EMT-B, Ch 34: Pediatric Emergencies

Skill Drill What are the three steps of inserting an oropharyngeal airway in a pediatric patient?

1) Determine the appropriately sized airway. Confirm the correct size visually, by placing it next to the pediatric patient's face. 2) Position the pediatric patient's airway with the appropriate method. 3) Open the mouth. Insert the airway until the flange rests against the lips. Reassess the airway.

Skill Drill What are the three steps of inserting a nasopharyngeal airway in a pediatric patient?

1) Determine the correct airway size by comparing its diameter to the opening of the nostril (nare). Place the airway next to the pediatric patient's face to confirm correct length. Position the airway. 2) Lubricate the airway. Insert the tip into the right naris with the bevel pointing toward the septum. 3) Carefully move the tip forward until the flange rests against the outside of the nostril. Reassess the airway.

Match the stage of childhood with the appropriate assessment descriptor. Stage-- 1) Infant 2) Toddler 3) Preschool-age 4) Adolescent Descriptor-- a. Interview the patient without the parent or caregiver present. b. Give the patient simple, appropriate choices, such as, "Would you like to sit up or lie down?" c. Do any painful or uncomfortable procedures at the end of the assessment process. c. Use visual clues and the Wong-Baker FACES pain scale.

1) Infant (ages 0-1) --> c. Do any painful or uncomfortable procedures at the end of the assessment process. 2) Toddler (ages 1-3) --> c. Use visual clues and the Wong-Baker FACES pain scale. 3) Preschool-age (ages 3-6) --> b. Give the patient simple, appropriate choices, such as, "Would you like to sit up or lie down?" 4) Adolescent (ages 12-18) --> a. Interview the patient without the parent or caregiver present. *(There is one additional stage of childhood than the four listed above: School-age, which is from ages 6-12)

Skill Drill What are the four steps of one-person bag-valve mask ventilation on a pediatric patient?

1) Open the airway and insert the appropriate airway adjunct. 2) Hold the mask on the pediatric patient's face with a one-handed head tilt-chin lift maneuver (EC clamp method). Ensure a good mask-face seal while maintaining the airway. 3) Squeeze the bag using the correct ventilation rate of 1 breath every 3 to 5 seconds, or 12 to 20 breaths/min. Allow adequate time for exhalation. 4) Assess the effectiveness of ventilation by watching bilateral rise and fall of the chest.

Skill Drill What are the three steps for positioning the airway in a pediatric patient?

1) Position the pediatric patient on a firm surface. 2) Place a folded towel about 1-inch (2.5-cm) thick under the shoulders and back. 3) Stabilize the forehead to limit movement and use the head tilt-chin lift maneuver to open the airway.

Skill Drill What are the six steps of immobilizing a patient (pediatric) in a car seat?

1) Stabilize the head in neutral position. 2) Place a short backboard or pediatric immobilization device between the patient and the surface he or she is resting on. 3) Slide the patient onto the short backboard or pediatric immobilization device. 4) Place a towel under the back, from the shoulders to the hips, to ensure neutral head position. 5) Secure the torso first; pad any voids. 6) Secure the head to the short backboard or pediatric immobilization device.

Skill Drill What are the six steps of immobilizing a pediatric patient?

1) Use a towel under the back, from the shoulders to the hips, to maintain the head in a neutral position. 2) Apply an appropriately sized cervical collar. 3) Log roll the child onto the short backboard or pediatric immobilization device. 4) Secure the torso first. 5) Secure the head. 6) Ensure that the child is strapped in properly.

When using the mnemonic CHILD ABUSE to assess a child for signs of abuse, you should recall that the "D" stands for: A. delay in seeking care. B. divorced parents. C. dirty appearance. D. disorganized speech.

A. delay in seeking care. --> The mnemonic CHILD ABUSE stands for Consistency of the injury with the child's developmental age, History inconsistent with the injury, Inappropriate parental concerns, Lack of supervision, Delay in seeking care, Affect, Bruises of varying stages, Unusual injury patterns, Suspicious circumstances, and Environmental clues. A delay in care may happen when the parent or caregiver does not want the abuse noted by other people.

When a small child falls from a significant height, the ______ MOST often strikes the ground first. A. head B. back C. feet D. side

A. head --> Compared to adults, pediatric patients have proportionately larger heads. When they fall from a significant height, gravity usually takes them headfirst. This is why head trauma is the most common cause of traumatic death in the pediatric patient.

The purpose of a shunt is to: A. minimize pressure within the skull. B. reroute blood away from the lungs. C. instill food directly into the stomach. D. drain excess fluid from the peritoneum.

A. minimize pressure within the skull. --> A ventriculoperitoneal (VP) shunt—simply called a "shunt"—is a tube that extends from the ventricles (cavities) of the brain to the peritoneal cavity. VP shunts are used to drain excess fluid from the brain, thus preventing increased pressure within the skull.

When assessing a conscious and alert 9-year-old child, you should: A. isolate the child from his or her parent. B. allow the child to answer your questions. C. obtain all of your information from the parent. D. avoid placing yourself below the child's eye level.

B. allow the child to answer your questions. --> A 9-year-old child is capable of answering questions. By allowing a child to answer your questions, you can gain his or her trust and build a good rapport, which facilitates further assessment and treatment. Do not isolate the child from his or her parent, yet do not allow the parent to do all the talking, unless the child is unable to communicate. When assessing any patient, you should place yourself at or slightly below the patient's eye level. This position is less intimidating and helps to minimize patient anxiety.

Treatment for a semiconscious child who swallowed an unknown quantity of pills includes: A. administering 1 g/kg of activated charcoal and rapidly transporting. B. monitoring the child for vomiting, administering oxygen, and transporting. C. positioning the child on his left side, elevating his legs 6 inches, and transporting. D. contacting medical control and requesting permission to induce vomiting.

B. monitoring the child for vomiting, administering oxygen, and transporting. --> If a semi- or unconscious child has ingested pills, poisons, or any other type of harmful substance, closely observe for vomiting, give high-flow oxygen (assist ventilations if necessary), and rapidly transport to the emergency department. Do not give activated charcoal to any patient who is not conscious and alert enough to swallow. Induction of vomiting is not indicated for anyone—regardless of age.

The AVPU scale is used to monitor a patient's level of consciousness. What does the "P" stand for? A. Pallor B. Pediatric C. Painful D. Pale

C. Painful --> The "P" in the AVPU scale stands for painful. If the patient is responsive to pain they should withdraw from it.

You respond to a sick child late at night. The child appears very ill, has a high fever, and is drooling. He is sitting in a tripod position, struggling to breathe. You should suspect: A. croup. B. pneumonia. C. epiglottitis. D. severe asthma.

C. epiglottitis. --> This child has all the classic signs of epiglottitis: high fever, drooling, and severe respiratory distress. Epiglottitis is a potentially life-threatening bacterial infection that causes the epiglottis to swell rapidly and potentially obstruct the airway.

A 4-year-old girl fell from a second-story balcony and landed on her head. She is unresponsive; has slow, irregular breathing; has a large hematoma to the top of her head; and is bleeding from her nose. You should: A. immediately perform a full-body scan to detect other injuries, administer high-flow oxygen, and transport at once. B. apply a pediatric-sized cervical collar, administer high-flow oxygen via pediatric nonrebreathing mask, and prepare for immediate transport. C. manually stabilize her head, open her airway with the jaw-thrust maneuver, insert an airway adjunct, and begin assisting her ventilations with a bag-valve mask. D. suction her airway for up to 10 seconds, insert a nasopharyngeal airway, apply a pediatric-sized cervical collar, and administer oxygen via pediatric nonrebreathing mask.

C. manually stabilize her head, open her airway with the jaw-thrust maneuver, insert an airway adjunct, and begin assisting her ventilations with a bag-valve mask. --> This child has a severe head injury and is not breathing adequately. You must manually stabilize her head to protect her spine, open her airway with the jaw-thrust maneuver, suction her airway if needed, insert an oropharyngeal airway, and assist her ventilations with a bag-valve mask. The full-body scan is performed after you have performed a primary assessment to detect and correct any life threats. The nasopharyngeal airway is contraindicated for this child; she has a head injury and is bleeding from her nose.

Which of the following statements regarding febrile seizures is correct? A. Febrile seizures usually indicate a serious underlying condition, such as meningitis. B. Most febrile seizures occur in children between the ages of 2 months and 2 years of age. C. Febrile seizures are rarely associated with tonic-clonic activity, but last for more than 15 minutes. D. Febrile seizures usually last less than 15 minutes and often do not have a postictal phase.

D. Febrile seizures usually last less than 15 minutes and often do not have a postictal phase. --> Febrile seizures are the most common seizures in pediatric patients; they are common between the ages of 6 months and 6 years of age. Most pediatric seizures are due to fever alone—hence the name "febrile" seizure. However, seizures and fever may indicate a more serious underlying condition, such as meningitis. Febrile seizures are characterized by generalized tonic-clonic activity and last less than 15 minutes; if a postictal phase occurs, it is generally very short.

How does pediatric anatomy differ from adult anatomy? A. The trachea is more rigid. B. The tongue is proportionately smaller. C. The epiglottis is less floppy. D. The head is proportionately larger.

D. The head is proportionately larger. --> There are several important anatomic differences between pediatric patients and adult patients. The head—specifically the occiput—is proportionately larger. Their tongue and epiglottis are also proportionately larger, and the epiglottis is floppier and more omega-shaped. The child's airway is narrower at all levels, and the trachea is less rigid and easily collapsible.

True/False: Use activated charcoal for pediatric patients who have ingested an acid, an alkali, or a petroleum product.

False

True/False: The most common cause of dehydration in pediatric patients is sweating.

False: The most common cause of dehydration in pediatric patients is vomiting and diarrhea.

True/False: Fever and altered LOC are common symptoms of meningitis in patients of all ages.

True

True/False: The postictal state begins once a seizure has stopped; the patient's muscles relax, becoming almost flaccid, and the breathing becomes labored.

True

In a normal adult, greater than 30% to 40% of blood volume loss significantly increases the risk of shock. What is the threshold of blood volume loss in children? a. 25% b. 30% c. 45% d. 50%

a. 25%

You are responding to a 9-1-1 call where the mother reported finding her 3-month-old daughter cyanotic and unresponsive in her crib. When you stimulate the child, she responds. This is an example of what condition? a. Apparent life-threatening event b. SIDS c. Shaken baby syndrome d. Febrile seizure

a. Apparent life-threatening event

Which of the following are true about the pediatric airway? (Select all that apply) a. The pediatric airway is smaller in diameter and shorter in length. b. The tongue is proportionally the same but more posterior. c. Children have a funnel-shaped upper airway. d. Smaller lungs mean that the oxygen reserves are smaller.

a. The pediatric airway is smaller in diameter and shorter in length. c. Children have a funnel-shaped upper airway. d. Smaller lungs mean that the oxygen reserves are smaller.

What does the PAT assess? a. Airway, breathing, circulation b. Appearance, work of breathing, circulation c. Alert, responsive, unresponsive d. Tone, interactiveness, consolabiliy, look, speech/cry

b. Appearance, work of breathing, circulation

What does respiratory syncytial virus (RSV) cause? a. Pneumonia b. Bronchiolitis c. Epiglottitis d. Pertussis

b. Bronchiolitis --> Bronchiolitis is a specific viral illness of newborns and toddlers, often caused by respiratory syncytial virus (RSV), that causes inflammation of the bronchioles.

________ is/are the recommended way to relieve a severe airway obstruction in an unconscious child. a. Abdominal thrusts b. Chest compressions c. Suctioning d. Sweeping

b. Chest compressions

If a pediatric patient begins seizing again during your care, which of the following would be your treatment priority? a. Stopping the seizure b. Securing and clearing the airway c. Providing rapid transport d. Maintaining the patient's body temperature

b. Securing and clearing the airway

You are using JumpSTART in a triage situation involving several children. How would you rate a patient who is breathing spontaneously, has a peripheral pulse, and is appropriately responsive to painful stimuli? a. Green tag b. Yellow tag c. Red tag d. Black tag

b. Yellow tag

Which of the following is true about a child's breathing? a. Older children experience intercostal muscle fatigue more quickly than younger children. b. A child's oxygen demand is about the same as that of an adult. c. Because less air is exchanged with each breath, detection of poor air movement or complete absence of breath sounds can be difficult. d. The trachea is proportionally larger in an infant, leading to a greater potential for choking.

c. Because less air is exchanged with each breath, detection of poor air movement or complete absence of breath sounds can be difficult.

Young children are more likely to experience ________ than adults. a. Cardiopulmonary arrest b. Femur fractures c. Greenstick fractures d. Sprains

c. Greenstick fractures

You are assessing a 6-year-old boy who has a fever of 102 and is showing signs of altered LOC. He is complaining of pain when he tries to turn his head. What condition should you suspect? a. Anaphylactic shock b. Febrile seizure c. Meningitis d. Spinal cord injury

c. Meningitis

A ________ provides 24% to 44% oxygen concentration. a. Blow-by b. BVM c. Nasal cannula d. Nonrebreathing mask

c. Nasal cannula

With which age group should you talk to the child, not just the parent, while taking the medical history? a. Toddler b. Preschooler c. School-age d. Adolescent

c. School-age --> School-age children (6-12 years) begin to act more like adults. Including them in the history-taking conversation helps build trust.

What should you use the Wong-Baker FACES scale to determine? a. Motor response b. LOC c. Work of breathing d. Pain level

d. Pain level --> The Wong-Baker FACES scale uses pictures of facial expressions to help assess the level of pain in a child.