Aemt Pediatrics (Mwn)

Front 1

characteristics of 0 to 2 months

Back 1

-Spend most time sleeping or eating
-Respond mainly to physical stimuli
-Have limited head control
-Predisposed to hypothermia
-Express themselves largely through crying
-Are not able to tell difference between parents and strangers

Front 2

characteristics of 2 to 6 months

Back 2

-Are more active and social
-Recognize caregivers
-4 months of age, able to hold their heads up
-May follow bright light or objects with eyes
-Increased awareness of surroundings
-Persistent crying, irritability, or lack of eye contact can be sign of significant illness, depressed mental status, delay in development.

Front 3

characteristics of 6 to 12 months

Back 3

Can sit unsupported
Reach for objects
Becoming more mobile
More aware of surroundings
Explore their own bodies
Begin teething and placing things in mouth
Babbling common

Front 4

toddler

Back 4

(1- 3 years of age) may have stranger anxiety

Front 5

assessment considerations age 6 to 12 years

Back 5

Can understand difference between emotional and physical pain.
Give appropriate choices and control when possible.
Respect patient’s modesty.
Rewarding the school-age child after a procedure can be very helpful.

Front 6

Anatomy of childs airway differs from adults....

Back 6

-Tongue takes up more room.
-Larynx is higher and more anterior.
-Airway is narrower.
-Neck and trachea are shorter.
-Infants suck air in when they cry.
-Gastric distention can interfere with movement of diaphragm, resulting in hypoventilation.
-If infant nasal passages are blocked by secretions, they may not have intuition to open mouths to breathe.

Front 7

Pediatric respiratory considerations

Back 7

-Tidal volume is similar to adolescents and adults, but metabolic oxygen demand is doubled.
-Infants Need to breathe faster than older child and Use diaphragm during inspiration
-Infants and children are highly susceptible to hypoxia.

Front 8

Proportionally, children have ________circulating blood volume than adults

Back 8

larger

Front 9

______________, in a child, often indicates impending cardiopulmonary arrest.

Back 9

Hypotension

Front 10

In children, Spinal cord injuries are ________ common

Back 10

less

Front 11

In child bone trauma, Injury to___________ may result in developmental abnormalities.

Back 11

epiphyseal plate

Front 12

The following should increase your index of suspicion for child abuse:

Back 12

-Conflicting information from caregivers
-Bruises or other injuries inconsistent with MOI
-Injuries inconsistent with child’s age and developmental abilities
-Anger or indifference about child’s injury
-Child appears scared by caregiver’s presence

Front 13

pediatric assessment triangle (PAT) .

Back 13

Appearance
(Assess adequacy of Ventilation; Oxygenation; Brain perfusion; Body homeostasis; CNS function)
TICLS mnemonic
Evaluate LOC using AVPU scale.
Observe from distance.
Work of breathing
Tachypnea
Abnormal airway noise
Retractions of intercostal muscles or sternum
Way patient positions himself or herself
Circulation - skin

Front 14

Abnormal LOC in infants/children characterized by:

Back 14

Age-inappropriate behavior or interactiveness
Poor muscle tone
Poor eye contact

Front 15

How is pulse assessed in infants and children?

Back 15

In infants, palpate brachial or femoral pulse.
In children older than 1 year, palpate carotid pulse.

Front 16

Transport decision- If less than ______ lb, transport in car seat.

Back 16

40 lb

Front 17

Infants, toddlers, preschool-age children should be assessed starting at ______and ending at _______.

Back 17

feet

head.

Front 18

Assessing Level of hydration in children

Back 18

-Assess skin turgor, note presence of tenting.
-In infants, note whether fontanelles are sunken or flat.
-Determine whether child is producing tears when crying.
-Determine if oral mucosa is moist or dry.
-ask how many diapers they've gone through in last 24 hrs

Front 19

Blood pressure is usually not assessed in children younger than _____________.

Back 19

3 years.

Front 20

best indication of circulatory status is

Back 20

Assessment of skin

Front 21

Infections causing airway obstruction.

Back 21

Croup
Epiglottitis

Front 22

Respiratory Emergencies Pneumonia Presentation:

Back 22

-Unusual rapid breathing
-Nasal flaring
-Tachypnea
-Crackles
-Hypothermia or fever
-Unilateral diminished breath sounds
Pediatric patient treatment:
Primary treatment will be supportive.
Monitor airway and breathing status.
If warranted:
Administer supplemental oxygen.
Establish IV or IO access en route.

Front 23

Bronchiolitis S&S, Tx

Back 23

Viral infection that causes inflammation of the bronchioles
Bronchioles become inflamed, swell, and fill with mucus.
Look for signs of dehydration.
Shortness of breath and fever may be present
Treatment
Maintain a calm demeanor when approaching.
Allow for a position of comfort.
Treat airway and breathing problems.
Call early for paramedic backup.

Front 24

Pertussis (whooping cough) S&S, Tx

Back 24

-Disease caused by a bacterium that is spread through respiratory droplets
-Not common in United States
-Cold-like symptoms
-Coughing becomes more severe and is characterized by distinctive whoop sound.
-Keep airway patent and transport.
-Communicable disease
-Practice standard precautions.

Front 25

Oxygen Delivery techniques for peds

Back 25

Blow-by technique
Nasal cannula
Nonrebreathing mask
Bag-mask device

Front 26

difference in adult vs child response to hypoxia

Back 26

Adults become hypoxic, heart gets irritable, sudden cardiac death occurs from arrhythmia.

Children become hypoxic and their hearts slow down, becoming more bradycardic.

Front 27

Signs of shock in children include:

Back 27

Tachycardia
Poor capillary refill (> 2 seconds)
Decrease in urine output
Absence of tears
Sunken or depressed fontanelle (infants)
Changes in LOC and behavior

Front 28

Assessing circulation, pay attention to:

Back 28

Pulse
Skin signs
Capillary refill time
Skin color

Front 29

Shock Tx in children

Back 29

Ensure airway is open; prepare for artificial ventilation.
Control bleeding.
Give supplemental oxygen.
Continue to monitor airway and breathing.
Position dictated by local protocol.
Keep warm with blankets and heat.
Establish vascular access and administer normal saline.
Provide immediate transport.
Contact paramedic backup as needed.
Allow caregiver to accompany whenever possible.

Front 30

catheter sizes for peds

Back 30

20-,22-,24-, and 26-gauge
Butterfly catheters

Front 31

IO infusion contraindicated if

Back 31

a secure IV is available or if possible fracture exists.

Front 32

If too much fluid is administered, overload can result and cause acute ______ side heart failure and ____________.

Back 32

left

pulmonary edema.

Front 33

Status epilepticus = Seizures that ....

Back 33

continue every few minutes without regaining consciousness or last longer than 30 minutes

Front 34

Febrile Seizures are common in children between______ (ages) and is caused by

Back 34

Common in children between 6 months and 6 years

Caused by abrupt rise in body temperature. May be sign of more serious problem. Provide cooling measures.

Front 35

Meningitis S&S

Back 35

-Changes can range from confusion to lethargy and/or -inability to understand commands or interact appropriately.
-pain that accompanies movement.
-Often results in characteristic stiff neck
-In an infant, increasing irritability and a bulging fontanelle without crying.
-Often leads to shock and death
-Children present with small, pinpoint, cherry-red spots or larger purple/black rash.

Front 36

An increase in body temperature
of __________or higher are abnormal and can be caused by______________

Back 36

100.4ºF (38ºC)

Infection
Status epilepticus
Neoplasm

Front 37

____________ is number one killer of children in US

Back 37

Trauma

Front 38

JumpSTART triage system

Back 38

Intended for pediatric patients younger than 8 years weighing less than 100 lb

Decision points=walking? spontaneous breathing; RR<15 or >45; appropriate response to pain

Green: Minor
Yellow: Delayed treatment
Red: Immediate response
Black: Deceased or expectant deceased

Front 39

Leading cause of death in infants younger than 1 year

Back 39

Sudden Infant Death Syndrome

Front 40

SIDS risk factors

Back 40

Mother younger than 20 years old
Mother smoked during pregnancy
Low birth weight
Baby is placed on his or her stomach in crib

Front 41

Classic ALTE is characterized by

Back 41

Cyanosis
Apnea
Distinct change in muscle tone
Choking or gagging

Front 42

ages for: Infancy; Toddlers; Preschool-age ; School-age;
Adolescents

Back 42

Infancy is the first year of life.
Toddlers are 1 to 3 years of age.
Preschool-age children are 3 to 6 years of age.
School-age children are 6 to 12 years of age.
Adolescents are 12 to 18 years of age.

Front 43

The three keys to successful use of bag-mask device in a child are

Back 43

(1) have appropriate equipment in right size;
(2) maintain a good face-to-mask seal; and
(3) ventilate at appropriate rate and volume.

Front 44

How does a child’s anatomy differ from an adult’s anatomy?

Back 44

There are several important anatomic differences between children and adults. A child’s head—specifically the occiput—is proportionately larger. The 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.

Front 45

Febrile seizures are characterized by ______________ and last less than _________minutes;

Back 45

generalized tonic-clonic activity

15

Front 46

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:

Back 46

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.

Front 47

Treatment for a semiconscious child who swallowed an unknown quantity of pills includes:

Back 47

monitoring the child for vomiting, administering oxygen, and transporting.

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.

Front 48

the mnemonic CHILD ABUSE to assess a child for signs of abuse,

Back 48

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.

Front 49

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:

Back 49

manually stabilize her head, open her airway with the jaw-thrust maneuver, insert an airway adjunct, and begin assisting her ventilations with a bag-mask device.

Front 50

by age ___ babies should make eye contact

Back 50

6 mo

Front 51

fontanelles close at age

Back 51

18 months

Front 52

always assess fontanelles in an infant, looking for:

Back 52

bulging=Increased ICP (menengitis, encephalitis)
sunken=dehydration

Front 53

tracheal tugging

Back 53

child's trachea tends to draw into the neck in respirtory distress

Front 54

until age ____ infants breath through their nose,

Back 54

4-6 months

Front 55

airway management considerations in children:

Back 55

-keep the nares clear in children younger than 6 months
-avoid hyper-extension of the neck
-keep airway clear of all secretions
-caution using airway adjuncts as tissues are soft, use positioning whenever possible

Front 56

respirtory tidal volume and oxygen demand in children vs adults

Back 56

same tidal volume but child has double the O2 demand.

Front 57

"belly breathers"

Back 57

refers to childs use of diaphram vs chest muscles to breathe (pressure on abdomen can restrict breathing)

Front 58

neonate: age; pulse and RR rates

Back 58

0-1 month

RR=30-60

HR=100-180

Front 59

Infant: age; pulse and RR rates

Back 59

1 month - 1 year

RR=25-50

HR=100 - 160

Front 60

Toddler: age; pulse and RR rates

Back 60

1-3 years

RR=20-30

HR=90-150

Front 61

Preschool: age; pulse and RR rates

Back 61

3-6 years

RR=20-25

HR=80-140

Front 62

School age: age; pulse and RR rates

Back 62

6-12 years

RR=15-20

HR=70-120

Front 63

Adolescent: age; pulse and RR rates

Back 63

12-18 years

RR=12-20

HR=60-100

Front 64

tachcardia vs bradycardia in children

Back 64

tachcardia = shock;

bradycardia= severe hypoxia (ominous sign) even in presence of normal blood pressure

Front 65

children are more susceptible to hypothermia due to:

Back 65

-larger BSA/weight ration
-thinner skin
-limited glycogen stores

Front 66

Pediatric assessment: TICLS mnemonic to assess "appearance" in the PAT triangle =

Back 66

Tone-muscle movement/ resistance

Interactiveness - Alert? Aware of others? grasp objects presented?

Consolability - consolable or inconsolable?

Look or gaze - fix on a face or "nobody home"

Speech or cry - strong & spontaneous or weak/ high-pitched, confused?

Front 67

when assessing a childs "work of breathing" look for:

Back 67

airway sounds - snoring, stridor, grunting
posturing - sniffing , tripod, refusing to lie down
Retractions - subclavicular, intercostal, head bobing
Flaring - nasal flaring on inspiration
Tachypnea

Front 68

Acrocyanosis

Back 68

normal=blue hands or feet in infants < 2 months old who are cold

Front 69

cap refill time is most reliable in children younger than___ years

Back 69

6

Front 70

Pediatric Glascow Coma Scale (infants)

Back 70

Best eye response: (E)
4.Eyes opening spontaneously
3.Eye opening to speech
2.Eye opening to pain
1.No eye opening or response

Best verbal response: (V)
5.Smiles, oriented to sounds, follows objects, interacts
4.Cries but consolable, inappropriate interactions.
3.Cries or screams persistently to pain.
2.grunts or moans to pain.
1.No verbal response.

Best motor responses: (M)
6.Infant moves spontaneously or purposefully
5.Infant withdraws from touch
4.Infant withdraws from pain
3.Abnormal flexion to pain for an infant (decorticate response)
2.Extension to pain (decerebrate response)
1.No motor response

Any combined score of less than eight represents a significant risk of mortality.

Front 71

apical pulse

Back 71

auscultating HR over chest

Front 72

bradycardia rates in infants and newborns

Back 72

newborns<100

infants<80

Front 73

begin CPR in infant or child with HR < ______

Back 73

60

Front 74

infection of the childs airway above the vocal cords is likely

infection of the childs airway below the vocal cords is likely

Back 74

Epiglottis

croup (=stridor)

Front 75

limit suctioning times to ___ seconds in infants and ___ in children

Back 75

5

10

Front 76

Albuterol sulfate Nebulizer dose for children

Back 76

2.5 mg/3 mL; 0.083% (unit dose)
◾
0.05 mg/kg to 0.15 mg/kg (min: 1.25 mg; max: 2.5 mg), 3 times (20 minutes between)

Front 77

BVM children with RR of:

Back 77

<12 or

>60

Front 78

NRB can't be used for blow-by O2 because of

Back 78

one-way valve (use drinking cup or other improvised device)

Front 79

when placed properly the IO needle will rest in the _________

Back 79

medullary canal

Front 80

use IO when

Back 80

unable to get IV in 3 tries or after 90 seconds in critically ill child.

Front 81

to miss the epiphyseal plate IO should be inserted

Back 81

two fingers below knee on medial side of leg

Front 82

IO complications:

Back 82

compartment syndrome
failed infusion
growth plate injury
osteomyelitis
skin infection
bony fracture

Front 83

Volutrol

Back 83

pediatric microdrip set

Front 84

laryngotracheobronchitis

Back 84

Croup

Front 85

assessing RR in child <3 count

Back 85

abdomen rises in 30 seconds

Front 86

classic apparent life threat event is characterized by

Back 86

distinct change in muscle tone

Front 87

____ is the 2nd most common cause of cardiopulmonary arrest in children

Back 87

shock