EMT - Chapter 34: Pediatric Emergencies

Questions and Answers

The first month of life after birth is referred to as the:

Premature phase

Neonatal period (correct)

Start of infancy

Toddler period

Which of the following statements regarding a 3-month-old infant is correct?

At this age, the infant typically sleeps for up to 8 hours a day

The infant is unable to turn his or her head and focus

A 3-month-old infant can distinguish a parent from a stranger (correct)

The infant should be aroused easily from a sleeping state

A child may begin to show signs of separation anxiety as early as:

12 months

24 months

6 months (correct)

18 months

Unless he or she is critically ill or injured, you should generally begin your assessment of a toddler:

At the feet Signup and view all the answers

Which of the following statements regarding preschool-age children is correct?

They can usually identify painful areas when questioned Signup and view all the answers

When assessing an 8-year-old child, you should:

Talk to the child, not just the caregiver Signup and view all the answers

When assessing or treating an adolescent patient, it is important to remember that:

They usually do not wish to be observed during a procedure Signup and view all the answers

Which of the following statements regarding a pediatric patient's anatomy is correct?

Children have a larger, rounder occiput compared to adults Signup and view all the answers

The normal respiratory rate for a newborn should not exceed ______ breaths/min.

60 Signup and view all the answers

Compared to an adult, the diaphragm dictates the amount of air that a child inspires because the:

Intercostal muscles are not well developed Signup and view all the answers

Pale skin in a child indicates that the:

Blood vessels near the skin are constricted Signup and view all the answers

Signs of vasoconstriction in the infant or child include:

Weak distal pulses Signup and view all the answers

Which of the following statements regarding spinal injuries in pediatric patients is correct?

If the cervical spine is injured, it is most likely to be an injury to the ligaments because of rapid movement of the head Signup and view all the answers

Compared to adults, the liver and spleen of pediatric patients are more prone to injury and bleeding because they are:

Proportionately larger and situated more anteriorly Signup and view all the answers

The suture of the anterior fontanelle is typically closed by _ months of age, and the suture of the posterior fontanelle is typically closed by _ months of age.

18, 6 Signup and view all the answers

The purpose of the pediatric assessment triangle (PAT) is to:

Allow you to rapidly and visually form a general impression of the child Signup and view all the answers

The components of the PAT are:

Appearance, work of breathing, and skin circulation Signup and view all the answers

After using the PAT to form your general impression of a sick or injured child, you should:

Perform a hands-on assessment of the ABCs Signup and view all the answers

A normal level of consciousness in an infant or child is characterized by:

Age-appropriate behavior, good muscle tone, and good eye contact Signup and view all the answers

You are dispatched to a residence for a child with respiratory distress. The patient, an 18-month-old female, is tachypneic, has sternal retractions, and is clinging to her mother. Her skin is pink and dry, and her heart rate is 120 beats/min. The MOST appropriate treatment for this child includes:

Administering blow-by oxygen and transporting the child with her mother Signup and view all the answers

Early signs of respiratory distress in the pediatric patient include all of the following, EXCEPT:

Cyanosis Signup and view all the answers

Before assessing the respiratory adequacy of a semiconscious infant or child, you must:

Ensure that the airway is patent and clear of obstructions Signup and view all the answers

You are dispatched to a local elementary school for an injured child. As you approach the child, you note that he is lying at the base of the monkey bars. He is unresponsive and there are no signs of breathing. You should:

Stabilize his head and check for a pulse Signup and view all the answers

Before positioning an infant or child's airway, you should:

Place him or her on a firm surface Signup and view all the answers

To ensure that the airway of an infant or small child is correctly positioned, you may have to:

Place a towel or folded sheet behind the shoulders Signup and view all the answers

When assessing an infant's ventilation status, you should:

Palpate the abdomen for rise and fall Signup and view all the answers

All of the following are normal findings in an infant or child, EXCEPT:

Head bobbing Signup and view all the answers

Drawing in of the muscles between the ribs or of the sternum during inspiration is called:

Retracting Signup and view all the answers

A high-pitched inspiratory sound that indicates a partial upper airway obstruction is called:

Stridor Signup and view all the answers

When assessing the heart rate of a 6-month-old infant, you should palpate the brachial pulse or ________ pulse.

femoral Signup and view all the answers

After determining that an infant or child has strong central pulses, you should:

Not rule out compensated shock Signup and view all the answers

After squeezing the end of a child's finger or toe for a few seconds, blood should return to the area within:

2 seconds Signup and view all the answers

Capillary refill time is MOST reliable as an indicator of end-organ perfusion in children younger than:

6 years Signup and view all the answers

Immediate transport is indicated for a child when he or she:

Has a history suggestive of a serious illness Signup and view all the answers

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 to 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:

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 Signup and view all the answers

If the situation allows, a child should be transported in a car seat if he or she weighs less than _____ lb.

40 Signup and view all the answers

Which of the following inquiries should you make in private when obtaining a SAMPLE history from an adolescent patient?

Sexual activity Signup and view all the answers

The secondary assessment of a sick or injured child:

May not be possible if the child's condition is critical Signup and view all the answers

Blood pressure is usually not assessed in children younger than _____ years.

3 Signup and view all the answers

Which of the following represents a low normal systolic blood pressure for a 6-year-old child?

82 mm Hg Signup and view all the answers

Early signs of respiratory distress in the child include:

Restlessness Signup and view all the answers

An infant or child with respiratory distress will attempt to keep his or her alveoli expanded at the end of inhalation by:

Grunting Signup and view all the answers

The MOST ominous sign of impending cardiopulmonary arrest in infants and children is:

Bradycardia Signup and view all the answers

A viral infection that may cause obstruction of the upper airway in a child is called:

Croup Signup and view all the answers

Infection should be considered a possible cause of an airway obstruction in an infant or child, especially if he or she presents with:

Drooling or congestion Signup and view all the answers

Signs of an upper airway obstruction in an infant or child include all of the following, EXCEPT:

Wheezing Signup and view all the answers

A 6-year-old male presents with acute respiratory distress. His mother states that she saw him put a small toy into his mouth shortly before the episode began. The child is conscious, obviously frightened, and is coughing forcefully. You should:

Encourage him to cough, give oxygen as tolerated, and transport Signup and view all the answers

Signs of a severe airway obstruction in an infant or child include:

An ineffective cough Signup and view all the answers

A child who has no recent history of illness suddenly appears cyanotic and cannot speak after playing with a small toy. You should:

Perform abdominal thrusts Signup and view all the answers

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:

Be prepared to assist her ventilations, transport at once, and request an ALS intercept en route to the hospital Signup and view all the answers

The MOST efficient way to identify the appropriately sized equipment for a pediatric patient is to:

Use a length-based resuscitation tape measure Signup and view all the answers

An oropharyngeal airway should not be used in children who have ingested a caustic or petroleum-based product because it may:

Cause the child to vomit Signup and view all the answers

When inserting an oropharyngeal airway in an infant or child, what should you ensure?

Ensure that his or her neck is hyperextended. Signup and view all the answers

Which of the following statements regarding the use of nasopharyngeal airways in children is correct?

They are rarely used in infants younger than 1 year. Signup and view all the answers

If a nasopharyngeal airway is too long, what may it cause?

Stimulate the vagus nerve. Signup and view all the answers

Use of a nonrebreathing mask or nasal cannula in a child is appropriate ONLY if:

His or her tidal volume is adequate. Signup and view all the answers

Which of the following children would benefit the LEAST from a nonrebreathing mask?

An unresponsive 5-year-old male with shallow respirations. Signup and view all the answers

When administering oxygen to a frightened child, it would be MOST appropriate to:

Place oxygen tubing through a hole in a paper cup. Signup and view all the answers

When ventilating a pediatric patient with a bag-mask device, the EMT should:

Block the pop-off valve if needed to achieve adequate chest rise. Signup and view all the answers

The MOST accurate method for determining if you are delivering adequate tidal volume to a child during bag-mask ventilations is to:

Observe the chest for adequate rise. Signup and view all the answers

Cardiac arrest in the pediatric population is MOST commonly the result of:

Respiratory or circulatory failure. Signup and view all the answers

In contrast to adults, deterioration to cardiac arrest in infants and children is usually associated with:

Severe hypoxia and bradycardia. Signup and view all the answers

A common cause of shock in an infant is:

Dehydration from vomiting and diarrhea. Signup and view all the answers

Blood loss in a child exceeding _____ of his or her total blood volume significantly increases the risk of shock.

25% Signup and view all the answers

Which of the following is the LEAST reliable assessment parameter to evaluate when determining the presence of shock in infants and children?

Blood pressure Signup and view all the answers

Common causes of seizures in children include all of the following, EXCEPT:

Hyperglycemia. Signup and view all the answers

Febrile seizures are MOST common in children between:

6 months and 6 years. Signup and view all the answers

In most children, febrile seizures are characterized by:

Generalized tonic-clonic activity, a duration of less than 15 minutes, and a short or absent postictal phase. Signup and view all the answers

Febrile seizures in a child:

May indicate a serious underlying illness. Signup and view all the answers

A 2-year-old female has experienced a seizure. When you arrive at the scene, what should you do?

Attempt cooling measures, offer oxygen, and transport. Signup and view all the answers

Which of the following groups of people is associated with the lowest risk of meningitis?

Females Signup and view all the answers

Signs and symptoms of meningitis in the infant or child include all of the following, EXCEPT:

Sunken fontanelles. Signup and view all the answers

Children with N meningitides would MOST likely present with:

Cherry-red spots or a purplish rash. Signup and view all the answers

The signs and symptoms of poisoning in children:

Vary widely, depending on the child's age and weight. Signup and view all the answers

When questioning the parent of a child who ingested a poisonous substance, which of the following questions would be of LEAST pertinence?

Why did your child ingest the poison? Signup and view all the answers

A 4-year-old female ingested an unknown quantity of liquid drain cleaner. Your assessment reveals that she is conscious and alert. What should you do?

Monitor her airway and give oxygen. Signup and view all the answers

Which of the following is the MOST appropriate dose of activated charcoal for a 20-kg child?

20 g Signup and view all the answers

The MOST common cause of dehydration in pediatric patients is:

Vomiting and diarrhea. Signup and view all the answers

An infant with severe dehydration would be expected to present with:

Absent urine output. Signup and view all the answers

Signs of severe dehydration in an infant include all of the following, EXCEPT:

Slowed level of activity. Signup and view all the answers

A 6-month-old male presents with 2 days of vomiting and diarrhea. What should you suspect?

Moderate dehydration. Signup and view all the answers

The EMT should be MOST concerned when a child presents with fever and:

A rash. Signup and view all the answers

Hyperthermia differs from fever in that it is an increase in body temperature:

Caused by the inability of the body to cool itself. Signup and view all the answers

Submersion injuries in the adolescent age group are MOST commonly associated with:

Alcohol. Signup and view all the answers

Which of the following statements regarding pediatric trauma is correct?

Children are more likely to experience diving-related injuries. Signup and view all the answers

When a child is struck by a car, the area of greatest injury depends MOSTLY on the:

Size of the child and the height of the bumper upon impact. Signup and view all the answers

Which of the following is MORE common in children than in adults following a head injury?

Nausea and vomiting. Signup and view all the answers

When immobilizing an injured child in a pediatric immobilization device, you should:

Secure the torso before the head. Signup and view all the answers

Padding underneath the torso when immobilizing an injured child is generally not necessary if he or she is:

Older than 8 to 10 years. Signup and view all the answers

The pediatric patient should be removed from his or her car seat and secured to an appropriate spinal immobilization device if:

The car seat is visibly damaged. Signup and view all the answers

When a child experiences a blunt chest injury:

The flexible ribs can be compressed without breaking. Signup and view all the answers

When a child experiences a blunt injury to the abdomen:

He or she can compensate for blood loss better than adults. Signup and view all the answers

Burns in children are commonly caused by all of the following, EXCEPT:

Entrapment in a structural fire. Signup and view all the answers

Critical burns in children include:

Partial-thickness burns covering more than 20% of the body surface. Signup and view all the answers

Greenstick fractures occur in infants and children because:

Their bones bend more easily than an adult's. Signup and view all the answers

Effective methods for providing pain relief to a child with an extremity injury include:

Positioning, ice packs, and emotional support. Signup and view all the answers

Which of the following findings is LEAST suggestive of child abuse?

Consistency in the method of injury reported by the caregiver. Signup and view all the answers

Bruising to the _________ is LEAST suggestive of child abuse.

Shins Signup and view all the answers

Death caused by shaken baby syndrome is usually the result of:

Bleeding in the brain. Signup and view all the answers

With regard to the legal implications of child abuse:

EMTs must report all suspected cases of child abuse. Signup and view all the answers

Study Notes

Pediatric Emergencies Overview

The neonatal period spans the first month after birth, crucial for infant health assessments.
A 3-month-old infant can distinguish parents from strangers, indicating developing social skills.

Developmental Milestones

Signs of separation anxiety can begin as early as 6 months.
For toddlers, assessment generally starts at the feet to reduce anxiety.
Preschoolers can identify painful areas when asked, aiding in pain management.

Assessment Protocols

Engage with the child directly during assessments, especially for older children.
Adolescents often prefer privacy during procedures; they may resist direct observation.

Anatomical Considerations

Pediatric patients possess anatomical differences, such as a larger occiput and a proportionally larger tongue.
The diaphragm is more significant for respiration in children due to less developed intercostal muscles.

Vital Signs and Indicators

Normal respiratory rate for newborns should not exceed 60 breaths per minute.
Weak distal pulses and pale skin are indicators of potential circulatory issues in children.

Respiratory Assessment

Early signs of respiratory distress include tachypnea and use of accessory muscles for breathing.
Observe for grunting as a sign of attempting to keep alveoli expanded during respiratory distress.

Airway Management

In cases of suspected airway obstruction, abdominal thrusts are indicated, especially if the child is cyanotic.
Avoid using oropharyngeal airways in children who might have ingested caustic substances, as it may induce vomiting.

Pediatric Transport Needs

Immediate transport is necessary for children showing signs of severe illness or critical condition.
In non-responsive cases, stabilize the head and check for pulse before initiating further interventions.

Equipment and Interventions

Use a length-based resuscitation tape measure for accurate pediatric equipment sizing.
Ensure adequate tidal volume before using nonrebreathing masks or nasal cannulas in children.

Special Situations

Children with severe respiratory distress, even with normal consciousness, may need ventilation assistance.
Postural adjustments, like placing towels behind shoulders, can help maintain an open airway in small children.

Signs of Severe Conditions

Rapidly identify severe airway obstructions characterized by ineffective coughing.
Bradycardia is a concerning sign indicating potential cardiopulmonary arrest in pediatric patients.

Infections and Emergencies

Conditions like croup can cause upper airway obstruction and need immediate attention.
Drooling in conjunction with respiratory distress may indicate a severe infection or obstruction.

Capillary Refill and Blood Pressure

Normal capillary refill time in children is ideally within 2 seconds; assess reliability when under 6 years old.
Blood pressure assessments are generally not performed on children younger than 3 years, focusing on other vital signs.

Conclusion

Maintaining a child-focused approach during assessments and interventions is vital for effective emergency care.
Recognizing developmental stages and physiological differences enhances the quality of care for pediatric patients.### Pediatric Emergency Care Notes
During oxygen administration, a parent should restrain the child while using a nasal cannula instead of a non-rebreathing mask to ensure comfort and safety.
Proper ventilation technique for pediatric patients includes blocking the pop-off valve as needed to achieve adequate chest rise when using a bag-mask device.
Monitoring chest rise is the most accurate way to assess if adequate tidal volume is being delivered during bag-mask ventilations.
The leading cause of cardiac arrest in pediatrics is respiratory or circulatory failure, rather than various other factors such as congenital defects or arrhythmias.
Infants and children usually experience deterioration to cardiac arrest associated with severe hypoxia and bradycardia, as opposed to adults who may show arrhythmic disturbances.
Shock in infants is commonly due to dehydration resulting from vomiting and diarrhea.
Blood loss of over 25% of total blood volume significantly increases the risk of shock in children.
Blood pressure is the least reliable indicator of shock presence when evaluating infants and children; heart rate, skin condition, and capillary refill are more reliable.
Common causes of seizures in children include infection, electrolyte imbalances, and poisonings, while hyperglycemia is not typically a cause.
Febrile seizures are most frequent in children aged 6 months to 6 years and are characterized by generalized tonic-clonic activity lasting under 15 minutes, with a short or absent postictal phase.
When assessing a child with a seizure and fever, cool the child and provide oxygen but transport immediately; meningitis must be considered in the presence of a rash.
For children experiencing poisoning, assessment varies widely based on age and weight; questions about the substance ingested are critical, while the reason for ingestion is less relevant.
A child with burns around the mouth from liquid drain cleaner should be monitored closely and given oxygen, with airway protection being the priority.
The standard dose of activated charcoal for a 20 kg child is 20 grams, which aids in managing poison ingestion.
The most common cause of dehydration in pediatric patients is vomiting and diarrhea, with signs of severe dehydration including absent urine output and extreme thirst.
Assess for a rash when a child presents with fever, as it may indicate more serious conditions.
Hyperthermia is regulated by the body’s failure to cool itself, distinguishing it from fever which is typically due to infection.
Submersion injuries among adolescents are often linked to alcohol consumption; preventive education is key.
Pediatric trauma often results from recklessness or accidents, with specific injuries depending on child size and location of impact.
When immobilizing injured children, secure the torso before the head to ensure stability and proper alignment.
Burns in children are frequently due to hot surfaces or scalds, while burns from structural fires are less common.
Partial-thickness burns exceeding 20% are classified as critical burns in children, requiring comprehensive medical evaluation.
Greenstick fractures are more common in children due to their more flexible bones compared to adults.
Emotional support, proper positioning, and the application of ice packs are effective pain relief methods for children with injuries.
Signs that suggest potential child abuse include atypical bruising patterns (not localized to shins) and inconsistent accounts of injury.
Shaken baby syndrome typically leads to death due to brain hemorrhaging; all suspected child abuse cases must be reported by EMTs to ensure child safety.

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Description

This quiz focuses on Pediatric Emergencies as covered in EMT Chapter 34. Test your knowledge on key concepts related to neonatal care and infant development. Prepare to enhance your understanding of the critical first month of life and common emergencies.