Chapter 43 Pediatric Emergencies

Appropriate treatment for a conscious child with anaphylaxis includes:

0.01 mg/kg epinephrine 1:1,000 IM.

Which of the following statements regarding acrocyanosis is correct?

Acrocyanosis is cyanosis of the hands and feet, and is a normal finding in infants younger than 2 months of age who are cold.

If a child with a functioning central venous line requires emergency drug therapy, you should:

Avoid using the central line if possible and attempt to establish peripheral IV access elsewhere.

Which of the following statements regarding chest trauma in children is correct?

Children are more prone to intrathoracic trauma due to compression forces

When caring for an infant or child who is in compensated shock, you should:

Establish IV or IO access en route to the hospital.

A 6-year-old girl who has been running a fever for the past 2 days presents with lethargy and tachycardia. Her heart rate is 170 beats/min and varies with activity. Her skin is cool and clammy, and her capillary refill time is 4 seconds. The cardiac monitor reveals a narrow complex tachycardia with a rate that varies between 150 and 170 beats/min. After applying high-flow oxygen, you should:

Establish vascular access and administer a 20-mL/kg normal saline bolus.

In contrast to adults, young children are more prone to liver and spleen injuries because the organs:

Extend well below the rib cage.

Establishing good rapport with the caregiver of a sick or injured child at the scene is vital because:

He or she will be a source of important information and assistance.

If you cannot palpate the femoral pulse in an unresponsive infant, you should:

Initiate CPR immediately.

When evaluating a child's oxygen saturation level with a pulse oximeter:

It should be evaluated in the context of the pediatric assessment triangle and remainder of the primary assessment.

Which of the following components is NOT used to distinguish sinus tachycardia from reentry supraventricular tachycardia?

QRS complex width

Ductal-dependent congenital heart defects typically present with __________ in the neonatal period.

Respiratory distress

You are assessing a 10-year-old child with apparent ventricular tachycardia, but cannot decide whether electrical or pharmacologic therapy is the most appropriate initial treatment approach. Which of the following interventions would pose the GREATEST potential for harm?

Starting an IV line and administering amiodarone followed by procainamide

In contrast to a child with pulmonary edema secondary to congestive heart failure, the respirations of a hypercarbic child without pulmonary edema would MOST likely be:

Tachypneic and without retractions

The decision to transport an acutely ill child immediately or remain at the scene to perform additional interventions is LEAST dependent on:

The child's age and fear level

If an infant or small child swallowed a rigid foreign body, he or she would MOST likely experience respiratory distress because:

The esophageal foreign body can compress the relatively pliable trachea.

Signs of compensated shock in the infant or child include all of the following, EXCEPT:

abnormal mentation.

A sick or injured child's general appearance is MOST reflective of:

his or her central nervous system function

The MOST appropriate vagal maneuver for an infant involves:

holding ice packs firmly to the face.

A 9-year-old who fell off his bike has an isolated deformity to his forearm and is in significant pain. The child is conscious and alert, his vital signs are stable, and his mother is present. Your initial effort to relieve this child's pain should involve:

providing calm reassurance to both mother and child.

When caring for a child with a ventricular shunt or gastrostomy tube, it is important to:

recognize that the caregiver is a key resource and that his or her expertise should be utilized to assist in the care of the child

Distributive shock in children is MOST often the result of:

sepsis

You should be MOST suspicious for child abuse when caring for an injured 4-year-old child if:

there was an unusual delay in calling 9-1-1.

The goal in treating a child with epiglottitis is to:

transport him or her to the hospital with a maintainable airway.

Early distributive shock in children is characterized by:

...

The incidence of sudden infant death syndrome peaks between the ages of:

2 and 4 months

A 6-year-old child has burns to his head, face, neck, and anterior chest. What percentage of his body surface area has been burned?

21%

Which of the following statements regarding burns in the pediatric patient is correct?

A child's larger skin surface-to-body mass ratio increases his or her susceptibility to heat and fluid loss

When attempting resuscitation of a child with pulseless electrical activity, you should:

Attempt to identify an underlying cause of the arrest.

A 12-year-old boy presents with marked respiratory distress; hot, moist skin; and anxiety. He is sitting with his chin thrust forward and has inspiratory stridor. According to the child's grandmother, his symptoms began suddenly about 30 minutes ago. You should be MOST suspicious for:

Bacterial epiglottitis.

You are dispatched to a daycare center for a 5-year-old girl with trouble breathing. Upon arriving at the scene, you assess the child and note that she is responsive to pain only, has weak intercostal retractions, and is breathing at a slow rate with shallow depth. You should:

Begin assisting her ventilations with a bag-mask device and assess her pulse rate.

Which of the following is LEAST characteristic of an apparent life-threatening event in an infant?

Brief loss of a pulse

Which of the following statements regarding bronchiolitis is correct?

Bronchiolitis is a viral infection of the lower airway that commonly affects infants and children younger than 2 years of age.

Your primary assessment of an unresponsive 5-year-old, 40-pound child reveals that he is apneic and pulseless. CPR is initiated and the cardiac monitor is applied, which reveals ventricular fibrillation. You should:

Defibrillate with 40 joules and immediately resume CPR.

Prior to administering pharmacologic therapy to an infant or child with pulseless ventricular tachycardia, the paramedic should perform:

Defibrillation

Appropriate bag-mask ventilation for an apneic 3-year-old child involves:

Delivering each breath over 1 second until the chest rises visibly.

The management for any potentially toxic exposure in children begins by:

Ensuring a patent airway.

Upon arriving at the scene of a 4-year-old girl who is ill, you assess her and note that she is tachypneic and tachycardic. Her skin is warm and moist, and there are no signs of increased work of breathing. The child's mother denies any vomiting or diarrhea. This child's tachycardia and tachypnea are MOST likely the result of:

Fever and anxiety

In contrast to adults, children:

Have proportionately larger heads.

Which of the following clinical presentations is MOST consistent with cocaine ingestion in a child?

Hypertension, tachycardia, diaphoresis, and mydriasis

Which of the following represents the correct drug, dose, and delivery route for an 18-kg child experiencing severe respiratory distress due to bronchospasm?

Ipratropium, 0.5 mg nebulized

Respiratory distress in children:

Is a compensated state in which increased work of breathing results in adequate pulmonary gas exchange.

The use of a straight blade during pediatric intubation:

Makes it easier to manipulate the epiglottis.

While assessing the airway of a 3-year-old girl who is unresponsive, you hear a snoring sound during each of her slow, shallow breaths. You should:

Manually maneuver her head and reassess her breathing status

A normal respiratory rate in a child:

May be observed if the child has been breathing rapidly with increased work of breathing and is becoming fatigued.

Counting an infant's respiratory rate for 15 seconds and then quadrupling that number:

May yield a falsely low respiratory rate because infants may have periodic breathing or variable respiratory rates with short periods of apnea.

Common signs and symptoms of meningitis in young children include all of the following, EXCEPT:

Nuchal rigidity.

Which of the following statements regarding nasogastric (NG) and orogastric (OG) insertion in children is correct?

Prior to inserting an NG or OG tube in an unresponsive child without a gag reflex, you should intubate his or her trachea. correct

A child's vocal cords can be difficult to visualize during intubation because:

The epiglottis is floppy and U-shaped.

Meningococcal meningitis with sepsis is typically characterized by a(n):

Purpuric rash

Etomidate should be avoided as an induction agent in pediatric intubation in the presence of:

Septic shock

Bradydysrhythmias in children MOST often occur secondary to:

Severe hypoxia.

When preparing to intubate a small child, it is important to remember that:

Small children have a relatively large occiput.

You would MOST likely encounter a child with a tracheostomy tube breathing spontaneously on room air if:

The purpose of the tube is to bypass a mechanical upper airway obstruction.

Dilated cardiomyopathy is a condition in which the heart is:

Weakened and enlarged, making it a less efficient pump.

Infants and children in shock:

compensate more efficiently than adults by increasing heart rate and peripheral vascular resistance.

If a child who is wearing a helmet strikes a fixed object on his or her bicycle and flies over the handlebars, you would MOST likely encounter:

compression injuries to the intra-abdominal organs

When an infant or child is in respiratory failure:

he or she can no longer compensate, which causes hypoxia and hypercarbia.

A conscious child who is in the sniffing position:

is trying to align the axes of the airway to improve ventilation

If a 2-year-old child with a foreign body airway obstruction becomes unresponsive, you should position him or her supine and then:

perform chest compressions

You should be MOST suspicious for cardiogenic shock in an infant or child if:

perfusion decreases following a fluid bolus.

The use of lorazepam for seizures in the prehospital setting is limited by its:

refrigeration requirement.

A child who is experiencing a moderate asthma attack would MOST likely present with:

wheezing during inspiration and expiration.

Beta blocker ingestion in small children would MOST likely cause:

Acute hypoglycemia

A 4-year-old girl presents with a fever of 103.2°F. The child's mother states that the fever came on suddenly and was not preceded by any symptoms. The child is conscious and alert with unlabored tachypnea, tachycardia, and a blood pressure that is consistent with her age. Prehospital treatment for this child includes all of the following, EXCEPT:

81 mg of aspirin.

You and your partner are caring for a child with stable supraventricular tachycardia that was refractory to initial treatment. As your partner is preparing to establish vascular access, the child's level of consciousness decreases markedly. You reassess the child and note that his femoral pulse is rapid and weak. You should:

Perform immediate synchronized cardioversion and reassess.

When assessing a child's circulation by looking at his or her skin, pallor is MOST indicative of:

Peripheral vasoconstriction and compensated shock

The MOST appropriate ET tube for a 6-year-old child is:

5.5 mm, uncuffed.

A 7-year-old conscious boy presents with marked respiratory distress. Your assessment reveals the presence of intercostal and supraclavicular retractions and nasal flaring. His oxygen saturation is 93% on room air, and his heart rate is rapid. The MOST appropriate initial treatment for this child involves:

Administering high-flow oxygen as tolerated, auscultating his lung sounds, and being prepared to assist his ventilations

You receive a call for a "sick child." When you arrive at the scene, the child's mother tells you that her 5-year-old son has had vomiting and diarrhea for the past day and will not eat or drink anything. On exam, the child's level of consciousness appears consistent with his age. His skin is cool and pale, he is tachypneic, his capillary refill time is 4 seconds, and his heart rate is 150 beats/min. The MOST appropriate treatment for this child involves:

Administering supplemental oxygen, keeping the child warm, assessing his blood glucose level, transporting, and establishing vascular access en route.

You receive a call at 11:50 PM for a 3-year-old boy with respiratory distress. As soon as you enter the child's residence, you can hear a loud, barking cough. You find the child sitting on his mother's lap. He is conscious and appears alert to his surroundings. According to the child's mother, he has been sick for the past few days with a low-grade fever, but then began experiencing a high-pitched cough. His skin is warm and dry, his heart rate is 120 beats/min, and his oxygen saturation is 99% on room air. There are no signs of increased work of breathing. You should:

Allow the child to assume a position of comfort, avoid agitating him, and transport him to the hospital.

You receive a call to a residence for a 6-year-old girl with a decreased level of consciousness. The child has hydrocephalus following surgery to remove a brain tumor and has a ventricular shunt in place. The child's level of consciousness is markedly decreased from its baseline, and the child's caregiver tells you that she thinks the shunt is obstructed. Which of the following sets of vital signs is MOST indicative of shunt obstruction and increased intracranial pressure?

Blood pressure 140/92 mm Hg; pulse 58 beats/min; respirations 8 breaths/min correct

Which of the following statements regarding a child's chest wall is correct?

Children are belly breathers because they rely heavily on their diaphragms

Which of the following statements regarding croup is correct?

Croup is a viral upper airway infection that may cause stridor.

Medications used to prevent an asthma attack include:

Inhaled steroids.

You are dispatched to a residence for a 17-year-old woman with acute abdominal pain. When you arrive and begin your assessment, it is clear that the patient is uncomfortable with the presence of her parents because she is reluctant to answer your questions. You should: .

Diplomatically ask the parents if their daughter can have some privacy

You are called to a residence for a ventilator-dependent child with respiratory distress. Upon your arrival, the child's mother tells you that the child was doing fine, but then suddenly began experiencing labored breathing. She further tells you that the child's home ventilator was recently replaced with a newer one. Assessment of the child reveals that she is in marked respiratory distress and has intercostal retractions. Your FIRST action should be to:

Disconnect the child from the ventilator and begin bag-mask ventilations.

The pediatric assessment triangle was designed to:

Help EMS providers form a hands-off general impression of an ill child.

You are assessing a 7-month-old infant who presents with listlessness, pallor, and increased work of breathing. The infant's mother tells you that the child was born 2 months premature and was in the neonatal intensive care unit for 3 weeks. She denies any recent vomiting, diarrhea, or fever. The infant's oxygen saturation is 89% and does not improve with supplemental oxygen. Her heart rate is rapid and weak and does not vary with activity. When you apply the cardiac monitor, you will MOST likely encounter a:

Narrow QRS complex rhythm with absent P waves and a heart rate greater than 220 beats/min.

Compared to adults, the smaller diameter of a child's airway makes it more vulnerable to:

Obstruction by the tongue.

A 2-year-old girl fell approximately 12 feet from a second-story window, landing on her head. Your primary assessment reveals that she is unresponsive; has slow, irregular respirations; and has blood draining from her mouth and nose. A rapid scan of her body does not reveal any gross injuries or bleeding. You should:

Open her airway with the jaw-thrust maneuver, suction her mouth and nose, insert an oral airway, and assist her ventilations with a bag-mask device.

With respect to CPR and foreign body airway obstruction procedures, the child should be treated as an adult once:

Secondary sexual characteristics have developed

Identified risk factors associated with sudden infant death syndrome include all of the following, EXCEPT:

Sleeping in a supine position.

First-degree heart block in children: s

Typically asymptomatic and does not require special treatment.

In contrast to toxic ingestions in toddlers, toxic ingestions in adolescents:

Typically involve multiple agents

When inserting an oropharyngeal airway in a child, you should:

Use a tongue blade to depress the tongue.

An infant or small child who falls from a significant height would MOST likely experience:

a traumatic brain injury.

A typical finding for a foreign body aspiration is:

an afebrile child with a sudden onset of coughing or gagging while playing.

Unlike sinus tachycardia, reentry supraventricular tachycardia in infants is characterized by:

an unvarying pulse rate.

Most injuries in pediatric patients:

are predictable and preventable events.

When mechanically securing an injured child's head and neck to a backboard, you should:

avoid placing a strap or tape over the chin.

Sorbitol is not recommended for use in young children because it:

can cause severe diarrhea and life-threatening electrolyte abnormalities.

Because stimulation of the parasympathetic nervous system and bradycardia can occur during intubation of a child, you should:

closely monitor the child's cardiac rhythm.

Bruises that occur _________________ are rarely incurred accidentally.

in a straight line

A 4-year-old boy is found unresponsive by his mother. When you begin your assessment, the child's mother tells you that her son apparently ingested some of her antihypertensive medication. The child has poor perfusion and is breathing poorly. As you are assisting the child's ventilations with high-flow oxygen, your partner informs you that the child's heart rate is 50 beats/min and weak and that the cardiac monitor reveals sinus bradycardia. You should:

initiate one-rescuer CPR while your partner attempts to establish vascular access.

You and your partner arrive at the scene shortly after a 2-year-old child experienced an apparent seizure. The child's father tells you that his son's entire body began shaking and that the episode lasted less than 5 minutes. Your assessment of the child reveals that he is conscious, is crying, and has hot, moist skin. His heart rate is 160 beats/min, and his respirations are 40 breaths/min. You should:

keep the child cool and transport him to the hospital for physician evaluation

In contrast to a complex febrile seizure, a simple febrile seizure:

lasts less than 15 minutes and occurs in children without underlying neurologic abnormalities.

The FIRST step in examining a toddler in stable condition is to:

let the child sit on a parent's lap.

Proficiency in ventilating apneic infants or children with a bag-mask device:

may avert the need for endotracheal intubation.

A child in anaphylactic shock:

may require a low-dose epinephrine infusion