NREMT Special Populations

Question 1

What is the formula for determining hypotension in a child (greater than 1)?

Answer 1

70 + 2 x the child’s age in years.

This is also called the “minimum normal” systolic. Numbers below this indicate hypotension.

Example: The minimum normal systolic blood pressure for an 8-year-old would be 86 mmHg. Below this may indicate hypotension.

Note that this is an approximation and you should always consider all vital signs and the complete patient picture.

Question 2

What ventilation device should you use when resuscitating a neonate?

How much air should you deliver with that device?

Answer 2

Use an appropriately sized BVM to ventilate. Do not use oxygen-powered devices (e.g. FROPVD/demand valve).

Deliver just enough air to make the chest rise. Too much air or too much force can easily cause a pneumothorax.

Question 3

What are the values for each body area in the pediatric rule of 9s?

Answer 3

Head - 18 (this is the big difference)

Anterior torso - 18

Posterior torso - 18

Legs 14 (7 front/7 back - this also differs from the adult)

Arms - 9

Genitalia - 1

Question 4

Define: Gravida

Answer 4

How many times a woman has been pregnant.

Question 5

What are fontanelles?

Answer 5

Fontanelles are the “soft spots” in an infant’s skull.

Question 6

What are signs of shock in an infant or young child?

Answer 6

Lethargy or altered mental status

Not responding to parents or the environment

Rapid pulse and respirations

Crying without tears

Infrequent urination (noted as dry diapers)

Sunken fontanelles

Increased capillary refill time (greater than 2 seconds)

Question 7

What treatment should be given to an infant with a pulse below 60 beats/minute?

Answer 7

Infants with a persistent pulse below 60 and other signs of poor perfusion that have not responded to ventilation should receive chest compressions.

Question 8

List the types of retractions that may be seen in a pediatric patient in respiratory distress.

Answer 8

Intercostal retractions (between the ribs)

Suprasternal retractions (above the sternum)

Supraclavicular retractions (above the clavicles)

Question 9

List the age ranges for each stage of development:

Infant

Toddler

Preschool

School age

Adolescent

Answer 9

Infant: birth - 1 year

Toddler: 1 - 3 years

Preschool: 3 - 6 years

School age: 6 - 12 years

Adolescent: 12 - 18 years

Question 10

What signs of respiratory distress are more commonly found in children?

Answer 10

Nasal flaring and see-saw breathing are signs of respiratory distress more commonly seen in children.

Question 11

Your patient has epiglottitis. How will he or she present?

Answer 11

Patients usually present with hoarseness, drooling, and sitting forward in a “sniffing” position. Retractions, fever, and stridor are also seen.

Question 12

Your pediatric patient has croup. How will he or she present?

Answer 12

Croup (laryngotracheobronchitis) is a viral infection that causes swelling around the larynx and trachea. Patients who have croup exhibit difficulty breathing and a “seal bark” cough. It may get worse at night and better during the day.

Croup usually occurs in patients less than 5 and in most cases is not critical, although it is frightening to parents.

Question 13

List several differences between the pediatric and adult respiratory system.

Answer 13

In the pediatric patient:

The tongue is larger and takes up more space in the mouth.

The mouth and nose are smaller.

The trachea is more pliable and can be damaged by even a slight overextension of the airway.

Funnel-shaped larynx with narrowest portion at the cricoid ring - may lead to easier obstruction.

The trachea is narrower and more affected by inflammation and swelling.

Chest walls are less muscular and more pliable.

Children breathe more from the diaphragm (sometimes called “belly breathers”).

Question 14

Why are sick infants prone to hypoglycemia?

Answer 14

Infants have limited glucose stores. They also have fast metabolic rates.

When an infant becomes ill, rapid pulse and respiratory rates use up this limited fuel (glucose) quickly leading to hypoglycemia.

Question 15

For each of the following vital signs explain whether you would see an increase or decrease in the geriatric patient when compared to an adult:

Body temperature

Pulse

Respirations

Blood pressure

Capillary refill

Answer 15

Body temperature: decrease

Pulse: increase (although medications may vary this)

Respirations: increase

Blood pressure: many geriatric patients develop hypertension but this varies

Capillary refill: increase

Question 16

How can you communicate with a patient who is deaf?

Answer 16

If the patient reads lips, face them and speak normally and clearly.

If the patient has a friend or relative who can communicate in sign language, that person may assist you.

You may communicate your questions and instructions to the patient in writing.

Question 17

What makes fontanelles bulge?

What makes fontanelles appear sunken?

Answer 17

Fontanelles may bulge from increased pressure in the skull from head injury. Meningitis may also cause bulging.

Sunken fontanelles may be caused by dehydration.

Question 18

List several ways to successfully relate to pediatric patients.

Answer 18

Don’t lie.

Introduce yourself.

Appear calm and non-threatening.

Explain what you are doing.

Involve parents when appropriate.

Offer an age appropriate toy or allow the child to bring a toy.

Question 19

How does the insertion of an oral airway differ between a child and an adult?

Answer 19

The oral airway in a child is inserted in the anatomical orientation of the airway (not upside down). A tongue blade may be used to help move the airway over the tongue into the proper position.

This technique is preferred because the palate in the child is softer and easier to damage and cause bleeding.

Question 20

Why are infants and young children more prone to head injury?

Answer 20

Infants and young children have large, heavy heads that are more likely to strike objects in falls.

Infants also have fontanelles which can increase the potential for injury from trauma.

Question 21

You are called to a patient on a ventilator at home who is experiencing respiratory distress. How would you care for this patient?

Answer 21

Assure the airway (trach) is clear and unobstructed.

Ventilate the patient with a BVM.

Consult with caregivers about function of the ventilator if necessary.

Transport the patient continuing ventilations.

Question 22

How often should you ventilate a neonate requiring respiratory support?

Answer 22

40 - 60 times per minute for the newborn. If the neonate is older (days after birth - 1 month), ventilate 30 - 40 times per minute.

Question 23

How should pediatric patients be transported in the ambulance?

Answer 23

Pediatric patients must be restrained during transport. Most stretcher straps are not adequate for secure pediatric transport because of patient size.

Use a multi-point harness system to restrain larger children.

Use a car seat (one is carried in many ambulances). Secure the infant or child in the seat and then securely attach the seat to the stretcher.

Question 24

Your patient’s wife tells you that her husband has an LVAD. What does this mean?

Answer 24

A left ventricular assist device is implanted in patients whose left ventricle is no longer strong enough to pump blood to the body. This is often due to heart failure.

Although the device is implanted, there is an external power unit that stays with the patient at all times.

There are also right ventricular assist devices and those which assist both ventricles (BiVAD).

Question 25

Your 86-year-old patient has atrial fibrillation. What should you expect when checking the pulse?

Answer 25

Atrial fibrillation is an irregular heart beat. You would expect to feel an irregular pulse. The rate can vary widely depending on whether the patient takes a medication for this condition.