, analyze the child's cardiac rhythm, and deliver a single shock if indicated.

Which of the following parameters is the LEAST reliable when assessing the perfusion status of a 2-year-old child? A) Capillary refill time B) Systolic blood pressure C) Skin color and temperature D) Presence of peripheral pulses

B You should not rely on the systolic blood pressure (SBP) when concluding the perfusion status of anyone. More reliable parameters include assessing peripheral pulses, capillary refill time (most reliable in children younger than 6 years of age), and the condition and temperature of the skin. Remember that the body's compensatory mechanisms work to maintain the SBP, so when it falls, this corresponds to decompensated shock. A maintained SBP does NOT rule out shock!

Your assessment of a 5-year-old child reveals that he is unresponsive with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Treatment for this child should include: A) high-flow oxygen via nonrebreathing mask and rapid transport. B) oxygen via a nasal cannula at 6 L/min and rapid transport. C) positive-pressure ventilation, chest compressions, and rapid transport. D) back slaps and chest thrusts while attempting artificial ventilations.

C A heart rate less than 60 beats/min in an infant or child, especially when accompanied by signs of poor perfusion and inadequate breathing, should be treated with positive-pressure ventilation, chest compressions, and rapid transport. Respirations of 8 breaths/min and a heart rate of 50 beats/min will not maintain adequate oxygenation and perfusion in a child. Passive oxygenation (ie, nasal cannula, nonrebreathing mask) is not appropriate for a child with inadequate ventilation, especially when accompanied by bradycardia. Back slaps and chest thrusts are indicated for a responsive infant with a severe foreign body upper airway obstruction.

A child typically begins to develop stranger anxiety when he or she is a/an: A) infant. B) neonate. C) toddler. D) preschooler.

C A toddler is a child between 1 and 3 years of age. During this period, children begin to walk and explore their environment. They are able to open doors, drawers, boxes, and bottles. Because they are explorers by nature and are not afraid, injuries in this age group increase. Stranger anxiety also develops early in this period. Toddlers often resist separation from caregivers and are afraid to let others come near them.

A 9-year-old girl was struck by a car while she was crossing the street. Your assessment reveals a large contusion over the left upper quadrant of her abdomen and signs of shock. Which of the following organs has MOST likely been injured? A) Liver B) Kidney C) Spleen D) Pancreas

C Abdominal trauma commonly occurs in children as the result of motor vehicle versus pedestrian accidents. The contusions over the left upper quadrant and the signs of shock suggest significant injury to the spleen. The liver lies in the right upper quadrant, and the pancreas and kidneys lie in the retroperitoneal space. Although the exact injury cannot be determined in the field, you must treat the patient for shock and provide rapid transport.

After clearing the airway of a newborn who is not in distress, it is MOST important for you to: A) apply blow-by oxygen. B) clamp and cut the cord. C) keep the newborn warm. D) obtain an Apgar score.

C After ensuring a patent airway (ie, suctioning and positioning), it is extremely important to keep the newborn warm. Newborns cannot maintain body temperature very well and hypothermia can develop very quickly. Blow-by oxygen should be given if the newborn is breathing adequately, but has cyanosis to the face, neck, or trunk (central cyanosis). The umbilical cord should not be clamped and cut until the cord has stopped pulsating and the newborn is breathing adequately. According to the 2015 guidelines for CPR and emergency cardiac care, delayed cord clamping after 30 seconds is suggested for term and preterm newborns who do not require resuscitation at birth. The Apgar score, which is performed at 1 and 5 minutes after birth (and every 5 minutes thereafter), is not used to determine the need for or extent of resuscitation; respiratory effort, heart rate, skin color, and oxygen saturation (SpO2) are used to determine this.

After the baby's head delivers, it is usually tilted: A) with the face up. B) posteriorly, face down. C) posteriorly, to one side. D) anteriorly, with the chin up.

C As the baby's head begins to deliver, it is usually in a posterior, face-down position. After the head delivers completely, however, it usually tilts to the side in preparation for delivery of the shoulders. Remember to check for the presence of a nuchal cord (umbilical cord wrapped around the neck), and to suction the baby's mouth and nose as soon as its head delivers.

Following delivery of a newborn, the 21-year-old mother is experiencing mild vaginal bleeding. You note that her heart rate has increased from 90 to 120 beats/min and she is diaphoretic. In addition to administering high-flow oxygen, treatment should include: A) uterine massage for 5 minutes, and then transport. B) placing her in a left-lateral recumbent position and transport. C) treating for shock and performing uterine massage during transport. D) placing sterile pads into her vagina and treating for shock during transport.

C Blood loss of up to 500 mL within the first 24 hours after delivery is considered normal and usually is well tolerated by the mother. However, any bleeding, regardless of the severity, with accompanying signs of shock, must be treated at once. In this case, you should apply high-flow oxygen, treat for shock (keep her supine and cover her with warm blankets), and provide rapid transport to the hospital while massaging the uterine fundus en route. Placing the mother on her left side is appropriate before she delivers (and if she is not in shock) and prevents supine hypotensive syndrome. Dressings should never be packed into the vagina; placing pads into the vagina increases the risk for maternal infection.

The MOST effective way to prevent cardiopulmonary arrest in a newborn is to: A) give blow-by oxygen as soon as it is born. B) suction its mouth and nose every 3 minutes. C) ensure effective oxygenation and ventilation. D) perform an Apgar assessment every 5 minutes.

C Cardiac arrest in the pediatric population, including the newborn, is usually the result of respiratory failure. To prevent this, it is essential to ensure effective oxygenation and ventilation at all times. This involves keeping the airway clear with suction, and, if necessary, administering blow-by oxygen or ventilating with a bag-valve-mask device. Blow-by oxygen is indicated for newborns with central cyanosis that is not rapidly dissipating. The newborn's mouth and nose should be suctioned twice, as soon as its head delivers and after the newborn has been dried, warmed, and properly positioned. Routine suctioning every 3 minutes is not indicated. The need for and extent of resuscitation is determined by assessing the newborn's respiratory effort, heart rate, skin color, and oxygen saturation (SpO2), not the Apgar score. The first Apgar score is not assessed until the newborn is 1 minute of age. Resuscitation, if needed, should begin within 15 to 30 seconds following delivery.

The MAIN reason why small children should ride in the backseat of a vehicle is because: A) they are much less likely to be ejected from the vehicle. B) the back of the front seat will provide a cushion during a crash. C) they can experience severe injury or death if the air bag deploys. D) their legs are highly prone to injury from striking the dashboard.

C Children younger than 12 years should ride in the backseat of a vehicle, preferably in the middle, and be restrained in a device that is appropriate for their size. Merely placing the child in the backseat does not reduce the risk of ejection; the child must be properly restrained. Young children, especially those restrained in a child safety seat, may be critically injured or killed by air bags if they are riding in the front passenger seat of a car. This occurs because the child safety seat positions the child too close to the air bag; the force of the deploying air bag may cause severe head and spinal trauma.

You should suspect physical abuse of a 4-year-old child if you observe: A) bruises to the anterior tibial area. B) curious siblings who are watching you. C) purple and yellow bruises to the thighs. D) that the child clings to his or her parent.

C EMTs always must keep the possibility of child abuse in the back of their minds when dealing with an injured child. Signs that would indicate abuse include, but are not limited to, bruises in areas that are not likely to be injured, such as the thigh, back, and chest; multiple bruises in varying colors, indicating various stages of healing; conflicting stories among caregivers; injuries that are beyond the developmental abilities of the child, such as a 2-year-old child who has "fallen from her bicycle"; and cases in which the child does not look at the parents or cling to them as one would expect an injured child to do. Siblings of an abused child are typically not curious onlookers as they have become accustomed to the abusive environment. As an EMT, you have a legal obligation to report any and all cases of suspected child abuse. Never accuse anyone of abusing a child. If you are wrong, you could be held liable for slander.

Which of the following signs is MOST indicative of inadequate breathing in an infant? A) Sunken fontanelles B) Abdominal breathing C) Expiratory grunting D) Heart rate of 130 beats/min

C Expiratory grunting in an infant or a child with a respiratory problem is an ominous sign; it indicates impending respiratory arrest. Grunting represents the child's attempt to maintain oxygen reserve in the lungs. Sunken fontanelles, the soft spots on the infant's skull, indicate dehydration. Because infants have a protuberant abdomen and rely heavily on their diaphragm to breathe, their abdomen appears to move more than their chest during breathing; this is a normal finding and is why infants are often referred to as "belly breathers." An infant or a child with inadequate breathing may be tachycardic at first; however, as hypoxia becomes more severe, bradycardia often occurs. Bradycardia in an infant or a child with a respiratory problem indicates impending cardiopulmonary arrest.

You arrive at a residence shortly after a 4-year-old boy experienced an apparent febrile seizure. The child is alert and crying. His skin is flushed, hot, and moist. His mother tells you that the seizure lasted about 2 minutes. You should: A) begin rapid cooling measures at once. B) give him acetaminophen or ibuprofen. C) provide supportive care and transport. D) allow the mother to take her child to the doctor.

C Febrile seizures are common in children between the ages of 6 months and 6 years; they occur when the child's body temperature suddenly rises or when an already febrile child experiences an acute fever spike. Treatment for a child who has experienced a febrile seizure involves providing supportive care (eg, monitoring ABCs, administering oxygen as tolerated) and transporting to the hospital. Any infant or child who experienced a seizure should be transported by EMS. Although febrile seizures are typically self-limiting and are rarely life threatening, there are other causes of fever and seizures, such as meningitis. The EMT is generally not authorized to administer medications unless directed by local protocol or direct medical control. Active cooling (eg, cool or cold water baths) should be avoided; a sudden lowering of the child's temperature may cause him to shiver, which may cause a sudden fever spike and induce another seizure.

Upon delivery of a baby's head, you see that the umbilical cord is wrapped around its neck. Initial treatment for this condition should include: A) clamping and cutting the umbilical cord. B) gently pulling on the cord to facilitate removal. C) trying to remove the cord from around the neck. D) keeping the cord moist and providing rapid transport.

C If you can see the umbilical cord wrapped around the newborn's neck (nuchal cord) when the head delivers, you should gently attempt to slide the cord from around the neck. If this is unsuccessful, you should clamp and cut the cord and continue the delivery. You must never pull on the umbilical cord. In cases where the umbilical cord is prolapsed (the cord presents before the baby), you should make an attempt to move the fetus off of the umbilical cord; this often involves inserting your gloved fingers into the vagina and gently lifting the baby's head off of the cord. Cover the exposed cord with sterile moist dressings, administer oxygen to the mother, and transport without delay.

Following an apparent febrile seizure, a 4-year-old boy is alert and crying. His skin is hot and moist. Appropriate treatment this child includes: A) rapidly cooling the child in cold water. B) allowing the parents to transport the child. C) offering oxygen and providing transport. D) keeping the child warm and providing transport.

C Most children with febrile seizures do not have any permanent aftereffects. The most appropriate treatment is to offer the child oxygen (usually via the blow-by technique), allow a parent to accompany the child in the back of the ambulance, and transport to the hospital. Although most seizures in children result from a simple infection (ie, ear infection) that causes an abrupt rise in body temperature, other illnesses such as meningitis and encephalitis can cause seizures as well and are far more serious. For this reason, any child with fever and seizures should be evaluated in the emergency department. Rapid cooling of the child should be avoided, as this will likely cause shivering, which could abruptly increase the child's temperature and cause another seizure. Children with a fever should be kept cool during transport (ie, removing clothing), but not to the point where they shiver.

During your assessment of a woman in labor, you see the baby's arm protruding from the vagina. The mother tells you that she needs to push. You should: A) gently push the protruding arm back into the vagina. B) encourage the mother to push and give her high-flow oxygen. C) cover the arm with a sterile towel and transport immediately. D) insert your gloved fingers into the vagina and try to turn the baby.

C On rare occasions, the presenting part of the fetus is neither the head nor the buttocks, but a single arm or leg. This is called a limb presentation. You cannot successfully deliver such a presentation in the field. These infants usually must be delivered at the hospital. If you encounter a limb presentation, instruct the mother to stop pushing if she is experiencing a contraction; instead, instruct her to pant. Pushing may place pressure on the fetus, potentially causing injury. Cover the protruding limb with a sterile dressing or towel and transport immediately. Never try to push the limb back in, and never pull on it. Place the mother on her back, with head down and pelvis elevated. Because both mother and fetus are likely to be physically stressed in this situation, give the mother high-flow oxygen.

A 4-year-old boy ingested an unknown quantity of drain cleaner. He is alert, has a patent airway, and has adequate breathing. You should: A) administer 1 g/kg of activated charcoal. B) give oxygen and perform a head-to-toe exam. C) contact poison control and give him oxygen. D) give 15 mL of syrup of ipecac and contact medical control.

C Once you determine that a poisoning has occurred and have identified the poison, you should contact the poison control center at once: (800) 222-1222. Give the patient high-flow oxygen or assist his or her ventilations if necessary. Induction of vomiting with syrup of ipecac is no longer recommended because of the risk of aspiration. Activated charcoal is contraindicated in patients who have ingested a corrosive substance (eg, drain cleaner) or a petroleum product (eg, gasoline, motor oil). A head-to-toe exam is not practical in this situation, at least initially. Follow the directions given to you by the poison control center, transport the child without delay, and monitor his condition en route.

Which of the following is the MOST common cause of seizures in children? A) life-threatening infection B) A temperature greater than 102ºF C) An abrupt rise in body temperature D) In inflammatory process in the brain

C Seizures in children most often are the result of fever (febrile seizures). The occurrence of febrile seizures is not necessarily affected by how high the child's temperature gets, but how quickly it rises. The hypothalamus in the brain may not be able to accommodate such abrupt increases in body temperature. High fevers in children can be the result of massive infections, such as meningitis or encephalitis.

The 5-minute Apgar assessment of a newborn reveals a heart rate of 130 beats/min, cyanosis of the hands and feet, and rapid respirations. The infant cries when you flick the soles of its feet and resists attempts to straighten its legs. These findings equate to an Apgar score of: A) 7 B) 8 C) 9 D) 10

C The Apgar score, which is obtained at 1 and 5 minutes after birth (and every 5 minutes thereafter), assigns numbers (0, 1, or 2) to the following five areas: appearance, pulse, grimace, activity, and respirations. A score of 1 is assigned for appearance if the newborn's body is pink, but its hands and feet remain blue. If its heart rate is greater than 100 beats/min, it receives a score of 2 for the pulse. If it cries and tries to move its foot away when soles of its feet are flicked, it is assigned a score of 2 for grimace/irritability. If it resists attempts to straighten its hips and knees, a score of 2 is assigned for activity/muscle tone. If its respirations are rapid, a score of 2 is assigned. Based on these parameters, the newborn in this scenario would receive an Apgar score of 9. Refer to your EMT textbook for a complete review of the Apgar score.

In which of the following situations would the EMT MOST likely deliver a baby at the scene? A) Contractions are 8 to 10 minutes apart and irregular. B) The hospital is 15 miles away and crowning is not present. C) A tornado has struck and blocked the only route to the hospital. D) The amniotic sac has ruptured and contractions occur regularly.

C The EMT should prepare for delivery at the scene when delivery is imminent or can be expected within a few minutes (eg, the mother feels the urge to push, contractions are 2 to 3 minutes apart and regular, crowning is present); when a natural disaster (eg, flood, fire, tornado) has occurred and your route to the hospital is blocked; and when transportation is not available (eg, mechanical malfunction of the ambulance). These are just some of the factors to consider when making that critical decision. Rupture of the amniotic sac and the onset of contractions signals the beginning of the first stage of labor; delivery is usually not imminent at this point and it is generally safe to transport.

You are dispatched to a residence for a 4-year-old female who is sick. Your assessment reveals that she has increased work of breathing and is making a high-pitched sound during inhalation. Her mother tells you that she has been running a high fever for the past 24 hours. Your MOST immediate concern should be: A) preparing to treat her for a febrile seizure. B) taking her temperature to see how high it is. C) assessing the need for ventilation assistance. D) determining if the child has a history of croup.

C The child is clearly experiencing respiratory distress and probably has croup (laryngotracheobronchitis), a viral upper airway infection. The presence of stridor (high-pitched sound heard during inhalation) indicates swelling of the upper airway. Your most immediate concern should be assessing the adequacy of her breathing and determining if ventilation assistance is necessary. If signs of respiratory failure are present (eg, signs of physical exhaustion, bradycardia, bradypnea [slow respirations]), you must begin assisting her ventilations with a bag-valve-mask device; otherwise, she will likely deteriorate and develop cardiac arrest. She may experience a febrile seizure if her fever acutely spikes; although this is a concern, it is not the most immediate concern in a child with an airway or breathing problem.

A 6-year-old boy presents with a high fever, a headache, and a stiff neck. He is conscious, but is not acting as a normal 6-year-old boy should. His mother told you that he vomited once before your arrival. You should be MOST concerned with: A) the potential for a febrile seizure. B) treating him for severe dehydration. C) the risk of permanent neurologic damage. D) performing a secondary assessment at the scene.

C The child's symptoms (eg, high fever, headache, stiff neck [nuchal rigidity]) are consistent with meningitis, inflammation and infection of the protective coverings of the brain and spinal cord (meninges). Meningitis can be viral, bacterial, or fungal in nature. One form of meningitis, Neisseria meningitidis (N. meningitidis), deserves special attention. N. meningitidis is a bacterium that causes a rapid onset of symptoms and can cause shock, permanent neurologic damage, or death; this should be your primary concern. Administer oxygen as tolerated and transport without delay. If the child experiences a seizure, it will likely be the result of increased intracranial pressure secondary to meningitis, not his fever. Nonetheless, you should monitor him carefully and be prepared to treat any seizure activity. The child may be dehydrated, but there is little you can do for this at the scene; again, transport without delay. A secondary assessment should be performed, if time permits, albeit en route to the hospital.

You are caring for a 6-year-old child with a possible fractured arm and have reason to believe that the child was abused. How should you manage this situation? A) Inform the parents of your suspicions. B) Call the police and have the parents arrested. C) Advise the parents that the child needs to be transported. D) Transport the child to the hospital regardless of the parents' wishes.

C The responding EMT must handle cases of suspected child abuse with great care. You must never accuse the parents or caregiver of abuse. If you are wrong, you could be held liable for slander. Actions that would suggest such accusation includes summoning the police to have the parents arrested. Instead, you should advise the parents or caregiver that the child needs to be transported by ambulance, even if the injury is not life-threatening. The goal is to get the child to safety; however, this must be done legally (with parental consent). In most cases, you need the consent of only one parent to transport the child. Once at the hospital, you must apprise the physician of your suspicions.

Appropriate treatment for an 18-year-old woman with severe vaginal bleeding may include all of the following, EXCEPT: A) high concentrations of oxygen. B) keeping her warm with blankets. C) placing sterile dressings into the vagina. D) covering the vagina with a trauma dressing.

C The source of bleeding from the vagina cannot be directly controlled in the field. You should never pack or place any dressings directly into the vagina, as this increases the risk of infection; furthermore, these dressings will simply have to be removed at the hospital. Instead, you should place a trauma dressing or similar material over the vagina. If the patient has signs of shock, administer high-flow oxygen, keep her warm, and transport without delay.

Which of the following injuries is MOST indicative of child abuse? A) Small laceration to the chin B) Burned hand with splash marks C) Bruising to the upper back D) Multiple bruises to the shins

C To detect child abuse, you must be familiar with injury locations and patterns consistent with an accident versus those that were intentionally inflicted. It is common for children to trip, fall, and strike their chin or forehead on a solid object; therefore, chin lacerations and hematomas to the forehead are common injuries. Small children frequently hit their legs on coffee tables, resulting in bruises to the shins. If a child accidentally sticks his or her hand in hot water, the hand is quickly pulled back by reflex, resulting in a splash pattern of burns. Injuries found in anatomically unlikely areas, such as the torso (back or front), upper arms and legs, or genitalia, should raise your index of suspicion. Burns that are not accompanied by splash marks should also make you suspicious. For example, if a child's hand or foot is intentionally held in hot water, you will see a clear line of demarcation (stocking-glove effect) without evidence of splash burns.

Which of the following is a sign of an altered mental status in a small child? A) Recognition of the parents B) Fear of the EMT's presence C) Inattention to the EMT's presence D) Consistent eye contact with the EMT

C Typically, a small child will fear the presence of a stranger in his or her environment and will maintain constant eye contact with the stranger; therefore, inattentiveness to your presence should alert you to the presence of an altered mental status.

When you begin to assess a woman in labor, she states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be MOST appropriate to ask next? A) Has your bag of waters broken yet? B) Have you had regular prenatal care? C) At how many weeks' gestation are you? D) How many other children do you have?

C When assessing a patient in labor, the first question you should ask is how far along in the pregnancy she is. If she is at less than 37 weeks' gestation (37 to 42 weeks is term), you should prepare for possible resuscitation of the newborn if delivery occurs in the field. Other questions, such as asking if her amniotic sac (bag of waters) has ruptured and whether she has received prenatal care, also can help you anticipate and prepare for potential complications. You should also inquire as to how many times the patient has been pregnant, regardless of whether she carried the baby to term (gravida), and the number of times she has carried a baby beyond 28 weeks, regardless of whether it was born dead or alive (para).

Which position is MOST appropriate for a mother in labor with a prolapsed umbilical cord? A) Left lateral recumbent B) Left side with legs elevated C) Supine with hips elevated D) Supine with legs elevated

C When the umbilical cord is prolapsed, the infant typically slides down the birth canal and rests on top of the cord, shutting off its own oxygen supply. Placing the mother supine with her hips elevated will cause the baby to slide back into the birth canal slightly, thereby relieving the pressure on the cord. It may be necessary to insert your gloved fingers into the mother's vagina and lift the baby's head off the cord. Give the mother high-flow oxygen and transport without delay. A lateral recumbent (on the side) position is appropriate for pregnant women without a prolapsed cord and will help prevent the occurrence of supine hypotensive syndrome, a condition in which the pregnant uterus compresses the inferior vena cava and compromises cardiac output.

A prolapsed umbilical cord is dangerous because the: A) cord might pull the placenta from the uterine wall during delivery. B) mother may die of hypoxia due to compromised placental blood flow. C) cord may be wrapped around the baby's neck, causing strangulation. D) baby's head may compress the cord, cutting off its supply of oxygen.

D A prolapsed umbilical cord, a condition in which a portion of the umbilical cord delivers before the baby, is a dangerous condition; the baby's head may compress the cord, cutting off its own supply of oxygen. Therefore, when a prolapsed umbilical cord is discovered, it is important to take immediate action. Place the mother in a position in which her hips are elevated. It may be necessary to insert your gloved fingers into the vagina and lift the baby's head off of the cord. A nuchal cord occurs when the umbilical cord is wrapped around the baby's neck; it is relatively common and is usually easily treated by simply sliding the cord from around the baby's neck. A nuchal cord and a prolapsed umbilical cord usually do not occur at the same time.

A 3-year-old boy is found to be in cardiopulmonary arrest. As you begin one-rescuer CPR, your partner prepares the AED. The appropriate compression to ventilation ratio for this child is: A) 3:1 B) 5:1 C) 15:2 D) 30:2

D A universal compression to ventilation ratio of 30:2 is used for all one-rescuer CPR (adult, child, and infant), with the exception of the newborn. A compression to ventilation ratio of 3:1 is used for newborns (one- and two-rescuer). Two-rescuer infant and child CPR is performed at a compression to ventilation ratio of 15:2. In this scenario, you are performing one-rescuer CPR as your partner prepares the AED; therefore, you should give 30 compressions and 2 breaths. However, when you and your partner resume CPR, give 15 compressions and 2 breaths.

Immediately upon delivery of a newborn's head, you should: A) dry the face. B) cover the eyes. C) suction the nose. D) suction the mouth.

D As soon as the newborn's head has delivered, you should first suction the mouth, then the nose. As the infant is forced through the birth canal, the thoracic cavity is squeezed, which causes the infant to expel amniotic fluid from the lungs. If this fluid is not thoroughly suctioned, it can be aspirated, resulting in inadequate ventilation and hypoxia. Immediately before or after suctioning the infant's airway, you should check for the presence of a nuchal cord (umbilical cord wrapped around the neck).

You should assist with the delivery of the baby's head by: A) carefully rotating its head to where it is facing up when it delivers. B) placing the palm of your hand firmly against the back of the baby's skull. C) grasping each side of the baby's head and gently pulling to facilitate delivery. D) placing your fingers on the bony part of the skull and applying gentle pressure.

D Assist with the delivery of the baby's head by placing the flat parts of your fingers on the bony part of the skull as it emerges from the vagina and then applying gentle pressure to avoid an explosive delivery. Avoid pressing your fingers on the anterior and posterior fontanelles (soft spots). Do not attempt to rotate the baby's head or pull on it to facilitate delivery; these actions clearly increase the risk of injury.

Your assessmment of a newborn reveals cyanosis to the chest and face and a heart rate of 90 beats/min. What should you do first? A) Resuction the mouth. B) Briskly dry off the infant. C) Begin chest compressions. D) Begin artificial ventilations.

D Central cyanosis (cyanosis to the head, face, and trunk) alone initially should be treated with blow-by oxygen; however, when it is accompanied by a heart rate that is less than 100 beats/min, artificial ventilations should be initiated and continued until the heart rate exceeds 100 beats/min. Newborn bradycardia is defined as a heart rate of less than 100 beats/min. Chest compressions are indicated if the newborn's heart rate falls below 60 beats/min, despite 30 seconds of adequate positive-pressure ventilation. A newborn should be dried off thoroughly, regardless of its appearance at birth.

A sudden onset of respiratory distress in a 5-year-old child with no fever is MOST likely the result of: A) infection of the lower airways. B) inflammation of the upper airway. C) a progressive upper airway infection. D) a foreign body airway obstruction.

D Children with no fever who have a sudden onset of respiratory distress should be treated for a foreign body airway obstruction. If the child is able to cough, cry, or speak, he or she is moving adequate air and has a mild airway obstruction. If the child is unable to cough, cry, or speak, and if he or she is cyanotic and has a decreased level of consciousness, he or she is not moving adequate air and has a severe airway obstruction. Epiglottitis, a bacterial infection of the upper airway, also causes a sudden onset of respiratory distress, but is accompanied by a high fever. Croup, a viral infection of the upper airway, typically does not present acutely; however, it is often accompanied by a low-grade fever. Lower airway infections (ie, bronchitis, bronchiolitis) typically present with a progessive onset of respiratory distress and abnormal lung sounds, such as wheezing and rhonchi.

Upon delivery of the baby's head, you note that the umbilical cord is wrapped around its neck. You should: A) keep the cord warm and moist and transport without delay. B) immediately clamp and cut the cord and continue the delivery. C) give the mother high-flow oxygen and transport her on her side. D) make one attempt to gently remove the cord from around its neck.

D If the umbilical cord is wrapped around the baby's neck (nuchal cord), the EMT should make one attempt to gently remove the cord from around its neck. If this is unsuccessful, clamp and cut the cord and continue with the delivery. A nuchal cord can cause fetal asphyxia and must be treated immediately upon discovery.

To maintain neutral alignment of an 18-month-old child's airway, you should: A) hyperextend the head. B) place a rolled towel behind the head. C) ensure that the head is slightly flexed. D) place padding in between the shoulder blades.

D Infants and small children have proportionately large heads, specifically the occiput (back of the head). Therefore, it is often necessary to place padding in between the scapulae (shoulder blades) to ensure neutral alignment of the head. Padding behind the head places the child's head in the sniffing position, which is used to facilitate intubation. If the infant's or child's head is hyperextended, the large occiput may push the head forward, resulting in hyperflexion. Flexing the child's head will collapse the trachea, resulting in obstruction of the airway.

Management for a woman who presents with a prolapsed umbilical cord includes all of the following, EXCEPT: A) lifting the baby's head off of the umbilical cord. B) ensuring that the cord stays moist during transport. C) placing the mother in a position that elevates her hips. D) relieving pressure off of the cord by gently pulling on it.

D Management of a prolapsed umbilical cord includes administering high-flow oxygen to the mother; placing the mother in a position that elevates her hips (eg, knee-chest position); carefully inserting your gloved fingers into the vagina to lift the baby's head off of the cord; ensuring that the cord stays moist by covering it with moist, sterile dressings; and transporting rapidly. Never make any attempt to pull on the umbilical cord for any reason; doing so may damage the cord, resulting in severe hemorrhage.

You are dispatched to a residence for a child having a seizure. When you arrive at the scene, the 4-year-old child's grandfather tells you that he has had several full body seizures over the past 20 minutes, but never woke up in between the seizures. The child's skin is hot and flushed. This is MOST indicative of: A) a febrile seizure. B) a focal motor seizure. C) an absence seizure. D) status epilepticus.

D Status epilepticus is defined as a prolonged (greater than 20 minutes) seizure or multiple seizures without a return of consciousness in between seizures. A febrile seizure is caused by an abrupt rise in body temperature, usually due to a non-life-threatening infection (eg, middle ear infection). Most febrile seizures last less than 5 minutes, have resolved by the time EMS arrives at the scene, and are not followed by a postictal period. The child in this scenario, although febrile (hot, flushed skin), did not experience a seizure caused by fever alone; you should suspect other causes of fever and seizures, such as meningitis. An absence seizure, also called a petit mal seizure, is characterized by a blank stare and an absence of tonic-clonic motor activity. Like febrile seizures, absence seizures are usually of short duration and are not followed by a postictal period. A focal motor seizure is isolated to one part of the body, such as an extremity, but can progress to a generalized (full body) seizure.

After drying, warming, and suctioning a newborn's mouth and nose, assessment reveals central cyanosis, a weak cry, and a heart rate of 60 beats/min. The EMT should: A) clamp and cut the umbilical cord and transport at once. B) begin chest compressions and reassess after 30 seconds. C) resuction the mouth and nose and reassess the heart rate. D) ventilate with a bag-valve-mask at 40 to 60 breaths/min.

D The intial treatment for a cyanotic and bradycardic newborn is positive-pressure ventilation (PPV). Ventilate the newborn with a bag-valve-mask device at a rate of 40 to 60 breaths/min and then reassess the heart rate after 30 seconds. If the heart rate is below 60 beats/min after 30 seconds of adequate PPV, you should begin chest compressions. The umbilical cord should not be clamped and cut until it stops pulsating and the newborn is breathing adequately. Unnecessary suctioning can worsen hypoxia and bradycardia and should be avoided.

Prevention of cardiac arrest in infants and small children should focus primarily on: A) keeping the child warm. B) avoiding upsetting the child. C) providing immediate transport. D) ensuring adequate ventilation.

D The most common cause of cardiac arrest in infants and children is failure of the respiratory system. Their hearts generally are healthy, and they rarely go into ventricular fibrillation (V-Fib). The key to preventing cardiac arrest in the majority of infants and children is to ensure adequate ventilation and oxygenation.

You have just delivered a baby girl. Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should: A) massage the lower part of the mother's uterus until the placenta delivers. B) give the newborn high-flow oxygen via a nonrebreathing mask and transport. C) reassess the newborn every 5 minutes and transport after the placenta delivers. D) keep the newborn warm, give oxygen to the mother if needed, and transport.

D The newborn is stable and does not require care beyond providing thermal management and monitoring. Oxygen is indicated for the newborn if it has central cyanosis (cyanosis to the face and trunk), and should be delivered via the blow-by technique with the flowmeter set at 5 L/min. Cyanosis to the periphery of the body (eg, hands and feet), which is called acrocyanosis, is a normal finding in the newborn. You should not wait at the scene for the placenta to deliver; it can take up to 45 minutes for this to occur. Begin transport, keep the newborn warm, and give oxygen to the mother if indicated. Massaging the uterine fundus (top part of the uterus) is indicated for women with postpartum vaginal bleeding (ie, BOTH the baby and placenta have delivered).

The purpose of the pediatric assessment triangle is to: A) identify if the child has a medical condition or a traumatic injury. B) detect immediate life threats through a quick hands-on assessment. C) determine whether or not the child requires a hands-on assessment. D) form a general impression of the child without touching him or her.

D The pediatric assessment triangle (PAT) is a structured assessment tool that allows you to rapidly form a general impression of the infant's or child's condition without touching him or her. The intent is to provide a "first glance" assessment to identify the general category of the child's physiologic problem and to establish urgency for treatment and/or transport. The PAT is a visual assessment of the child before performing a hands-on assessment. It consists of three elements: appearance (muscle tone and mental status), work of breathing, and circulation to the skin. The only equipment required for the PAT are your own eyes and ears. The PAT will help the EMT determine if the child's problem is of a respiratory, circulatory, or neurologic nature.

If a woman is having her first child, the first stage of labor: A) generally does not allow time for you to transport. B) is typically very short and lasts only about 2 hours. C) is shorter than in women who have had other children. D) is usually the longest and lasts an average of 16 hours.

D There are three stages of labor: dilation of the cervix, delivery of the baby, and delivery of the placenta. The first stage begins with the onset of contractions and ends when the cervix is fully dilated. Since assessing for cervical dilation is not performed in the prehospital setting, the first stage of labor is said to have ended when crowning occurs. Because the cervix has to be stretched thin by uterine contractions until the opening is large enough for the fetus to pass through into the vagina, the first stage is usually the longest, lasting an average of 16 hours for a first delivery. With subsequent pregnancies, the first stage of labor typically progresses more quickly. You will usually have enough time to transport the mother during the first stage of labor, especially if this is her first pregnancy. It should be noted, however, than some primigravida (pregnant for the first time) women progress through the first stage of labor very quickly.

Which artery should you palpate when assessing for a pulse in an unresponsive 6-month-old patient? A) Radial B) Carotid C) Femoral D) Brachial

D You should assess the brachial pulse in infants younger than 1 year of age. The carotid or femoral pulse can be assessed in children older than 1 year of age. A carotid pulse is difficult to locate in infants because they have minimal space between their head and shoulders.

A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect: A) croup. B) epiglottitis. C) lower respiratory infection. D) foreign body airway obstruction.

D You should suspect a foreign body airway obstruction in any child who presents with an acute onset of respiratory distress in the absence of fever. Croup, epiglottitis, and lower airway infections (ie, bronchiolitis, bronchitis) commonly present with a fever. If the child is experiencing a mild airway obstruction, in which he or she is moving adequate air, has a normal level of consciousness, and has pink skin, do not attempt to relieve the airway obstruction; doing so may result in a severe airway obstruction. Offer oxygen and transport the child to the hospital without delay. If signs of a severe airway obstruction are present (ie, ineffective cough, decreased level of consciousness, cyanosis), you should perform abdominal thrusts until the object is expelled or the child becomes unresponsive. If the child becomes unresponsive, perform chest compressions.