Volume 5 Chapter 4
Documenting a suspected child abuse case in your patient care report should:
follow a discussion with legal counsel regarding what you are allowed to document.
Evaluation of breathing adequacy in the pediatric patient includes assessment of all of the following conditions except ______________
heart rate.
Your patient is a 10-year-old boy who was struck by a car traveling 35 miles per hour as he crossed a street. He responds to verbal stimuli and has pale, cool skin. He has a heart rate of 142, respirations of 32, and a capillary refill time of greater than 4 seconds. You estimate he weighs 65 lb. You have initiated oxygen and an IV of normal saline; if 65 lb is 29.5 kg that can be rounded to 30 kg, then how many mL should your initial bolus be?
600
You should consider the heart rate of a 5-year-old patient to be bradycardic beginning at a rate below how many beats per minute?
70
Generally, adolescents:
are good historians.
Above what respiratory rate would a 10-year-old child be considered to be breathing abnormally fast?
30/min
What is the proper dose of amiodarone for a pediatric patient?
5.0 mg/kg
What is the initial setting for asynchronous cardioversion in a pediatric cardiac arrest patient displaying ventricular tachycardia?
2 joules per kilogram
What should be the initial dosage of an isotonic crystaline solution for use in a 4-year-old hypovolemic shock patient?
20 mL/kg
What age should a pediatric patient be before blood pressures are routinely utilized?
3 years
You are on scene with a pediatric patient who is obtunded due to a congenital brain defect. As you are assessing the patient, you note that she has a gastric feeding tube and currently is hooked up to a machine that is delivering a feeding. You have not seen this type of pump before and have little experience with gastric tubes. What action should you take?
Ask the patient and caregivers about the device.
Which of the following is a sign specifically of respiratory arrest?
Absent chest wall motion
A 3-year-old child presents with a high fever, flushed cheeks, crying, and refusal to take food or fluids. He is sitting up and refuses to lie down. Lung sounds are clear and equal. Vital signs are HR 128, capillary refill less than 2 seconds, RR 28, and SpO2 98 percent on room air. Which of the following treatment plans would be appropriate for this patient?
Administer humidified oxygen, transport in a position of comfort, and alert the receiving hospital.
Which of the following medications is not used in pediatric cardiac arrest?
Atropine
Children in which age group worry about their physical image more than those in any other pediatric age group?
Adolescents, ages 13-18 years
Which of the following is the most common cause of cardiac arrest in an infant or young child?
Airway and respiratory problems
You are providing care to a 2-year-old who you suspect is suffering from laryngotracheobronchitis. Medical command has recommended administration of racemic epinephrine, which you do not carry. What alternative may he recommend you administer?
Albuterol
Which of these is not a concern that Emergency Medical Services for Children (EMSC) has identifed?
An individualized approach to pediatric care
You are caring for a pediatric patient who relies on a home ventilator 24 hours a day. If you have any doubts whether the ventilator is working, which of the following should you immediately do?
Begin bag-valve mask ventilations, while you have the caregiver try to troubleshoot the ventilator.
You are caring for a 2-year-old child who has been sick with a fever, diarrhea, and vomiting for 24 hours. To assess perfusion, which of these would provide you with the least reliable information aboutdehydration?
Blood pressure
What finding in a distressed infant or child may indicate hypoxia and is an ominous sign of cardiac arrest?
Bradycardia
Which of the following findings seems least consistent with child abuse?
Bruises on both knees of a 5-year-old
Which of these is the best description of asthma?
Inflammatory disease of the lower airways
Several large EMS systems have abandoned the practice of pediatric endotracheal intubation in favor of simple:
CPAP.
High winds blew down a tent at an outdoor high school graduation reception. A fire started from the fuel used for the hot buffet. Several people were injured by the tent collapse, and several patients have burns. The first patient you triage is a 3-year-old girl. She is not breathing. You open her airway, but she does not start breathing. What is the next action?
Check the patient's pulse.
You are caring for a lethargic infant following EMS notification by a babysitter. The babysitter tells you that the infant was like that when the parents left for a party, and she called 911 after they left. You notice that the infant is very small for his weight, appears very dirty, has dried urine in his diaper, and has bruises on both arms. Which of the following should you be concerned about?
Child abuse and neglect
What is not a routine challenge of pediatric care for the paramedic?
Children cannot receive care without a parent or guardian present.
While you are questioning a 4-year-old with abdominal pain, he tells you that his stomach started hurting last week. Which of the following should you do next?
Continue questioning the child but verify information with the parents.
A 12-year-old patient collided face first with another child while both were riding bikes. The patient bit his tongue when his jaw was struck and received a black right eye and bloody nose. He is alert and oriented, and after you suction some blood from his airway appears to have no respiratory compromise, with respirations clear bilaterally and 20/minute. Your index of suspicion should be high for what other injury?
Dental
What type of shock in the pediatric patient occurs when there is a marked decrease in peripheral vascular resistance?
Distributive
Which of these statements best describes why paramedics should be knowledgeable about pediatric patients who are dependent on medical technology?
EMS may be called when the medical condition worsens or a medical device fails.
The ______________ was formed for the express purpose of improving the health of pediatric patients who suffer potentially life-threatening illnesses or injuries.
EMSC
Which percentage of body surface area is correct according to the pediatric modifications for the rule ofnines?
Entire leg is 13.5 percent
What is the single most common cause of injury in children?
Falls
You are transporting a dehydrated 9-month-old who has had a fever, vomiting, and diarrhea for 12 hours. He is lethargic with pale, cool, mottled skin and capillary refill time of 4 seconds. His respiratory rate is 38, and you have initiated oxygen administration and have started an IO infusion followed by an initial bolus of fluid according to protocol. The patient's perfusion has not improved. Which of the following is the best choice with regard to fluid resuscitation?
Give a second bolus of 20 mL/kg
You are at a racetrack where a racecar crashed into the fence separating the grandstands from the track. A large amount of debris, including tires and large pieces of the car, was propelled through and over thefence, striking several spectators. As you approach the area, a man and a child run toward you. The man has a bleeding head wound, to which he has applied pressure with a piece of clothing. The child has an obvious deformity of his shoulder. What is the correct triage category for the child?
Green
You have arrived on the scene of a child with reported difficulty breathing. The patient is a 4-year-old male who is sitting on the floor, putting together a puzzle with his mother. One of the first things that you notice is that the child is grunting with every exhalation. Which of the following should you suspect as the cause of the grunting?
He is having difficulty keeping his lower airways open.
A 2-year-old child ingested some lamp oil intended for use in an old-fashioned kerosene lamp. The patient presents with a depressed respiratory rate, gastrointestinal irritation, and a diminished level of consciousness. What type of poisoning do you suspect?
Hydrocarbon
You are evaluating an 18-month-old child who presents with a history of fever, diarrhea, and vomiting. You notice that the child has very dry lips. Her skin is dry, mottled, and cool, and her radial pulse is weak in comparison with her carotid pulse. Her respirations are 30 with adequate depth. Her lung sounds are clear, and her pulse oximetry shows an SpO2 of 96 percent with a heart rate of 140/minute. Her blood glucose level is 60 mg/dL. What is the primary problem for which you will treat this patient?
Hypoperfusion
Which of the following categories of pediatric shock is NOT considered a type of distributive shock?
Hypovolemic
What is the most common cause of pediatric bradyarrhythmias?
Hypoxia
Why is it important for the paramedic to observe the child's respiratory rate before beginning the examination?
If the child becomes distressed during the examination, then the respiratory rate will be impossible to determine.
Children in which age group should be examined in toe-to-head order?
Infants, ages 6-12 months
You are assessing a pediatric patient who has a rapid respiratory rate, absent alveolar breath sounds, a dropping pulse oximetry reading, and a spontaneous pulse of 102. What should you do next?
Initiate positive pressure ventilation.
Which of these terms should be used to convey the preventable nature of childhood trauma?
Injury
You note gastric distention in a 6-month-old patient experiencing respiratory failure you are attempting to ventilate but for whom you are not able to achieve adequate tidal volume. What do you do?
Insert an 8.0 French nasogastric tube.
Which stage of shock develops when the body can no longer compensate for decreased tissue perfusion and the patient enters cardiac arrest?
Irreversible
You are assessing a 20-month-old child with a history of fever for the past 36 hours along with coughing. He is upset and crying, but you do not notice any tears. What is the significance of the lack of tears?
It is a sign that the child is suffering from severe dehydration.
Which of the following airways can be used with a 4-year-old pediatric patient?
LMA
You are transporting a 4-year-old child who has burns on the forearms and hands consistent with cigarette burns. Which of the following should you avoid when documenting your patient care report?
Making a statement about who you suspect caused the abuse
Which of the following would arouse your suspicions of child neglect?
Malnutrition
Which of the following presentations is most consistent with bronchiolitis?
Mild upper respiratory infection signs and symptoms that progressively deteriorate over 1 to 2 days to respiratory distress with fever, cough, tachypnea, crackles in the lungs, and wheezing
What is a common complication of a tracheostomy tube that a mucus plug may cause?
Obstruction
The term neonate describes infants from birth to what age?
One month
A 13-year-old girl is having a sleepover at a friend's house and has been found unresponsive. She responds to painful stimuli by groaning. Her pupils are 3 mm PERRL. Her skin is cool, pale, and moist. Breath sounds are clear and equal, although breathing is shallow and she is snoring. Vital signs are HR 92, BP 96/70, RR 22, and SpO2 96 percent on room air. Which of the following should you do first?
Open the airway with a head-tilt/chin-lift maneuver.
In the secondary assessment of a 7-year-old child with difficulty breathing and a history of reactive airway disease, which of the following would give the paramedic the least amount of relevant information about the patient's ventilation and oxygenation?
Palpating the abdomen
Which information should raise the index of suspicion for abuse?
Parents of a child with multiple bruises and burns offer inconsistent explanations that are not consistent with the types of injuries.
Which of the following best identifies the age group of patients who should be triaged by using the JumpSTART system?
Patients who look younger than a young adult
Which of these modifications to care should you use when caring for pediatric patients?
Place padding behind the shoulders and neck of an infant or small child to maintain neutral alignment of the neck.
According to the pediatric assessment triangle, which of the following is used to assess the work of breathing when forming a general impression of the patient?
Presence of grunting, stridor, wheezing, crowing
Which of these terms is best applied to the majority of childhood injuries?
Preventable
If present, which of the following findings should alert the paramedic that a child is in respiratory failure?
Profound cyanosis
What term is used to describe the situation in which a child is regularly threatened, yelled at, or humiliated but not otherwise harmed?
Psychological abuse
Which of the following characterizes febrile seizures?
Recent onset of fever or cold symptoms
Which of the following actions should you take if you suspect that your pediatric patient is a victim ofabuse?
Report your findings to the appropriate authorities, including to the receiving hospital personnel.
The majority of childhood medical emergencies involve which body system?
Respiratory
You respond to a call for a 10-year-old patient who hit a road sign while traveling at high speed on a bicycle. The child is unconscious with no eye opening or motor or verbal response and has a severe contusion to the head. You note elevated blood pressure but a depressed heart rate with decreasing, deep respirations and an SpO2 of 92 percent. What do you assess as the problem and how do you manage this patient?
Severe traumatic brain injury with increasing intracranial pressure, to be managed with rapid sequence intubation, ventilation, supplemental oxygen, and rapid transport to a pediatric trauma facility
You are caring for a 5-year-old who was injured when his older brother accidentally stabbed him in the thigh with a pocketknife. The patient has lost about 350 mL of blood. He is pale, with cool, diaphoreticskin, and is awake but very still. As part of your treatment, you have applied direct pressure to the wound, applied oxygen, and covered the patient with a blanket. The patient's mother is very upset and does not want to let go of the child's hand. How should you go about completing your treatment?
Show the mother where to sit so she can remain with the child while allowing you to work.
According to the pediatric assessment triangle, which of the following is used to assess circulation to the skin?
Skin color
What is the oxygenation goal for a pediatric patient receiving oxygen?
SpO2 of 94 percent or greater
Which of the following is an example of a commonly used neuromuscular blocking agent that can be used in a pediatric RSI procedure?
Succinylcholine
Which of the following statements is accurate regarding sudden infant death syndrome (SIDS)?
The cause of SIDS is not yet known; SIDS is a diagnosis that is given when other potential causes of death have been ruled out.
The combination of increased oxygen requirements and decreased oxygen reserves makes infants and children especially susceptible to ______________
hypoxia.
An 8-year-old male patient presents with pale, cool, clammy skin; tachycardia and tachypnea; a weak peripheral pulse; and a decreased level of consciousness. The parents say the patient has been sick and vomiting with diarrhea for several days. You respond with:
administration of supplemental oxygen and establishment of IV access for a 20 mL/kg bolus of normal saline.
A seven-year-old female patient who was drowning in a pond was rescued and resuscitated prior to your arrival. It is a cold day and the water soaking the patient's clothing is very cold. What can you assume for this patient?
The low temperature of the water might have helped protect the child against brain injury.
A 4-year-old boy presents with a history of increasing respiratory difficulty over the previous 6 hours, including grunting and wheezing, particularly with active play. His skin is warm and dry. There is no cyanosis of the lips or nail beds. On your arrival, the patient's respiratory rate is 27 per minute. You notice grunting on expiration and an occasional dry cough. Auscultation of the lungs reveals widespread wheezing throughout all lung fields. Vital signs are HR 116, capillary refill less than 2 seconds, and SpO2 97 percent on room air. According to the parents, the child has suffered episodes similar to this one when visiting friends overnight but has had only one episode at home. The pediatrician has not prescribed medications for home use. What should you do?
Transport and administer albuterol 2.5 mg by small-volume nebulizer.
Which of these statements is true?
The paramedic always must report suspected sexual abuse to the appropriate authorities and the medical personnel who will be assuming care of the patient.
When does respiratory failure occur?
The respiratory system is unable to meet the body's demands for oxygen intake and carbon dioxide removal.
Which statement best describes the purpose of the JumpSTART triage method?
To do the most good for the greatest number of patients
When responding to a report of a patient with difficulty breathing, you find a pediatric male about 3 years old in a hospital bed at home. He is cared for 24 hours a day by his parents. You note a small, round tube that exits from the patient's neck, through which he is breathing. Given this finding, which of these devices does the patient most likely have?
Tracheostomy tube
You are called to a residence for a 7-year-old child in hypovolemic shock. You note evidence of severe dehydration as well as malnutrition. The child is wearing dirty clothes and appears to be unwashed. Thechild's home is visibly unclean. What is your immediate priority?
Treat the child for shock, administering oxygen and establishing IV access for the replacement of fluids.
Which of these devices should you anticipate when responding to a pediatric patient who is dependent on medical technology?
Vascular access devices, urinary catheters, ventilators, and feeding tubes
During triage of a 6-year-old patient, you discover the following: The patient is awake, breathing 32 times/minute, has a palpable pulse, and responds to verbal stimuli. What is the correct triage category for this patient?
Yellow
You are caring for a 5-year-old who was found in her yard near a roadside crying with a scalp laceration causing some bleeding. In addition to assessing the head injury, controlling bleeding, and spinalimmobilization, what do you anticipate for this patient?
You will find evidence of other traumatic injuries.
The pediatric advanced life support (PALS) criteria for a physiologically unstable child does not include:
a heart rate of 100 beats per minute.
The most accurate method for determining the size of airway to use in pediatric resuscitation is touse:
a length-based resuscitation tape, such as a Broselow Tape.
During the management of a pediatric patient with a reactive airway disease and wheezing, you elect to provide a nebulized bronchodilator. Any of the following drugs could be used for this purpose in a pediatric patient except ______________
beclomethasone
A viral infection of the pediatric upper airway that results in inflammation of the subglottic region is knownas:
croup.
The mildest form of respiratory impairment is classified as respiratory ______________
distress.
An inflammation of an airway structure that is often due to a bacterial infection in children and is known to be potentially life threatening is:
epiglottitis.
A 7-year-old child following a drowning incident in a swimming pool is pulseless and apneic. Treatment for this patient should not include:
epinephrine administration every 5 to 15 minutes.
You respond to a shooting at a high school; the shooter has been apprehended, and law enforcement has certified the scene as safe. A 16-year-old patient presents with a small-caliber gunshot wound in the lower middle abdomen. The gunshot wound is small and not bleeding much, and there is no exit wound. This presentation suggests that:
internal bleeding and possible organ damage should be suspected.
Compared to an adult's, an infant's or child's:
lung tissues are more fragile.
The less frequently a paramedic uses a skill, the:
more likely that it is outside the scope of the paramedic's practice.
JumpSTART provides a framework for triage decisions that is:
objective.
When performing ventilation on an infant receiving CPR, it may likely be necessary to:
occlude the pop-off valve.
A four-year-old male patient presents with stridor, a cough, and hoarseness when speaking. The paramedic should:
place the patient in a position of comfort and transport immediately.
Conditions that place a pediatric patient at risk of cardiopulmonary arrest include all of the following except ______________.
respiratory rate greater than 40.
Shouting helps assess an infant's:
response to verbal stimuli.
Capillary refill time is considered reliable as a sign of perfusion primarily in children less than ______________ years of age.
six
You are suctioning a 10-year-old female patient's airway following the patient having vomited. The patient has a decreased level of consciousness. You should:
suction no deeper than you can see.
When an infant dies from an unknown cause, it is termed:
sudden infant death syndrome.
You are caring for a 6-year-old who was struck by a car on the street in front of her home in a very impoverished part of town. Her distraught father yells at you to hurry up and says, "If this was a kid on the other side of the tracks, you would be moving faster!" Which of the following is the most appropriate response?
"I know this is upsetting. We are moving as fast as we can without making her condition worse. As long as I have your word that you won't yell at us, you can ride in the ambulance, and we will tell you everything we are doing."
You are caring for a 4-year-old male in hypovolemic shock. Which of the following statements would be most important to communicate to the receiving facility during the ED hand-off report?
"Peripheral pulses are strong and equal bilaterally after the 1 liter IV bolus of 0.9% NS."
