Emergency Care of Children 1

Question 1

Primary focus of neonatal resuscitation

Answer 1

Respiratory assistance with effective positive-pressure ventilation

Question 2

Cardiac arrest is most commonly secondary to:

Answer 2

Respiratory failure in children

Question 3

Suggested guidelines to minimize the impact of the limitations inherent in a transport environment:

Answer 3

1) Prepare transport vehicle - should be prepared to meet the special needs of the child
2) Stabilize the patient before transport - time spent undertaking goal directed intensive care interventions early in the course of illness does not worsen outcomes
3) Monitor as many physiologic parameters as possible electronically - especially at risk for hypothermia and hypoglycemia
4) Anticipate deterioration - prepare for gastric decompression, chest tube insertion, transfusion etc

Question 4

Pediatric conditions at risk for deterioration during transport:

Answer 4

Pneumonia
Recurrent BRUE
Foreign body aspiration
Airway obstructions
Epilepsy
Poisoning/overdose
Multisystem/severe intracranial trauma
Tracheitis
Severe asthma
Metabolic derangements
Sever sepsis

Question 5

APGAR score at 1 and 5 minutes after delivery:

(Scored 0, 1, 2)

Answer 5

Appearance or color
(blue/pale, acrocyanotic, completely pink)

Pulse or heart rate
(Absent, <100, >100)

Grimace or reflex irritability
(No response, grimace, crying/active)

Activity or muscle tone
(Limp, some flexion, fully flexed)

Respiratory effort
(Absent, weak, crying/normal)

If AS at 5th min is <7, cont at 5 min intervals until >=7 is reached

Question 6

Point of care glucose testing done to infants…

Answer 6

Of diabetic mothers
Small and large for gestational age
Depressed or irritable
Poor response to initial steps of resuscitation

Question 7

Infants who are spontaneously breathing, whether delivered through clear or meconium-stained amniotic fluid, DO NOT REQUIRE TRACHEAL SUCTIONING because it can cause:

Answer 7

Reflex bradycardia and apnea

Question 8

For all newborns with a heart rate of <100 bpm or who are gasping or apneic after 30 seconds, provide:

Answer 8

Positive pressure ventilation with a self-inflating or flow inflating bag or a T piece resuscitator

Question 9

STEPS IN NEONATAL RESUSCITATION
(Based on table 108-2)

Management for:
Infant breathing, crying, good tone

Answer 9

Routine newborn care
Warm, dry, delay cord clamping 1-3 minutes, observe

Question 10

STEPS IN NEONATAL RESUSCITATION
(Based on table 108-2)

Management for:
Poor tone or respiratory effort or respiratory distress

Answer 10

Warm, open airway, clear nose and mouth (only of obstructed), dry, stimulate

Question 11

STEPS IN NEONATAL RESUSCITATION
(Based on table 108-2)

Management for:
Labored breathing or persistent cyanosis with HR >100

Answer 11

Clear nose and mouth, monitor o2 saturation, provide o2 only to maintain in appropriate levels, consider CPAP

Question 12

STEPS IN NEONATAL RESUSCITATION
(Based on table 108-2)

Management for:
Apnea, gasping, or HR <100

Answer 12

Positive pressure ventilation (PPV)
Cont for 30s, taking corrective steps if no improvement in HR

Question 13

STEPS IN NEONATAL RESUSCITATION
(Based on table 108-2)

Management for:
HR <60 bpm

Answer 13

Initiate CPR :
3:1 compression to ventilations ratio
90:30 compressions and ventilations per minute

Question 14

STEPS IN NEONATAL RESUSCITATION
(Based on table 108-2)

Management for:
HR <60 after appropriate ventilation and CPR

Answer 14

Administer Epinephrine
Consider volume expansion if blood loss: treat hypoglycemia

Question 15

Dose of Epinephrine:

Answer 15

0.01 to 0.03 mg/kg IV or IO
(0.1 to 0.3 ml/kg of 1:10,000 solution)

0.05 to 0.1 mg/kg
(0.5 to 1ml/kg of 1:10,000 solution)

Question 16

Recommended maneuver to clear a choking infant’s airway (conscious):

Answer 16

Alternating sequence of 5 back blows and 5 chest thrusts

Question 17

AHA specifically discourages 2 common maneuvers used in foreign body management in adult patients:

Answer 17

1) Heimlich maneuver in <1 y/o - potential injury to abdominal organs
2) Blind finger sweeps - possibility of pushing foreign body farther into the airway

Question 18

Cardioversion initial dose

Answer 18

0.5 J/kg in the synchronized mode
Double the energy level if the 1st attempt is unsuccessful

Question 19

Sedation and intubation drugs doses using the 3:2:1 rule:

Answer 19

Fentanyl 3 mcg/kg IV
Ketamine 2mg/kg IV
Rocuronium 1mg/kg IV

Question 20

Very late and ominous sign of cardiovascular compromise in children

Answer 20

Hypotension

Question 21

The mean systolic blood pressure in children 1-10 y/o can be estimated using the formula:

Answer 21

90 + (2 x age) mmHg

Question 22

Hypotension can be estimated as SBP less than:

Answer 22

70 + (2 x age) mmHg

Question 23

Indications for endotracheal intubation in the trauma patient:

Answer 23

1) GCS <8 or lack of airway protective reflexes
2) Respiratory failure due to inadequate oxygenation or ventilation
3) Impending airway compromise
4) Lack of neuromuscular respiratory drive
5) Significant hypovolemia with depressed sensorium
6) Unstable patients in need of CT, angioembo, or operative intervention
7) Transport if critically injured patients to another institution, especially over long distances

Question 24

Given the minimal risks and plausible benefit of Tranexamic acid in pediatric polytrauma, it should be strongly considered within _____ of injury in adolescents as well as children of all ages requiring blood transfusion.

Answer 24

3 hours

Question 25

________ are not recommended to treat acute spinal cord injury in children. It increases the risk of infection and do not result in significant neurologic improvements in children.

Answer 25

Corticosteroids