Uthscsa Paramedic Special Pops Test 2 Pediatrics

Front 1

The first month of life is considered the _______ period.

Back 1

neonatal

Front 2

define: infancy

Back 2

First 12 months of life

Front 3

Define: Toddler

Back 3

period including ages 1 to 3 years

Front 4

Children are not capable of reasoning, and develop a growing ability to crawl, walk, run, and climb during this developmental stage.

Back 4

Toddler (1-3 years)

Front 5

Assessment of toddlers begins with....

Back 5

observation of the child’s interactions with the caregiver, vocalizations, and mobility using the Pediatric Assessment Triangle (PAT)

Front 6

Children can recognize caregivers, make eye contact, roll over and sleep through the night as early as what age?

Back 6

2-6 months

Front 7

Teething, sitting without support, crawling, babbling, and separating anxiety develop in children around what age?

Back 7

6-12 months

Front 8

Define: Preschool-age child

Back 8

3 - 5 years

Front 9

The development of basic reasoning, crawling/walking, imitation of others, making believe and understanding object permanence is characteristic of what age group?

Back 9

12-18 months

Front 10

Running/climbing, understanding cause/effect, and attachment to certain objects develops in what age group?

Back 10

18-24 months

Front 11

development of fine motor skill, toilet training, jumping with both feet, knowing 250-500 words, and the ability to name a friend is indicative of what developmental stage (age)?

Back 11

24-36 months (2-3 years)

Front 12

T/F
With a preschool-age child you should offer simple choices instead of give only yes/no questions.

Back 12

True. You should offer simple choices and avoid yes/no questions.

Front 13

Define: school-age child (middle childhood)

Back 13

6 - 12 years

Front 14

By the age of ______ years, anatomy and physiology of children are similar to those of adults

Back 14

8

Front 15

Breasts develop between ages ____ and ____ years.

Menstrual period begins between ages ____ and ___ years.

Back 15

Breasts: 8 -13 years

Menstrual: 9 - 16 years

Front 16

Testicles increase in the size around age ____ years.

Back 16

10

Front 17

Define: Adolescent (age)

Back 17

13 - 17 years

Front 18

With respect to CPR and foreign body airway obstruction procedures, once __________ have developed, treat an adolescent as an adult.

Back 18

secondary sexual characteristics (breasts or facial/axillary hair)

Front 19

When treating an adolescent, should you get history from the adolescent while the caregiver is present?

Back 19

If possible, address the adolescent without a caregiver present especially about sensitive topics such as sexuality or drug use.

Front 20

An infant’s head is ______ its ultimate adult size.

Back 20

two thirds

Front 21

Infants and young children tend to land on their ______ when they fall.

Back 21

Head

Front 22

________ is the leading cause of death and significant disability in pediatric trauma patients.

Back 22

Traumatic brain injury

Front 23

The proper way to position the airway of a *seriously injured*, younger than 3 years old, patient is:

Back 23

Place a thin layer of padding under the back to obtain neutral position, because of proportionally larger occiput

Front 24

The proper way to position the airway of a *seriously ill*, younger than 3 years old, patient is:

Back 24

Place a folded sheet under occiput to obtain sniffing position, because of proportionally larger occiput

Front 25

In infants, the posterior fontanelles close by age ________.

Back 25

4 months.

Front 26

In infants, the Anterior fontanelles close by age ________.

Back 26

1 year

Front 27

Bulging fontanelles suggests:

Back 27

increased intracranial pressure.

Front 28

Sunken fontanelles suggests:

Back 28

dehydration

Front 29

With regard to breathing, during the first few months of life, infants are _________.

Back 29

obligate nose breathers.

Front 30

Narrowest part of a young child’s airway occurs at the level of the ___________.

Back 30

cricoid cartilage.

Front 31

Pediatric tracheal cartilage is softer and more collapsible and you should avoid hyperextension of neck because this may result in _________, kinking of the trachea.

Back 31

reverse hyperflexion

Front 32

Infants use the _________, not chest muscles, during inspiration.

Back 32

diaphragm

Front 33

Infants and children, especially during respiratory distress, are highly susceptible to hypoxia because of these 3 factors:

Back 33

a. Decreased functional residual capacity
b. Increased oxygen demand
c. Easily fatigued respiratory muscles

Front 34

If you are going to use a BVM with an infant or child, the Bag’s volume should have no less than ________ mL.

Back 34

450-500 mL

Front 35

Children rely mainly on _______ to maintain adequate cardiac output and compensate for decreased oxygenation.

Back 35

pulse rate.

Infant’s pulse rate can be 200 beats/min or more when compensating for injury or illness.

Front 36

Absolute blood volume in children is less than adults, and is approximately _____ mL/kg.

Back 36

70 mL/kg

Front 37

Suspect ________ when an infant or child presents with tachycardia.

Back 37

Shock

Front 38

Hypotension in a child is an ominous sign, often indicates impending __________.

Back 38

cardiopulmonary arrest

Front 39

neonate (0-1 month) respiratory rates:

Back 39

30 to 60 breaths/min

Front 40

Infant (1 month - 1 year) respiratory rates:

Back 40

25 to 50 breaths/min

Front 41

Toddler (1 to 3 years) respiratory rates:

Back 41

20 to 30 breaths/ minute

Front 42

preschool-age (3 to 5 years) respiratory rates

Back 42

20 to 25/minute

Front 43

School-age (6 to 12 years) respiratory rates

Back 43

15 to 20/ minute

Front 44

Adolescent (13-17 years) respiratory rates

Back 44

12 - 20/min

Front 45

adult (18+ years) respiratory rates

Back 45

12 - 20/min

Front 46

neonate (0-1 month) pulse rate

Back 46

100 - 180 bpm

Front 47

Infant (1 month - 1 year) pulse rates:

Back 47

100 to 160 bpm

Front 48

Toddler (1 to 3 years) pulse rates:

Back 48

90 - 150 bpm

Front 49

preschool-age (3 to 5 years) pulse rates

Back 49

80 to 140 bpm

Front 50

School-age (6 to 12 years) pulse rates

Back 50

70 - 120 bpm

Front 51

Adolescent (13-17 years) pulse rates

Back 51

60 - 100 bpm

Front 52

adult (18+ years) pulse rates

Back 52

60 - 100 bpm

Front 53

In young children, the cervical spine fulcrum is higher because head is heavier, that is it is closer to cervical disks: ________.

As child grows, fulcrum descends to “adult level," which is around cervical disks: ______ through ______

Back 53

i. Closer to C1-C2

ii. C5 through C7

Front 54

An Infant who sustains blunt head trauma involving acceleration-deceleration forces is at high risk for a fatal,___________ as opposed to a school-age child which will likely sustain a ____________ and may be paralyzed.

Back 54

infant: high cervical spinal injury

school-age: lower cervical spinal injury

Front 55

T/F?
Bones of growing children are weaker than their ligaments and tendons, making fractures more common than sprains.

Back 55

True

Front 56

Thin chest walls in children makes it easy to hear heart and lung sounds, however, pneumothoraces and esophageal intubations are often missed due to:

Back 56

sounds readily transmitted throughout the chest.

Front 57

You should always check ____________ in pediatric patients presenting with lethargy, seizures, or decreased activity.

Why?

Back 57

blood glucose levels

Infants and children have less subcutaneous (fatty) tissue and limited stores of glycogen and glucose are rapidly depleted as a result of injury or illness.

Front 58

How will hypoglycemia in children affect their thermoregulation?

Back 58

It takes glucose to produce energy that is required for thermoregulation, and children have very little glycogen compared with adults, therefore children are highly susceptible to hypothermia.

Front 59

Newborns lack the ability to _____ (way of producing heat).

Back 59

shiver

Front 60

What are 'ossification centers'?

Back 60

growth plates of bones

Front 61

During what phase of your assessment should you use the Pediatric Assessment Triangle to form a hands-off, from-the-doorway, general impression?

Back 61

The first step of the Primary assessment.

Front 62

What are the Standardized three elements of the Pediatric Assessment Triangle (PAT)?

Back 62

appearance, work of breathing, and circulation

Front 63

Do you assess a patient using the PAT before or after assessing the ABCs?

Back 63

The pediatric assessment triangle is performed prior to assessing ABCs

Front 64

Describe the purpose of the Pediatric assessment triangle (PAT).

Back 64

15- to 30-second assessment that paints an accurate clinical picture of cardiopulmonary status and level of consciousness

Front 65

This part of the PAT is often the most important factor in determining the severity of illness, need for treatment, and response to therapy.

Back 65

Appearance

Front 66

What does the mnemonic TICLS (tickles) stand for and what does it assess?

Back 66

TICLS assesses 'appearance' in the PAT.

(a) Tone
(b) Interactiveness
(c) Consolability
(d) Look or gaze
(e) Speech or cry

Front 67

The first element of the PAT to be assessed is __________, and it reflects adequacy of ventilation, oxygenation, brain perfusion, body homeostasis, and central nervous system (CNS) function

Back 67

Appearance

Front 68

How should you use the PAT to assess 'appearance'?

Back 68

Observe from a distance, allowing child to interact with caregiver.
Use TICLS mnemonic while observing from the doorway.
Delay touching the patient until you have formed a general impression; your touch may agitate the child.
Unless a child is unconscious or critically ill, take your time in assessing appearance by observation.

Front 69

The 'hands-on' portion of the primary assessment after using the 'hands-off' PAT is ______.

Back 69

assessing the ABCs

Front 70

This part of the PAT is often a better assessment of oxygenation and ventilation status than auscultation or respiratory rate

Back 70

Work of breathing

Front 71

Are listening for abnormal airway sounds and looking for signs of increased breathing effort considered hands-on or hands-off assessment techniques?

Back 71

Hands-off assessment

Front 72

Grunting is described as...

Back 72

a form of auto-PEEP (positive end expiratory pressure) involving exhaling against a partially closed glottis

Front 73

How does grunting affect alveoli and gas exchange?

Back 73

grunting is a way to distend lower respiratory air sacs or alveoli to promote maximum gas exchange.

Front 74

What type of respiratory conditions do patients who present with "grunting" typically suffer from ?

Back 74

Seen with lower airway conditions such as pneumonia and pulmonary edema
Suggests moderate to severe hypoxia
Reflects poor gas exchange because of fluid in the lower airways and air sacs

Front 75

Wheezing is defined as:

Back 75

a musical tone caused by air being forced through constricted or partially blocked small airways.
(a) Often occurs during exhalation only
(b) Can occur during inspiration and expiration during severe asthma attacks
(c) Often heard only by auscultation, though severe obstruction may result in wheezing that is audible without a stethoscope

Front 76

Physical signs of increased work of breathing include:

Back 76

Abnormal positioning and retractions

Front 77

This is a form of retractions seen only in infants

Back 77

Head bobbing:
(a) Use of neck muscles to help breathing during severe hypoxia
(b) Neck extends during inhalation; head falls forward during exhalation.

Front 78

Define 'Retractions'

Back 78

The recruitment of accessory muscles of respiration to provide more “muscle power” to move air into the lungs in the face of airway or lung disease or injury

Front 79

These are 4 things to consider when using PAT to assess 'work of breathing' to make your general assessment of oxygenation and ventilation status.

Back 79

(a) Abnormal airway sounds
(b) Abnormal positioning
(c) Retractions
(d) Nasal flaring

Front 80

3 characteristics combined to estimate severity of illness and the likely underlying pathology when using the PAT to assess 'Circulation to skin'.

Back 80

(a) Pallor
(b) Mottling
(c) Cyanosis

Front 81

This may be the initial sign of poor circulation or the only visual sign with compensated shock in children.

Back 81

Pallor (paleness)

Front 82

_______ reflects vasomotor instability in the capillary beds demonstrated by patchy areas of vasoconstriction and vasodilation.

Back 82

Mottling

Front 83

___________, is the most extreme visual indicator of poor perfusion or poor oxygenation.

Back 83

cyanosis

Front 84

Define: Acrocyanosis

Back 84

blue hands or feet in an infant younger than 2 months,
Normal finding when a young infant is cold

Front 85

How do you determine the difference between true cyanosis and acrocyanosis?

Back 85

True cyanosis is seen in the skin and mucous membranes; acrocyanosis is blue hands/feet in an infant less than 2 months.

Front 86

Your pediatric transport decision should be based on the _________ findings

Back 86

PAT

Front 87

During what stage of your assessment should you estimate your child patient’s weight (because much of your care will depend on child’s size)?

Back 87

Early in the later half of the primary assessment during the hands-on assessment of the ABCs.

Front 88

The best method for estimating a child's weight to base your care on is using ________?

Back 88

Broselow tape, or length-based resuscitation tape

Front 89

Broselow tape, or length-based resuscitation tape stimates weight and height in pediatric patients weighing up to_____ lb (____ kg).

Back 89

75 lb (34 kg).

Front 90

Describe the 4 steps involved in using the Broselow tape, or length-based resuscitation tape.

Back 90

To use, follow these steps:
(1) Measure child’s length from head to heel with the tape (red portion at the head).
(2) Note the weight in kilograms that corresponds to the measured length at the heel.
(3) If child is longer than the tape, use adult equipment and medication doses.
(4) From the tape, identify appropriate equipment sizes and medication doses.

Front 91

Breathing component of primary assessment ABCs for peds involves the following 3 things:

Back 91

(a) Calculate the respiratory rate.
(b) Auscultate breath sounds.
(c) Check pulse oximetry for oxygen saturation

Front 92

What is true of the changes in ECG patterns as an neonate grows into an infant?

Back 92

Large right sided forces in neonates/young infants are normal, and the forces progressively shift to the left side with age.

Front 93

Is the blood flow to an infant's brain more or less than that of an adult? how does it affect injury potential?

Back 93

Pediatric brain: nearly twice the blood flow − Makes even minor injuries significant
− Increases dangers of hypoxia

Front 94

In the abdomen/pelis of pediatric patients, the organs are situated ________ and are relatively ______.

How does this affect injury potential?

Back 94

Organs are situated more anteriorly and are relatively large.

Even seemingly insignificant forces can cause serious internal abdominal injury

Front 95

Most growth plates will be closed by ________.

Back 95

late adolescence

Front 96

T/F
growth plate fractures require high energy MOI.

Back 96

False

− Growth plate fractures can be seen with low- energy MOIs.

Front 97

Verify the pediatric respiratory rate per minute by counting the number of chest rises in _____ seconds and then ______ that number.

Back 97

30 seconds, double the number

*Counting for only 10 to 15 seconds may give a falsely low respiratory rate.

Front 98

Auscultate pediatric breath sounds with a stethoscope over the ___________ line to hear abnormal lung sounds during inhalation and exhalation.

Back 98

midaxillary

Front 99

If you cannot determine whether abnormal respiratory sounds are being generated in the lungs or upper airway, hold the stethoscope over __________ and listen.

Back 99

the nose or trachea

Front 100

If you cannot find a peripheral pulse (radial/brachial), you should check for central pulses at the ____________ in infants/young children and ________ in older children/adolescents.

Back 100

Check the femoral pulse in infants and young children, and the carotid pulse in older children and adolescents.

Front 101

To assess level of consciousness in the primary assessment you can use the AVPU system or the ___________.

Back 101

Pediatric Glasgow Coma Scale

Front 102

The pain scale used for children showing faces depicting various levels of pain is called ___________.

Back 102

Wong-Baker FACES scale

Front 103

3 non-pharmacologic techniques for reducing pain in peds:

Back 103

(a) Distraction techniques with toys or stories
(b) Visual imagery techniques and music
(c) Sucrose pacifiers in neonates

Front 104

If conducting a full-body exam for infants, toddlers, and preschool-age children start at the _____ and end at the _____.

Back 104

start at feet and end at the head

Front 105

In conducting a full-body exam for older children, use the _______ approach.

Back 105

head-to-toe

Front 106

Pus in the ear of a ped patient may indicate these 2 things:

Back 106

ear infection or perforation of the eardrum

Front 107

Check capillary refill in patients younger than _______.

Back 107

6 years

Front 108

One formula for determining the lower acceptable limit in children ages 1 to 10 years:

minimal systolic blood pressure = ___________________.

Back 108

80 + (2 X age in years)

Front 109

Given the difficulty related to getting the blood pressure of pediatric patients, you should make _______ attempt(s) before moving on the rest of your assessment.

Back 109

make one attempt.
If unsuccessful, move on to the rest of the assessment.

Front 110

To assess for disability, you should check these 4 things:

Back 110

1- LOC: the AVPU scale or Pediatric Glasgow
Coma Scale
2- • Assess pupillary response.
3- • Evaluate motor activity.
4 − Assessment of pain must consider age.

Front 111

Pediatric glascow coma scale Verbal response for infant and child <2 years and scoring.

Back 111

5 points - Infant coos or babbles (normal activity)
4 points - Infant is irritable and continually cries
3 points - Infant cries to pain
2 points - Infant moans to pain
1 point - No verbal response

Front 112

Pediatric glascow coma scale Verbal response for child 2+ years and scoring.

Back 112

5 points - Oriented and converses
4 points - Confused, but able to answer questions
3 points - Inappropriate responses, words are discernible
2 points - Incomprehensible speech / sounds
1 point - none

Front 113

Transport a pediatric trauma patient immediately if they have any of these 4 complications:

Back 113

− Serious MOI
− Physiologic abnormality
− Significant anatomic abnormality
− Unsafe scene

Front 114

In a pediatric patient with apparent respiratory distress, you should first _________.

Back 114

Determine the severity.
- Distress, failure, or arrest??

Front 115

Respiratory distress entails ______.

Back 115

increased work of breathing to maintain oxygenation and/or ventilation.
A compensated state in which increased work of breathing results in adequate pulmonary gas exchange
Classified as mild, moderate, or severe.

Front 116

These 4 are hallmarks of _________.
i. Retractions (suprasternal, intercostal, subcostal)
ii. Abdominal breathing
iii. Nasal flaring
iv. Grunting

Back 116

Respiratory distress

Front 117

In _____________, a patient can no longer compensate for underlying pathologic or anatomic respiratory problem by increased work of breathing.

Back 117

Respiratory failure

Front 118

These 3 signs are hallmarks of _________.
i. Decreased or absent retractions due to chest wall muscle fatigue
ii. Altered mental status due to inadequate oxygenation and ventilation of the brain
iii. Abnormally low respiratory rate

Back 118

Respiratory failure

Front 119

An awake patient with stridor, increased work of breathing, and good color on the PAT is suffering from a _________.

Initial management includes:

Back 119

mild upper airway obstruction

i. Position of comfort
ii. Providing supplemental oxygen as tolerated
iii. Transport to an appropriate facility.
iv. Avoid agitating the child; stimulus could worsen the situation.
Monitor continuously

Front 120

Presence of unilateral wheezing may tip you off to a foreign body lodged in _________.

Back 120

a mainstem bronchus

Front 121

A patient with___________ is likely to be cyanotic and unconscious when you arrive due to profound hypoxia.

Back 121

severe airway obstruction

Front 122

Removing a foreign body airway obstruction in responsive infants involves:

Back 122

Delivering five back slaps and five chest thrusts:

Front 123

The procedure for removing a foreign body airway obstruction in unresponsive infants is:

Back 123

If the infant loses consciousness, look inside the mouth.
ii. If you see the object, remove it.
iii. If not, start CPR beginning with 30 chest compressions (15 compressions if two rescuers are present and the patient is an infant or child).
iv. If there is no pulse, or the pulse rate is less than 60 beats/min, begin CPR.
v. Continue compressions, always looking in the mouth, and attempting ventilations until the obstruction is relieved.
vi. Then, assess for a pulse.

Front 124

Most effective method for removing a foreign body airway obstruction with a responsive adult or child

Back 124

The abdominal thrust maneuver (Heimlich maneuver)

Front 125

If while performing the heimlich maneuver, a child falls unresponsive, what steps should you take next?

Back 125

a) Position supine and perform 30 chest compressions (15 compressions if two rescuers are present and the patient is an infant or child).
(b) Open the airway and look in the mouth, attempting to remove the foreign body only if you can see it.
(c) After looking in the mouth, attempt to ventilate the patient.
(d) If the first breath does not produce visible chest rise, reopen the airway and reattempt to ventilate.
(e) If both breaths fail to produce visible chest rise, continue chest compressions.
(f) If you are unable to relieve a severe airway obstruction in an unresponsive patient with these basic techniques, proceed with direct laryngoscopy (visualization of the airway with a laryngoscope) for the removal of the foreign body.
(g) Insert the laryngoscope blade into the mouth. If you see the foreign body, carefully remove it from the upper airway with Magill forceps.

Front 126

An infant and a child fall unresponsive due to airway obstruction. What is the next step for each patient?

Back 126

infant: visualize airway to look for foreign obstruction, then begin chest compressions

child: begin 30 chest compressions, then look for obstruction

Front 127

After attempting to ventilate an unresponsive child, you did not see chest rise. The next step is:

If that fails, what should you do next?

Back 127

reopen the airway and reattempt to ventilate.

If both breaths fail to produce visible chest rise, continue chest compressions.

Front 128

If you are unable to relieve a severe airway obstruction in an unresponsive patient with 2 failed attempted ventilations, proceed with___________ for the removal of the foreign body.

Back 128

direct laryngoscopy (visualization of the airway with a laryngoscope)

Front 129

Onset of anaphylaxis symptoms generally occurs in what time frame?

Back 129

immediately after exposure

Front 130

Characterize symptoms 'Mild anaphylaxis' in a child.

Back 130

Child may experience only hives and some wheezing

Front 131

Characterize symptoms 'severe anaphylaxis' in a child.

Back 131

Child may be in respiratory failure and shock when you arrive.

Front 132

These symptoms found during the primary assessment would give you a provisional diagnosis of _____.

hives, in addition to...
(a) Swelling of the lips and oral mucosa
(b) Stridor and/or wheezing
(c) Diminished pulses

Back 132

Severe anaphylaxis

Front 133

“Gold standard” treatment for anaphylaxis is ___________.

Back 133

epinephrine

Front 134

Give epinephrine for anaphylaxis by the intramuscular (IM) route at a dose of _______ of the 1:1,000 solution, to a maximum dose of _______.

Back 134

dose: 0.01 mg/kg

max dose: 0.3 mg

Front 135

In addition to epinepherine, you should give Diphenhydramine for its antihistamine effect at a dose of ___________ IV to a max dose of _____.

Back 135

dose: 1 to 2 mg/kg IV to a maximum of 50 mg

Front 136

Treatment of anaphylaxis should include these 5 things:

Back 136

− Epinephrine
− Supplemental oxygen
− Fluid resuscitation for shock
− Diphenhydramine
− Bronchodilators

Front 137

laryngotracheobronchitis is otherwise called:

Back 137

croup

Front 138

This upper airway viral infection is the Most common cause of upper airway emergencies in young children

Back 138

croup

Front 139

what 3 viruses mainly cause croup?

Back 139

Parainfluenza virus (most commonly responsible for croup)

respiratory syncytial virus (RSV)
adenovirus

Front 140

Croup is transmitted by _______ and primarily affects ages _________.

Back 140

respiratory secretions.

5 years and younger

Front 141

The virus causing croup targets _______, causing edema and progressive airway obstruction leading to the hallmark sign of croup: stridor.

Back 141

subglottic space - the narrowest part of the pediatric airway

Front 142

The onset of croup is typically in the seasons of ____________ and symptoms typically come on during the ______.

Back 142

fall/winter

night

Front 143

SAMPLE history for croup usually reveals:

Back 143

several days of cold symptoms and low-grade fever, followed by barky cough, stridor, and trouble breathing. The cough and respiratory distress are often worse at night.

Front 144

Initial management for Croup includes:

Back 144

Use of cool mist or nebulized saline is controversial.

Nebulized epinephrine (racemic, L-epi) is the treatment of choice with any of the following:
(a) Stridor at rest
(b) Moderate to severe respiratory distress
(c) Poor air exchange
(d) Hypoxia
(e) Altered appearance

Front 145

Nebulized epinephrine is available in two formulations:

Back 145

racemic epinephrine and L - epinephrine

Front 146

The dose for nebulized racemic epinephrine (2.25%) is:

Back 146

0.5 mL mixed in 3 mL of normal saline.

Front 147

The dose for L -epinephrine is ______ of the 1:1,000 solution (maximum, 5 mg per dose); this form can be diluted with normal saline to bring the volume to 3 mL.

Back 147

0.25 to 0.5 mg/kg

Front 148

Advanced airway placement is rarely needed with croup patients, if you do select an ET tube though, you should:

Back 148

choose an ET tube one-half to one size smaller than normal for age or size to accommodate the subglottic edema.

Front 149

describe Epiglottitis

Back 149

Life-threatening inflammation of the supraglottic structures, usually due to bacterial infection

Front 150

Epiglottitis is rare due to vaccine against:

Back 150

Haemophilus influenzae, type B

Front 151

Classic presentation using PAT for epiglottitis is:

Back 151

Child will look sick, be anxious, and sit upright in the sniffing position with the chin thrust forward to allow for maximal air entry.

May be drooling because of an inability to swallow secretions

Work of breathing is increased.

Pallor or cyanosis may be evident.

Front 152

SAMPLE history in a patient with epiglottitis will reveal a sudden onset of_____________.

Back 152

a sudden onset of high fever and sore throat in preschool or school-age children.

Front 153

In a patient with epiglottitis, Do not attempt to ______________ because this can precipitate complete airway obstruction, and do not insert ___________.

Back 153

Do not attempt to look in the mouth

do not insert an IV line

Front 154

If you attempt to place an ET tube in an epiglottitis patient you should select a size ________.

Back 154

one to two sizes smaller than anticipated in the event of complete obstruction during transport.

Front 155

Describe Bacterial tracheitis

Back 155

Invasive exudative bacterial infection of the soft tissues of the trachea.
Typically presents with cough, stridor, and respiratory distress of varying degree with a history of a preceding viral infection.

Front 156

When treating a patient with Bacterial tracheitis, do not ____________as it can precipitate complete airway obstruction, and do not________.

Back 156

do not look in the mouth.

do not start an IV line

Front 157

If you attempt to place an ET tube in an Bacterial tracheitis patient you should select a size ________.

Back 157

one to two sizes smaller than anticipated in the event of complete obstruction during transport.

Front 158

With a suspected epiglottitis patient, be sure to ask about _________.

Back 158

immunizations

Front 159

Pathophysiology in upper airway emergencies involves restriction of ______________.

Back 159

air flow into the lungs (inhalation)

Front 160

Pathophysiology of lower airway respiratory emergencies involves restriction of air flow ___________.

Back 160

out of the lungs (exhalation).

Front 161

Most common chronic illness of childhood and most common respiratory complaint encountered by prehospital providers

Back 161

Asthma

Front 162

These 3 components of asthmalead to obstruction and poor gas exchange:

Back 162

i. Bronchospasm
ii. Mucus production
iii. Airway inflammation

Front 163

4 Signs of severe respiratory distress and impending respiratory failure with asthma include:

Back 163

i. Decreasing alertness
ii. Tripod position
iii. Deep retractions
iv. Cyanosis

Front 164

___________ alone may be heard with mild to moderate asthma attacks, while _____________ with moderate to severe asthma attacks.

Back 164

expiratory wheezing

Wheezing may be heard on inspiration and expiration

Front 165

_______ are the most common controller medications for chronic asthma.

Back 165

Inhaled steroids

Front 166

________ is the most common beta-2 agonist drug used as a rescue medication for asthma attacks.

Back 166

Inhaled albuterol

Front 167

Gold standard treatment for asthma attacks include:

Back 167

bronchodilators, beta-agonists that relax smooth muscles in the bronchioles, decreasing bronchospasm and improving air movement and oxygenation

Front 168

These doses (small child, large child) of albuterol is often used for nebulization treatment of asthma attacks:

Back 168

Unit doses of 2.5 mg of albuterol premixed with 3 mL of normal saline for most young children.

For a larger child or a child of any age who is in severe distress, consider 5 mg of albuterol as the initial dose

Front 169

4 points of initial management of asthma:

Back 169

− Position of comfort
− Supplemental oxygen
− Bronchodilators
− Epinephrine for severe respiratory distress

Front 170

Studies have shown that the combination of albuterol and_________ (which may be mixed and delivered together by nebulizer) is more effective than albuterol given alone.

Back 170

ipratropium

Front 171

An isomer of albuterol, _______, reportedly has fewer side effects and is likely an acceptable alternative to albuterol.

Back 171

levalbuterol

Front 172

The dose of ipratropium given for asthma is based on the patient’s weight:

Back 172

Less than 10 kg: A 0.25 mg unit dose nebulized or one puff by MDI
ii. More than 10 kg: A 0.5 mg unit dose nebulized or two puffs by MDI

Front 173

If nebulized albuterol is used, _______ puffs are equivalent to 2.5 mg administered by nebulizer.

Back 173

4

Front 174

If a child is in severe respiratory distress, is obtunded, or has markedly diminished air movement on auscultation, a dose of epinephrine may be required

It works by:

Back 174

Will cause immediate relaxation of bronchial smooth muscles, opening the airways to allow bronchodilators to work

Front 175

_____________ is problematic for patients with an asthma exacerbation.
High inspiratory pressures force air into the lungs, but exhalation is compromised by bronchospasm, mucus production, and inflammation.Leads to air trapping and a high risk of pneumothorax and pneumomediastinum

Back 175

assisted ventilation

Front 176

Assisted ventilation of an asthma attack patient should only happen if:

Back 176

the patient has respiratory failure and has failed to respond to IM epinephrine and high-dose bronchodilators.
If performed, use slow rates to allow time for adequate exhalation: Goal is adequate oxygenation.

Front 177

Describe Bronchiolitis

Back 177

Inflammation or swelling of the small airways (bronchioles) in the lower respiratory tract due to viral infection

Front 178

the 2 viruses responsible for Bronchiolitis.

Back 178

Most common source is respiratory syncytial virus (RSV), also newer virus, metapneumovirus.

Front 179

Brochiolitis primarily affects __________, and is ________ contagious.

Back 179

infants and children younger than 2 years
very contagious

Front 180

Signs and symptoms of _________ are difficult to distinguish from asthma, but one clue is age: _______ is rare in children younger than 1 year.

Back 180

bronchiolitis

asthma is rare in children <1 year

Front 181

An infant with a first-time wheezing episode in late fall or winter likely has ________.

Back 181

bronchiolitis

Front 182

paramedic management of bronchiolitis is _________.

Back 182

entirely supportive

Front 183

Bronchiolitis is dangerous as there is a risk for ________, especially among these groups:
− First months of life
− Prematurity
− Lung disease
− Congenital heart disease
− Immunodeficiency

Back 183

respiratory failure.

Front 184

Describe Pneumonia

Back 184

Common disease process that affects the lower airway and the lung.

Often caused by a virus in infants and toddlers
Incidence of bacterial pneumonia increases as children get older.

Front 185

Children with _________ typically have a recent history of a cough or cold, or a lower airway infection (ie, bronchiolitis).
Often pediatric patients will present with unusually rapid breathing, or will breathe with grunting or wheezing sounds.
Additional signs and symptoms include:
i. Nasal flaring
ii. Tachypnea
iii. Crackles
iv. Chest pain
v. Hypothermia or fever

Patient may exhibit unilateral diminished breath sounds.

Back 185

pneumonia

Front 186

Primary treatment of pneumonia:.

Back 186

is supportive.

Monitor airway and breathing status.
Administer supplemental oxygen if required.
Vascular access is generally not indicated, perform en route if needed.

Front 187

Describe Pertussis

Back 187

Also known as whooping cough
Highly contagious, potentially deadly disease
Caused by a bacterium that is spread through respiratory droplets

Front 188

Typical signs and symptoms of _________ are similar to a common cold: coughing, sneezing, and a runny nose.

Back 188

Pertussis

Front 189

In which condition does coughing progressively become more severe and is characterized by the distinctive whoop sound heard during the inspiratory phase.

Back 189

Pertussis (whooping cough)

Front 190

In a patient where coughing has become so severe that it can cause postcough vomiting, conjunctival hemorrhage, and cyanotic hypoxia, you should suspect the patient is suffering from:

Back 190

pertussis (whooping cough)

Front 191

Treatment for moderate to severe respiratory distress associated with bronchiolitis:

Back 191

can include Inhaled albuterol or nebulized racemic epinephrine may be given for moderate to severe respiratory distress.

Front 192

describe Cystic fibrosis (CF)

Back 192

Genetic disease that primarily affects the respiratory and digestive systems. Chronic production of copious amounts of thick mucus in the respiratory and digestive tracts

Front 193

Describe Bronchopulmonary dysplasia

Back 193

Spectrum of lung conditions found in premature neonates who required long periods of high-concentration oxygen and ventilator support

Front 194

Potential paramedic treatments for Bronchopulmonary dysplasia includes:

Back 194

Continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) may be beneficial.
intubation, oxygen therapy
bronchodilators such as albuterol may be tried
Ipratropium may be beneficial and should be considered.
Oral and IM steroids can be considered acutely.
(Eg, prednisone or dexamethasone)

Front 195

At home management of Bronchopulmonary dysplasia includes:

Back 195

 Long periods of high concentration oxygen
Ventilator support
usually on home oxygen

Front 196

NPAs are typically not used for this age group:______

Back 196

children younger than 1 year because of the small diameter of their nares, which tend to become easily obstructed by secretions

Front 197

Two most common oxygen delivery methods with pediatric patients:

Back 197

i. Blow-by technique
ii. Nonrebreathing mask

Front 198

Do not use a_________ for blow-by oxygen, because it may blow fluorocarbons into the child’s airway.

Back 198

Styrofoam cup

Front 199

Deliver breaths at a rate of _________ for infants and children.
i. One breath every _________
ii. Squeeze bag only until you see chest rise

Back 199

12 to 20 breaths/min
3 to 5 seconds

Front 200

When you ventilate pediatric patients with BVM, each breath should be given over a period of _______.

Back 200

1 second

Front 201

Pediatric-specific advanced airway equipment is mandatory, including:
(a) Range of laryngoscope blades, sizes ________
(b) ET tubes, sizes ____ (for field deliveries of premature infants) to ____

Back 201

a. laryngoscope blades, sizes 0 to 3
b. ET tubes 2.5 to 6.0

Front 202

________ blades make it easy to lift the floppy epiglottis to provide a direct view of the vocal cords.

Back 202

Straight (Miller or Wis-Hipple)

Front 203

If a ______ blade is used, the tip of the blade is positioned in the vallecula to lift the jaw and epiglottis to visualize the vocal cords

Back 203

curved (Macintosh)

Front 204

The appropriately sized laryngoscopy blade extends from the patient’s ___________.

Back 204

mouth to the tragus of the ear.

Front 205

Accepted pediatric blade size guidelines:
(a) Premature newborn:
(b) Full-term newborn to 1 year:
(c) 2 years to adolescent:
(d) Adolescent or older:

Back 205

(a) Premature newborn: size 0 straight blade
(b) Full-term newborn to 1 year: size 1 straight blade
(c) 2 years to adolescent: size 2 straight blade
(d) Adolescent or older: size 3 straight or curved blade

Front 206

Use a length-based resuscitation tape measure to choose the appropriate ET tube size or, for children older than 1 year, use this formula for uncuffed ET tubes:

Back 206

[Age (in years) + 16] ÷ 4 = Size of tube (in mm)

Front 207

If you must use a cuffed ET tube, you should __________ a size.

Back 207

size down half a size.
That is, if a 4 y/o needs a 5.0 mm uncuffed, you can use a 4.5 cuffed.

Front 208

For patients who are younger than _______, you may choose to use uncuffed ET tubes, although a noninflated cuffed tube is acceptable

Back 208

8 to 10 years

Front 209

The appropriate depth for insertion of ET tube is ___________.

Back 209

2 to 3 cm beyond the vocal cords.

Front 210

Uncuffed tubes often have a black glottic marker at the tube’s distal end to use as a guide.
When you see this line ___________, stop.

Back 210

go through the vocal cord

Front 211

Cuffed ET tubes: When the cuff is___________, stop.

Back 211

just below the vocal cords

Front 212

Insert ET tube to a depth that is equal to____________.

Back 212

three times the inside diameter of the tube

Front 213

Preoxygenate (do not hyperventilate) with a bag-mask device and 100% supplemental oxygen for at least ________ before you attempt intubation using the “squeeze, release, release” technique

Back 213

2 to 3 minutes

Front 214

If an intubated child deteriorates, use the _______ mnemonic to identify the potential problem and institute an appropriate intervention.

Back 214

DOPE
(a) Displacement
(b) Obstruction
(c) Pneumothorax
(d) Equipment failure

Front 215

Limit pediatric intubation attempts to ____ seconds.

Back 215

20

Front 216

Choosing an ET tube for a patient less than 1 y/o should be based on:

Back 216

length based resuscitation tape

Front 217

invasive gastric decompression is contraindicated in __________.

Back 217

unresponsive children

Front 218

To select a tube for invasive gastric decompression:

Back 218

Determine with a pediatric resuscitation tape measure, or use a tube size twice the uncuffed ET tube size that the child would need. For example, a child who needs a 5.0-mm uncuffed ET tube requires a 10F OG or NG tube
OR
Measure the tube on the patient. Tube length should be the same as the distance from the lips or tip of the nose (depending on whether the OG or NG route is used) to the earlobe plus the distance from the earlobe to the xiphoid process.

Front 219

IF you are considering invasive gastric decompression and the patient is unresponsive and has a poor or absent gag reflex, perform _________.

Back 219

perform ET intubation before gastric tube placement.

Front 220

Check invasive gastric decompression tube placement by __________. Use a syringe with an appropriate adapter to quickly instill 10 to 20 mL of air through the tube while auscultating over the________. If you hear a rush of air (or gurgling) over the stomach, the placement is correct.

Back 220

aspirating stomach contents.
Use a syringe with an appropriate adapter to quickly instill 10 to 20 mL of air through the tube while auscultating over the left upper quadrant. If you hear a rush of air (or gurgling) over the stomach, the placement is correct.

Front 221

3 types of shock you'll see in peds:

Back 221

− Hypovolemic − Distributive − Cardiogenic

Front 222

Most common cause of shock in infants and young children, with loss of volume occurring due to illness or trauma

Back 222

Hypovolemic shock

Front 223

Infants and young children have small blood volume, usually about __________. (80 mL/kg body weight

Back 223

80 mL/kg body weight

Front 224

In medical shock, you may see signs of dehydration such as these 4:

Back 224

a. Sunken eyes
b. Dry mucous membranes
c. Poor skin turgor
d. Delayed capillary refill with cool extremities

Front 225

_________ is the mainstay of treatment for hypovolemic shock, whether medical or traumatic in origin.

Back 225

Volume replacement

Front 226

Choose appropriate drip set, and attach it to the fluid.
i.______ for a child who needs volume replacement
ii. ______ for a child who needs a medication infusion
Use a ______ drip set whenever possible.

Back 226

Macrodrip set (eg, 10 gtt/mL)

Microdrip set (eg, 60 gtt/mL)

use a Buretrol drip set whenever possible

Front 227

Once IV access is established, fluid resuscitation should begin with isotonic fluids only, such as normal saline or lactated Ringer’s.
Begin with ________ then reassess, continue for a total of ____ boluses.

Back 227

20 mL/kg

3

Front 228

With ________ shock, you can attempt IV or IO access en route.

Back 228

compensated

Front 229

In _________ shock with hypotension, begin initial fluid resuscitation on scene.

Back 229

decompensated