Chapter 34

Question 1

Thoughts and behaviors:
...: first year of life
...: 1 to 3 years
...-age: 3 to 6 years
...-age: 6 to 12 years
...: 13 to 18 years

Answer 1

infancy
toddler
preschool
school
adolescenet

Question 2

Infancy is defined as first year of life.
First month after birth is neonatal or newborn period.
0 to 2 months
Spend most time … and …
Cannot tell the difference between …and …
…is one of the main modes of expression
Inconsolability could be a sign of …

Answer 2

sleeping; eating
parents; strangers
crying;
significant illness

Question 3

infant contd:
2 to 6 months
Persistent …, …, or lack of … can be an indicator of serious illness, depressed mental status, or a delay in development.
6 to 12 months
May cry if separated from parents or caregivers
Persistent … or …can be symptoms of serious illness.

Answer 3

crying; irritability; eye contact

crying; irritability

Question 4

infant contd:
Assessment
Observe infant from a …
Caregiver should hold baby during physical assessment.
Provide …comfort.
Do painful procedures at …of assessment.
Complete each procedure efficiently and avoid interruptions.
Explain each procedure to the parent or caregiver before you perform it.

Answer 4

distance
sensory
end

Question 5

toddler:
12 to 18 months
Because they are …by nature and not afraid, injuries increase.
May not be able to fully …, leading to increased risk of choking
18 to 24 months
May cling to parents or comforting toy

Answer 5

explorers;

chew food;

Question 6

toddler contd: 
Assessment
May have ...
May resist separation from caregiver
May have a hard time ...
Can be distracted
Begin your assessment at the ....
Persistent ...can be a symptom of serious illness or injury.

Answer 6

stranger anxiety
describing pain
feet
crying

Question 7

preschool-age child:
Ages 3 to 6 years
… still high risk
Assessment
Can understand directions and be specific in describing painful areas
Much history must still be obtained from caregivers.
Communicate …and …

Answer 7

foreign body aspiration airway obstruction

simply; directly

Question 8

preschool child contd:
Assessment (cont’d)
Appealing to child’s …may facilitate examination.
Never lie to the patient.
Patient may be easily distracted.
Begin assessment at …, moving to ….
Use adhesive bandages to cover the site of an injection or other small wound.
Modesty is developing; keep child covered as much as possible.

Answer 8

imagination; feet; head;

Question 9

school-age years:
6 to 12 years
Children begin to understand …
Assessment
Begins to be more like the adult assessment
To help gain trust, … not just the caregiver.
Probably familiar with the process of a physical exam
Start with …and move to the …

Answer 9

death; talk to the child; head; feet

Question 10

school-age years assessment contd:
Assessment
Give the child ….
Ask questions that let you control the answer.
Allow the child to listen to his or her heartbeat.
Understand the difference between physical and emotional pain.
Provide simple explanations about what is causing pain and what will be done.
Ask the parent’s or caregiver’s advice.

Answer 10

choices;

Question 11

adolescents:
13 to 18 years
Physically similar to adults
Still children …
A time of experimentation and risk-taking behaviors
Assessment
Can often understand complex concepts and treatment options
Allow them to be involved in their own care.
EMT of … should do physical exam.
Allow them to speak openly and ask questions.
Female patients may be …
Have clear understanding of the purpose and meaning of pain

Answer 11

emotionally;
same gender
pregnant

Question 12

Anatomy of airway differs from adults
Pediatric airway is …in diameter and … in length.
Lungs are smaller.
Heart is … in chest.

Answer 12

smaller; shorter; higher

Question 13

Anatomy of airway differs from adults (cont’d)
Glottic opening is …and positioned more …, and neck appears to be nonexistent.
As child develops, the neck becomes proportionally longer as the vocal cords and epiglottis achieve anatomically correct adult position.

Answer 13

higher; anteriorly;

Question 14

Anatomy of airway differs from adult (cont’d)
Larger, rounder …
Proportionally larger … Long, floppy, U-shaped epiglottis
Less-developed rings of cartilage in the ..
Narrowing, funnel-shaped upper airway
Diameter of trachea in infants is about the same as a ….

Answer 14

occiput;
tongue
trachea
drinking straw

Question 15

Anatomy of airway differs from adult (cont’d)
Children have oxygen demand …that of an adult.
Diaphragm muscles dictate amount of oxygen inspired.
Gastric distention can interfere with movement of the diaphragm and lead to ….
Breath sounds are more easily heard because of …chest walls.
Detection of poor air movement or complete absence of breath sounds may be more difficult.

Answer 15

twice
hypoventilation
thinner

Question 16

Important to know normal pulse ranges
Infant’s heart can beat …beats/min or more.
Children are able to compensate for decreased perfusion by … the vessels in the skin.
Signs of vasoconstriction include … (early sign), … in the extremities, delayed …, and …hands or feet.

Answer 16

160; 
constricting 
pallor
weak distal pulses
capillary refill
cool

Question 17

pulse rates by age: 
newborn-3 months: … to … 
3 m- 2yrs: … to … 
2 yrs- 10 yrs: … to …. 
>10 years: … to …

Answer 17

85; 205
100; 190
60; 140
60; 100

Question 18

Pediatric nervous system is immature, underdeveloped, and not well protected.
Head-to-body ratio of infant and young child is disproportionately ….
Occipital region is larger, which increases the …of the head during a fall.
Subarachnoid space is relatively …, leaving less cushioning for brain.
Brain tissue and cerebral vasculature are fragile and prone to bleeding from …forces.

Answer 18

larger
momentum
smaller
shearing

Question 19

Pediatric brain requires higher cerebral blood flow, oxygen, and glucose.
At risk for … from hypotension and hypoxic events
Spinal cord injuries are less common.
If injured, it is more likely to be an injury to the …because of a fall.
For suspected neck injury, perform manual in-line stabilization or follow local protocols.

Answer 19

secondary brain damage

ligaments

Question 20

Abdominal muscles are less developed.
Less protection from trauma
Liver, spleen, and kidneys are proportionally …and situated more …and ….
Prone to bleeding and injury

Answer 20

larger; anteriorly; close to one another

Question 21

Open… allow bones to grow.
As a result of growth plates, bones are softer and more flexible, making them prone to ….
…discrepancies can occur if injury to growth plate occurs.
Bones of an infant’s head are flexible and soft.
… is highly elastic and pliable.

Answer 21

growth plates
stress fractures
bone length
thoracic cage

Question 22

Pediatric integumentary system differs in a few ways:
…skin and less …
Composition of skin is thinner and tends to …more deeply and easily with less exposure
Higher ratio of body surface area to body mass leads to larger …and …losses.

Answer 22

thinner; subcutaneous fat
burn
fluid; heat

Question 23

Traumatic scene where the child is unresponsive or too young to communicate
Assume the injury was significant enough to cause … or …injuries.
Perform cervical spine immobilization if suspected MOI is severe.

Answer 23

head; neck

Question 24

Form a general impression.
Use… (PAT) to determine if the patient is sick or not sick–> entails appearance, work of breathing, and circulation to skin
Can be performed in less than 30 seconds
For pediatric patient you will now perform a hands-on ABCs assessment.
Assess and treat any life threats as you identify them by following the …. format.

Answer 24

pediatric assessment triangle; ABCDE

Question 25

Always position airway in … position for pediatric patients
Breathing
Use the look, listen, feel technique.
Place both hands on patient’s chest to feel for rise and fall of chest wall.
… in infants is considered adequate.
…is an ominous sign and indicates impending respiratory arrest.

Answer 25

neutral sniffing; Belly breathing; Bradypnea

Question 26

Circulation
Determine if patient has a pulse, is bleeding, or is in shock.
In infant, palpate brachial or … pulse.
In children older than 1 year, palpate carotid pulse.
Strong central pulses usually indicate that the child is not … .
Weak or absent peripheral pulses indicate decreased …

Answer 26

femoral; hypotensive; perfusion

Question 27

Circulation (cont’d)
Tachycardia may be early sign of ….
Interpret pulse within the context of overall history, the PAT, and primary assessment.
Evaluate trend of increasing or decreasing pulse rate.
Feel skin for temperature and moisture.
Estimate the capillary refill time.

Answer 27

hypoxia

Question 28

Disability
Use AVPU scale or pediatric GCS.
Check … response.
Look for symmetric movement of …
Pain is present with most types of injuries.
Assessment of pain must consider developmental age of patient.
Hands-on ABCs require that the caregiver remove some of patient’s clothing for observation.
More prone to …events
Should be kept warm during transport

Answer 28

pupil
extremities
hypothermic

Question 29

Transport decision (cont’d)
If less than 40 lb, transport in …
Mount a … to a stretcher.
Follow manufacturer’s instructions to secure car seat in captain’s chair.
Do not use the pediatric patient’s own car seat.

Answer 29

car seat; car seat

Question 30

Questions to ask based on chief complaint:
NOI or MOI
Length of sickness or injury
Key events leading up to injury or illness
Presence of …
Effects of illness or injury on …
Patient’s …
Recent eating, drinking, and urine output
Changes in bowel or bladder habits
Presence of vomiting, diarrhea, abdominal pain
Presence of …
Obtain name and phone number of caregiver if they are not able to come to the hospital with you.

Answer 30

fever; behavior; activity level; rashes

Question 31

blood pressure is usually not assessed in patients younger than … years
Use a cuff that covers … of the pediatric patient’s upper arm.

Answer 31

3; two thirds

Question 32

Vital signs (cont’d)
Use this formula to determine blood pressure for children ages 1–10 years:
… = systolic blood pressure
Respiratory rates may be difficult to interpret.
Count respirations for at least 30 seconds and double that number.
In infants and those younger than 3 years, evaluate respirations by assessing the rise and fall of the …

Answer 32

70 + (2 x child’s age in years); abdomen

Question 33

… problems are the leading cause of cardiopulmonary arrest in the pediatric population.
Failure to recognize and treat will lead to death.
Patient must work harder to breathe and will eventually go into respiratory failure if left untreated.
In the early stages, you may note changes in behavior, such as …, …, and …

Answer 33

respiratory; combativeness; restlessness; anxiety

Question 34

As the patient progresses to possible respiratory failure
Efforts to breathe decrease.
Chest rises less with inspiration.
Changes in behavior and, eventually, altered level of consciousness
Patient may experience periods of …
… becomes hypoxic.
Respiratory failure does not always indicate airway obstruction.
May indicate trauma, … problems, …, or … disturbances

Answer 34

apnea; heart muscle; nervous system; dehydration; metabolic

Question 35

Infections can cause obstruction.
Infection should be considered if patient has …, … , …, and ..symptoms.
Croup
Epiglottitis

Answer 35

congestion; fever; drooling; cold

Question 36

Obstruction by foreign object may involve upper or lower airway.
Obstruction may be partial or complete.
Signs and symptoms associated with partial upper airway obstruction include decreased breath sounds and ….
Signs and symptoms of lower airway obstruction include … and/or …
Best way to auscultate breath sounds in the pediatric patient is to listen to both sides of the chest at armpit level.

Answer 36

stridor; wheezing; crackles

Question 37

pneumonia:
…cause of death in children
Pneumonia is a general term that refers to an infection to the lungs.
Presentation in pediatric patient
Pediatric patient treatment
Diagnosis of pneumonia must be confirmed in the hospital.

Answer 37

Leading

Question 38

…: An infection of the airway below the level of the vocal cords, usually caused by a virus
Typically seen in children between ages 6 months and 3 years
Easily passed between children
The hallmark signs of croup are … and a …cough.
Treatment

Answer 38

croup; stridor; seal-bark

Question 39

…: Bacterial infection of the soft tissue in the area above the vocal cords
Incidence decreased since development of vaccine
Epiglottis can swell to two to three times normal size.
Children look ill, report a very sore throat, and have a high fever.
Tripod position and drooling

Answer 39

epiglottitis

Question 40

…: Specific viral illness of newborns and toddlers, often caused by RSV
More common in premature infants and results in copious secretion
Look for signs of …, shortness of breath, and …

Answer 40

bronchiolitis; dehydration; fever

Question 41

Pertussis (whooping cough) is caused by a … spread via respiratory droplets.
Signs and symptoms similar to a ..To treat pediatric patients, keep the airway patent (open) and transport.
Pertussis is contagious, so follow standard precautions, including wearing a mask and eye protection.

Answer 41

bacterium; cold

Question 42

… are rarely used in infants younger than 1 year

Answer 42

NPAs

Question 43

oxygen delivery devices:
Several options for pediatric patient
… technique at 6 L/min provides more than 21% oxygen concentration.
Nasal cannula at 1 to 6 L/min provides 24% to 44% oxygen concentration.
Nonrebreathing mask at 10 to 15 L/min provides up to 95% oxygen concentration.
BVM at 10 to 15 L/min provides nearly 100% oxygen concentration.

Answer 43

Blow-by;

Question 44

Nonrebreathing mask, nasal cannula, or simple face mask are indicated for pediatric patients who have adequate respirations and/or tidal volumes.
BVM is used for those with respirations less than …breaths/min or more than …breaths/min, an altered LOC, or inadequate tidal volume.

Answer 44

12; 60

Question 45

Pediatric patients respond differently than adults to fluid loss.
May respond by … heart rate, … respirations, and showing signs of … or … skin

Answer 45

increasing; increasing; pale; blue

Question 46

Hemophilia is a congenital condition in which patients lack normal ….
Most forms are hereditary and severe.
Predominantly found in … population
Bleeding may occur spontaneously.
All injuries become serious because blood does not clot.

Answer 46

clotting factors; male

Question 47

Result of disorganized electrical activity in the brain
Manifests in a variety of ways
Subtle in infants, with an abnormal … , …, and/or “…” motions
More obvious in older children with repetitive muscle contractions and unresponsiveness
Longer and more intense seizures take longer for the imbalance to ….
Recurring or prolonged seizures should be considered life threatening.
Protect from harm and call for ALS backup.

Answer 47

gaze; sucking; bicycling; correct itself

Question 48

meningitis: inflammation of tissue that covers the spinal cord and brain
Individuals at greater risk:
… 
Newborn infants
Compromised...  by AIDS or cancer
History of ..., ..., ...surgery
Children who have had head trauma
Children with ..., ..., or other foreign bodies in their brain or spinal cord

Answer 48

males
immune system
brain; spinal cord; back
shunts; pins;

Question 49

Signs and symptoms vary with age.
Neisseria meningitidis is a bacterium that causes rapid onset of meningitis symptoms.
Often leads to …and death
Children present with small, pinpoint, cherry-red …or a larger ….

Answer 49

shock; spots; purple/black rash

Question 50

poisoning emergencies and management:
Common among children
Common sources
Signs and symptoms vary, depending on substance, age, and weight.
May appear normal, …, …, or …
Some substances only take one pill to be lethal.
Be alert for signs of abuse.

Answer 50

confused; sleepy; unconscious

Question 51

poisoning contd:
After primary assessment, ask caregiver the following:
What is the …involved?
Approximately how much was ingested?
What time did the incident occur?
Any changes in … or level of consciousness?
Any choking or …after the exposure?

Answer 51

substance; behavior; coughing

Question 52

dehydration emergencies and management
Occurs when fluid …. is greater than fluid …. Vomiting and diarrhea are common causes.
Can lead to …. and death if left untreated
Infants and children are at greater risk.
Life-threatening dehydration can overcome an infant in a matter of …
Can be mild, moderate, or severe

Answer 52

loss; intake; shock; hours

Question 53

fever emergencies and management: 
An increase in body temperature
...°F (38°C) or higher are abnormal.
Rarely life threatening
Common causes 
Result of internal body mechanism in which heat ...is increased and heat … is decreased

Answer 53

100.4; generation; loss

Question 54

fever emergencies contd:
Accurate body temperature is important for pediatric patients.
Patient may present with signs of …, …, …, a …, hot skin, flushed cheeks, and, in infants, bulging ….
Transport and manage ABCs.

Answer 54

resp distress; shock; stiff neck; rash; fontanelles

Question 55

febrile seizures: 
Common between 6 months and 6 years
Caused by ...alone
Typically occur on ...of febrile illness
Characterized by ... activity
Last less than ... with little or no postictal state
May be sign of more serious problem 
Management

Answer 55

fever
first day
tonic-clonic
15 mins

Question 56

drowning emergencies:
Take steps to ensure your own safety.
Second-most-common cause of unintentional death among children
Children younger than age 5 are most at risk
… frequently a factor with adolescents
Principal condition is lack of oxygen.
A few minutes without oxygen affects heart, lungs, and brain.
…from submersion in icy water
Diving increases risk of neck and spinal cord injuries.

Answer 56

Alcohol; hypothermia

Question 57

trauma emergencies:
Number-one killer of children in the United States
Quality of care can impact recovery.
The muscles and bones of children continue to grow well into adolescence.
Fracture of the …is rare: Source of major blood loss
Older children and adolescents are prone to … fractures.

Answer 57

femur; long bone

Question 58

Head injuries
Common in children because the size of the head in relation to the body
Infant has softer, thinner skull.
May result in brain injury
… and …. may cause great deal of blood loss if not controlled.
… and …are common signs and symptoms of a head injury in children.

Answer 58

scalp; facial vessels; nausea; vomiting

Question 59

Chest injuries
Usually the result of blunt trauma
Chest wall flexibility in pediatric patients can produce a …
Abdominal injuries
Common in pediatric patients
Monitor all patients for signs of shock.
If signs of shock are evident, prevent …with blankets.

Answer 59

flail chest; hypothermia

Question 60

Burns
Burns to children are considered more serious than burns to adults.
Have more surface area to relative total body mass, which means greater fluid and heat loss
Do not tolerate burns as well as adults
More likely to go into …, develop …, and experience …problems

Answer 60

shock; hypothermia; airway

Question 61

Injuries to the extremities
Children have immature bones with active growth centers.
Growth of long bones occurs from the ends at specialized growth plates–>Potential weak spots
… or … fractures can occur.
Generally, extremity injuries in children are managed in the same manner as adults.
Painful deformed limbs with evidence of broken bones should be splinted.

Answer 61

Incomplete; greenstick

Question 62

Injuries to specific body systems–>Pain management
First step is recognizing the patient is in pain.
Look for visual clues and use the W… pain scale.
Interventions are limited to …, …, and extremity …(to decrease pain and swelling to injury site).
ALS interventions may be needed.
Another important tool is kindness and providing emotional support.

Answer 62

Wong-Baker FACES; positioning; ice packs; elevation

Question 63

JumpSTART triage system
Intended for patients younger than age ... years and weighing less than .... lb
Four triage categories
… 
… 
… 
...

Answer 63

8; 100
green
yellow
red
black

Question 64

JumpSTART triage system (cont’d)
…: minor not in need of immediate treatment
Able to walk (except in infants)
…: delayed treatment
Presence of spontaneous breathing with peripheral pulse, responsive to painful stimuli
…: immediate response
Apnea responsive to positioning or rescue breathing, respiratory failure, or inappropriate painful response
… : deceased or expectant deceased
Apneic without pulse, or apneic and unresponsive to rescue breathing

Answer 64

Green; Yellow; Red; Black

Question 65

CHILD ABUSE mnemonic: 
C: … of injury with child's age
H: … inconsistent with injury
I: inappropriate … 
L: lack of … 
D: delay in … 
A: … 
B: … of varying ages
U: unusual … patterns
S: … circumstances
E: environmental clues

Answer 65

consistency
history
parental concerns
supervision
seeking care
affect
bruises
injury
suspicious

Question 66

Bruises
Observe color and location.
Burns
Burns to the penis, testicles, vagina, or buttocks are usually inflicted by ….
Burns that look like a …are usually inflicted by someone else.
You should suspect child abuse if the child has cigarettes burns or … pattern burns.

Answer 66

someone else; glove; grid

Question 67

Fractures
Fractures of the …or …do not normally occur without major trauma.
Falls from bed are not usually associated with fractures.

Shaken baby syndrome:
Infants may sustain life-threatening head trauma by being shaken or struck.
Shaking tears …in the brain, resulting in bleeding around the brain.

Answer 67

humerus; femur; blood vessels

Question 68

sexual abuse:
Any age and gender can be a victim of sexual abuse.
Maintain an index of suspicion.
Assessment
Limited to determining type of …required
Treat …and …as well.
Do not examine genitalia unless there is evidence of bleeding or other injury.

Answer 68

dressing; bruises; fractures

Question 69

… (SIDS): Unexplained death after complete autopsy
About 3,500 infants die of SIDS annually.
Babies should be placed on their … on a firm mattress, in a crib free of bumpers, blankets, and toys.
Babies should sleep in the same room, but not the same bed, chair, or sofa, as an adult.
Impossible to predict

Answer 69

Sudden infant death syndrome; backs

Question 70

SIDS contd: 
Risk factors
Mother younger than age ... 
Mother … during pregnancy
Low ...
Can occur at any time of day
You are faced with three tasks:
Assessment of the scene
Assessment and management of patient
Communication with and support of the family
Victim of SIDS will be pale or blue, not breathing, and unresponsive.

Answer 70

20 years; smoked; birth weight;

Question 71

Infants who are not breathing, cyanotic, and unresponsive sometimes resume breathing and color with stimulation.
… (ALTE)
Classic ALTE is characterized by:
Distinct change in …
… or …
After ALTE, may appear healthy and show no signs of illness or distress.
Must complete careful assessment and provide rapid transport to the ED.
Pay strict attention to airway management.
Assess history and environment.
Allow caregivers to ride in the back of the ambulance.
Physicians will determine the cause.

Answer 71

Apparent life-threatening event; muscle tone; choking; gagging