Chapter 34 Pediatric Emergencies

Submersion injuries in the adolescent age group are MOST commonly associated with: A. alcohol B. child abuse C. hyperthermia D. swimming pools

A. alcohol

Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler: A. at the feet. B. in the ambulance. C. at the head. D. en route to the hospital.

A. at the feet.

An 8-year-old female with a history of asthma continues to experience severe respiratory distress despite being given multiple doses of her prescribed albuterol by her mother. She is conscious but clearly restless. Her heart rate is 130 beats/min and her respiratory rate is 30 breaths/min. She is receiving high-flow oxygen via a nonrebreathing mask. You should: A. be prepared to assist her ventilations, transport at once, and request an ALS intercept en route to the hospital. B. continue high-flow oxygen therapy, contact medical control, and request permission to administer more albuterol. C. begin immediate ventilation assistance and ensure that you squeeze the bag forcefully in order to open her bronchioles. D. begin chest compressions if she becomes unresponsive and her heart rate falls below 80 beats/min.

A. be prepared to assist her ventilations, transport at once, and request an ALS intercept en route to the hospital.

A viral infection that may cause obstruction of the upper airway in a child is called: A. croup. B. asthma. C. bronchitis. D. epiglottitis.

A. croup. Chapter 34, page 1244, Respiratory Emergencies and Management

When a child experiences a blunt injury to the abdomen: A. he or she can compensate for blood loss better than adults without signs of shock developing. B. his or her blood pressure falls with as little as 5% blood loss. C. your assessment will most often reveal bruising to the abdomen. D. delayed capillary refill indicates a state of decompensated shock.

A. he or she can compensate for blood loss better than adults without signs of shock developing.

While triaging patients at the scene of a motor-vehicle crash, you encounter a 5-year-old child who is unresponsive and apneic. After positioning his airway, you should: A. palpate for a carotid pulse. B. categorize him as immediate. C. categorize him as deceased. D. deliver 5 rescue breaths.

A. palpate for a carotid pulse.

Compared to adults, the liver and spleen of pediatric patients are more prone to injury and bleeding because they are: A. proportionately larger and situated more anteriorly. B. more vascular despite the fact that they are proportionately smaller. C. spaced further apart, which causes them to shift following trauma. D. lower in the abdominal cavity, where the muscles are not as strong.

A. proportionately larger and situated more anteriorly.

EMTs are assessing a 2-year-old child who was riding in a car seat when the vehicle struck a tree while traveling at 45 MPH. The child is conscious and appears alert. There are no obvious signs of trauma to the child, and the car seat does not appear to be damaged. The EMTs should: A. remove the child from the car seat and secure him to a pediatric immobilization device. B. leave the child in the car seat, but pad around the child's head with towels or a pillow. C. remove the child from the car seat and secure both him and his mother to the stretcher. D. secure the child in the car seat with straps and apply a pediatric-sized cervical collar.

A. remove the child from the car seat and secure him to a pediatric immobilization device.

When assessing or treating an adolescent patient, it is important to remember that: A. they usually do not wish to be observed during a procedure. B. it is generally not necessary to explain procedures in advance. C. they often request medication to help in the relief of severe pain. D. they cannot understand complex concepts and treatment options.

A. they usually do not wish to be observed during a procedure.

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.

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

Answer: A Rationale: 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.

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.

Answer: A Rationale: 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 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.

Answer: B Rationale: 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.

Answer: B Rationale: 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.

When a child is struck by a car, the area of greatest injury depends MOSTLY on the: A. height of the child and the speed at which the car was traveling. B. age of the child and the size of the car that struck him or her. C. size of the child and the height of the bumper upon impact. D. speed at which the car was traveling when impact occurred.

B. age of the child and the size of the car that struck him or her.

Infection should be considered a possible cause of an airway obstruction in an infant or child, especially if he or she presents with: A. skin that is cool and dry. B. drooling or congestion. C. acute respiratory distress. D. extreme restlessness.

B. drooling or congestion.

A 4-year-old, 16-kg female ingested an unknown quantity of liquid drain cleaner. Your assessment reveals that she is conscious and alert, is breathing adequately, and has skin burns around her mouth. You should: A. place her supine and elevate her legs. B. monitor her airway and give oxygen. C. determine why the ingestion occurred. D. administer 16 g of activated charcoal.

B. monitor her airway and give oxygen.

Severe burns in children include: A. any superficial or partial-thickness burn that involves the legs or arms. B. partial-thickness burns covering more than 20% of the body surface. C. second-degree burns covering more than 10% of the body surface. D. superficial burns covering more than 10% to 15% of the body surface.

B. partial-thickness burns covering more than 20% of the body surface.

To ensure that the airway of an infant or small child is correctly positioned, you may have to: A. place bulky padding behind his or her occiput. B. place a towel or folded sheet behind the shoulders. C. slightly flex the neck to prevent tracheal kinking. D. hyperextend the neck to ensure adequate alignment.

B. place a towel or folded sheet behind the shoulders.

The MOST efficient way to identify the appropriately sized equipment for a pediatric patient is to: A. estimate the child's weight based on age. B. use a length-based resuscitation tape measure. C. estimate the child's weight based on appearance. D. ask a relative if he or she knows the child's weight.

B. use a length-based resuscitation tape measure.

The purpose of the pediatric assessment triangle (PAT) is to: A. determine if the child's vital signs are within the age-appropriate limits. B. facilitate a rapid head-to-toe assessment of the child by visualization only. C. allow you to rapidly and visually form a general impression of the child. D. gather critical data by performing a rapid hands-on assessment of the child.

C. allow you to rapidly and visually form a general impression of the child.

Signs of a severe airway obstruction in an infant or child include: A. pink, dry skin. B. crying and anxiety. C. an ineffective cough. D. mild respiratory distress.

C. an ineffective cough.

The secondary assessment of a sick or injured child: A. is a rapid head-to-toe exam to detect life threats. B. should be performed, regardless of the circumstances. C. may not be possible if the child's condition is critical. D. is most appropriate when your transport time is short.

C. may not be possible if the child's condition is critical.

Which of the following statements regarding a 3-month-old infant is correct? A. The infant is unable to turn his or her head and focus. B. The infant should be aroused easily from a sleeping state. C. At this age, the infant typically sleeps for up to 8 hours a day. D. A 3-month-old infant can distinguish a parent from a stranger.

D. A 3-month-old infant can distinguish a parent from a stranger.

Which of the following statements regarding sudden infant death syndrome (SIDS) is correct? A. SIDS is most commonly the result of an overwhelming infection. B. Certain cases of SIDS are predictable and therefore preventable. C. The cause of death following SIDS can be established by autopsy. D. Death as a result of SIDS can occur at any time of the day or night.

D. Death as a result of SIDS can occur at any time of the day or night.

You respond to a skate park where a 10-year-old male fell from his skateboard and struck his head on the ground; he was not wearing a helmet. He is responsive to painful stimuli only and has a large hematoma on the back of his head. After your partner stabilizes his head and opens his airway, you assess his breathing and determine that it is slow and irregular. His pulse is slow and bounding. You should: A. apply high-flow oxygen via a nonrebreathing mask, perform an in-depth secondary assessment, apply full spinal precautions, and transport. B. insert an oral airway, hyperventilate him with a bag-valve mask, apply full spinal precautions, and transport to the closest trauma center. C. apply high-flow oxygen via a nonrebreathing mask, obtain baseline vital signs, apply full spinal precautions, and perform a secondary assessment. D. assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center.

D. assist his ventilations, be prepared to suction his mouth if he vomits, apply full spinal precautions, and prepare for immediate transport to a trauma center.

Signs and symptoms of meningitis in the infant or child include all of the following, EXCEPT: A. a stiff or painful neck. B. headache and fever. C. altered mental status. D. sunken fontanelles.

D. sunken fontanelles.

Febrile seizures are MOST common in children between the ages of: A. 3 moths and 4 years B. 6 months and 6 years C. 8 months and 8 years D. 18 months and 10 years

B. 6 months and 6 years

Which of the following is the LEAST reliable assessment parameter to evaluate when determining the presence of shock in infants and children? A. Pulse rate B. Blood Pressure C. Skin condition D. Capillary refill

B. Blood Pressure

Cardiac arrest in the pediatric population is MOST commonly the result of: A. a complete airway obstruction. B. failure of the respiratory system. C. a congenital cardiovascular defect. D. lethal cardiac rhythm disturbances.

B. failure of the respiratory system.

A 5-year-old child has had severe vomiting and diarrhea for 4 days. Which of the following assessment findings would be the MOST indicative of decompensated shock? A. Capillary refill time of 4 seconds B. Respiratory rate of 30 breaths/min C. Blood pressure of 70/40 mm Hg D. Pulse rate greater than 120/min

C. Blood pressure of 70/40 mm Hg Chapter 34, page 1254, Circulation Emergencies and Management

Which of the following statements regarding a pediatric patient's anatomy is correct? A. The tracheal rings of a child are more rigid than an adult's. B. A child's tongue is proportionately smaller than an adult's. C. Children have a larger, rounder occiput compared to adults. D. The child's epiglottis is less floppy and smaller than an adult's.

C. Children have a larger, rounder occiput compared to adults.

After using the pediatric assessment triangle (PAT) to form your general impression of a sick or injured child, you should: A. evaluate the child's baseline vital signs. B. obtain a SAMPLE history from the parents. C. perform a hands-on assessment of the ABCs. D. assess the child's heart rate and skin condition.

C. perform a hands-on assessment of the ABCs.

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

An infant with severe dehydration would be expected to present with: A. excessive tearing. B. moist oral mucosa. C. bulging fontanelles. D. absent urine output.

D. Absent urine output. Chapter 34, page 1259, Poisoning Emergencies and Management

Which of the following statements regarding preschool-age children is correct? A. They realize that injuries are not a form of punishment. B. Preschoolers are usually not fearful of pain or separation C. The preschool age begins after the child turns 2 years old. D. They can usually identify painful areas when questioned.

D. They can usually identify painful areas when questioned.

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.

Answer: C Rationale: 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.

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.

Answer: C Rationale: 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.

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.

Answer: D Rationale: 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.

Answer: D Rationale: 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.