Pediatric Emergencies Flashcards
The specialized medical practice devoted to the care of young patients
Pediatrics
The first year of life
Infancy
The first month of life
Neonatal or newborn period
Infants younger than 2 months spend most of their time ___
Sleeping or eating
Infants respond mainly to ___
Physical stimuli such as light, warmth, hunger, and sound
Infants sleep for up to ___
16 hours a day
An infant should be ___ from a sleeping state
Aroused easily
If an infant cannot be aroused easily from a sleeping state ___
This is an emergency
Infants less than 2 months have a ___ for feeding
Sucking reflex
Separation anxiety may be present at ___
6 to 12 months
Toddler age
After infancy until 3 years
Preschool age
3 to 6
School age
6 to 12
Adolescent age
12 to 18
Stage of life with the most growth
Childhood
Anatomic differences between adult and pediatric airway
- Airway is smaller in diameter
- Airway is shorter
- Lungs are smaller
- Heart is higher in the chest
- Glottic opening is higher and positioned more anteriorly
- Neck appears nonexistent
- Larger, rounder occiput requiring more careful positioning of the airway
- Proportionally larger tongue and more anterior in the mouth
- Tongue larger relative to the mandible and can block airway
- Long, floppy epiglottis infants and toddlers proportionally larger in relation to the size of the airway
- Less-developed rings of cartilage in the trachea, may collapse if the neck is flexed or hyperextended
- Narrowing funnel-shaped upper airway to a cylinder-shaped lower airway
Diameter of infant trachea
Same as a drinking straw
Infant breathing
Obligate nose breathers
Infant respiration rate
30 to 60 /min
Toddler respiration rate
24 to 40 /min
Preschool respiration rate
22 to 34 /min
School age respiration rate
18 to 30 /min
Adolescent respiration rate
12 to 16 /min
Child oxygen demand is about ___ of an adult
Twice
The smaller lungs with higher oxygen demand increases the risk of ___
Hypoxia because of apnea or ineffective ventilation efforts
Anything that places pressure on the abdomen of a young child can ___
Block movement of the diaphragm and cause respiratory compromise
Auscultating breath sounds in children
Easier because of thinner chest walls, but detecting poor air movement or absent breath sounds is harder because less air is exchanged with each breath
Child’s primary method for compensating for decreased perfusion
Increase heart rate
Children are able to compensate for decreased perfusion by constricting ___
The vessels in the skin
Constriction of the blood vessels can be so profound that ___
Blood flow to the extremities can be diminished
Signs of vasoconstriction include ___
- Pallor (early sign)
- Weak distal pulses
- Delayed capillary refill time
- Cool hands or feet
Newborn to 3 months pulse rate
85 to 205 /min
3 months to 2 years pulse rate
100 to 190
2 to 10 years pulse rate
60 to 140
> 10 years pulse rate
60 to 100
The pediatric brain requires a higher amount of ___
Cerebral blood flow, oxygen, and glucose
Glucose stores in the pediatric patient
Limited
The pediatric brain is at risk for secondary brain damage from ___
Hypotension and hypoxic events
The pediatric brain tissue and cerebral vasculature is fragile and susceptible to bleeding from ___
Shearing forces
If a child’s cervical spine is injured, it is most likely to be an injury to the ___
Ligaments as the result of a fall
Pediatric GI differences
- Muscle structures less developed, less protection from trauma
- Liver and spleen are proportionally larger and situation more anteriorly
- Organs closer together, more prone to multi organ trauma
- Liver, spleen, and kidneys are injured more frequently
At the ends of the long bones, enable the bones to grow during childhood
Growth plates
The open growth plates are ___ than ligaments and tendons
Weaker
Immobilize extremities with suspected sprains or strains because they may be ___
Fractures through the growth plates
Soft spots on the newborn skull anterior and posterior
Fontanelles
The anterior fontanelle will close at ___
18 months
The posterior fontanelle will close at ___
6 months
Some bulging of the fontanelles is a normal assessment finding when the infant is ___
Either crying, coughing, or lying on the back or stomach
Fontanelles of an infant can be an important assessment tool for such issues as ___
- ICP (bulging in a non-crying infant)
- Dehydration (sunken appearance)
Structured assessment tool that allows you to rapidly form a general impression of the child’s condition without touching the child
Pediatric assessment triangle
PAT
Pediatric assessment triangle
When you assess an infant or child, use the PAT to determine if the patient is ___
Sick or not sick
The PAT can be performed in less than ___
30 seconds
Components of the PAT
- Appearance
- Circulation to skin
- Work of breathing
Appearance portion of the PAT
Muscle tone and mental status
Can also help to determine if the patient is sick or not sick
TICLS (or tickles)
TICLS
- Tone
- Interactiveness
- Consolability
- Look or gaze
- Speech or cry
Tone (TICLS)
- Is the child moving or resisting examination vigorously?
- Does the child have good muscle tone?
- Is the child limp, listless, or flaccid?
Interactiveness (TICLS)
- How alert is the child?
- How readily does a person, object, or sound distract or draw their attention?
- Will the child reach for, grasp, and play with a toy or examination instrument?
- Is the child uninterested in playing or interacting with anyone?
Consolability (TICLS)
- Can the child be consoled or comforted by anyone?
- Is the crying or agitation unrelieved by gentle reassurance?
Look or gaze (TICLS)
Does the child fix the gaze on a face, or is there a vacant, glassy-eyed stare?
Speech or cry (TICLS)
- Is the cry strong and spontaneous or weak or high-pitched?
- Is the content of speech age-appropriate or confused or garbled?
Increased work of breathing often manifests as ___
- Abnormal airway noise (grunting or wheezing)
- Accessory muscle use (contractions of the muscles above the clavicles)
- Retractions (drawing in of the muscles between the ribs or of the sternum during inspiration)
- Head bobbing (head lifting and tilting back during inspiration and forward during expiration)
- Nasal flaring (nares widening, usually during inspiration)
- Tachypnea
- Tripod position (Used by older children to maximize effectiveness of airway)
An “uh” sound heard during exhalation
Grunting
The grunting reflects the child’s ___
Attempt to keep the alveoli open
Above the clavicles
Supraclavicular
Drawing in of the muscles between the ribs
Intercostal retractions
Drawing in of the sternum
Substernal retractions
External opening of the nose
Nares
Pallor of the skin and mucous membranes may be seen in ___
Compensated shock or with anemia or hypoxia
Mottling is caused by ___
Constriction of peripheral blood vessels
Mottling is a sign of ___
Poor perfusion
Cyanosis reflects ___
A decreased level of oxygen in the blood
Cyanosis is a ___ sign of respiratory failure or shock
Late sign
XABCDE
- Exsanguination
- Airway
- Breathing
- Circulation
- Disability
- Exposure
Always position the pediatric airway in a ___
Neutral sniffing position
Keeping the airway in a neural sniffing position accomplishes two goals
- Keeping the trachea from kinking
- Maintaining proper alignment to restrict spinal motion
Bradypnea indicates ___
Impending respiratory arrest
Where to take infant pulse
Brachial or femoral
In children older than 1 year, where to take the pulse
Carotid
A strong central pulse does not rule out the possibility of ___
Compensated shock
Bradycardia in children
Less than 80 /min
Bradycardia in newborns
Less than 100 /min
Bradycardia in a pediatric patient indicates ___
Impending cardiopulmonary arrest
Tachycardia may indicate ___
Early sign of hypoxia or shock, but may also indicate fever, anxiety, pain, and excitement
Capillary refill is most reliable in ___
Children younger than 6
BLSCPR
Blood pressure
LOC
Skin: color, temp, moisture
Capillary refill time
Pulse: rate, rhythm, strength
Respiratory rate, effort, pattern
The Wong-Baker FACES Pain Rating Scale may help assess pain in children aged ___
3 and older
Why are children susceptible to hypothermia?
- Thermoregulatory system is immature
- Thin skin
- Lack of subcutaneous fat
- Larger skin surface area to mass ratio
- Infants younger than 6 cannot shiver
Newborns younger than ___ are the most susceptible to hypothermia
1 month
Infant GCS score
Eye opening
4 - Open spontaneously
3 - Open to speech or sound
2 - Open to pressure
1 - No response
Verbal
5 - Coos, babbles
4 - Irritable cry
3 - Cries to pain
2 - Moans to pain
1 - No response
Motor
6 - Normal spontaneous movement
5 - Localizes to pressure
4 - Withdraws from pressure
3 - Abnormal flexion (decorticate)
2 - Abnormal extension (decerebrate)
1 - No response (flaccid)
Child GCS score
Eye opening
4 - Open spontaneously
3 - Open to speech
2 - Open to pressure
1 - No response
Verbal
5 - Oriented conversation
4 - Confused conversation
3 - Cries
2 - Moans
1 - No response
Motor
6 - Obeys verbal commands
5 - Localizes to pressure
4 - Withdraws from pressure
3 - Abnormal flexion (decorticate)
2 - Abnormal extension (decerebrate)
1 - No response (flaccid)
Significant MOIs
Same as adult except:
1. Any fall higher than the child especially a head-first landing
2. Bicycle crash (when not wearing a helmet)
Rapid transport is indicated for ___
- Significant MOI
- History compatible with a serious illness
- Physical abnormality noted during primary assessment
- Potential serious anatomic abnormality
- Significant pain
- Abnormal LOC, altered mental status, or signs of shock
Considerations when making a transport decision
- Type of clinical problem
- Expected benefits of ALS treatment in the field
- Local EMS system protocols
- Your comfort level
- Transport time to the hospital
Children ___ should be transported in a car seat if the situation allows
Weighing less than 40 lbs who do not require spinal motion restriction
Children younger than ___ should be transported in a rear-facing position
2
Why do children under 2 need to be transported in a rear-facing position
Lack of mature neck muscles
Questions to ask during history taking
- NOI or MOI
- How long has it been happening
- Key events leading to it
- Presence of fever
- Effects on the child’s behavior
- Activity level
- Recent eating, drinking, and urine output
- Change in bowel or bladder habits
- Vomiting, diarrhea, abdominal pain
- Rashes
A ___ should be suspected in any child who refuses to bear weight
Lower extremity injury
When should the assessment begin at the feet and end at the head?
Infants, toddlers, and preschool age children who do not have apparent life-threatening injuries or illnesses
The presence of pus in the ear may indicate ___
An ear infection or perforation in the ear drum
Acidosis may impart a ___ odor on the breath
Fruity
If the pediatric patient cannot move their neck and has a high fever, this may indicate ___
Meningitis
BP cuff should cover ___
2/3 of the upper arm
A BP cuff that is too small may give a ___
Falsely high reading
A BP cuff that is too big may give a ___
Falsely low reading
Equation to determine BP in children under 10
70 + (2 X Child’s age in years) = lowest expected systolic BP
How long to assess respirations
30 seconds
How long to assess pulse rate
60 seconds, unless rushed
Neonate 1-4 days systolic BP
60 to 76
Neonate 4 days to 1 months systolic BP
67 to 84
Infant 1-3 months systolic BP
73 to 94
Infant 3-6 months systolic BP
78 to 103
Infant 6 months to 1 year systolic BP
82 to 105
Child 1-2 years systolic BP
85 to 104
Child 2-7 years systolic BP
88 to 106
Child 7-15 years systolic BP
96 to 115
Adolescent 15-18 years systolic BP
110 to 131
Child’s possible behavioral changes in the early stages of respiratory distress
Anxiety, restlessness, or combativeness
Signs of respiratory distress
Nasal flaring, abnormal breath sounds, accessory muscle use, and the tripod position
If the heart rate is less than ___ despite ventilations with high-flow oxygen, begin CPR
60 /min
Consider infections as a possible cause of airway obstruction if a child has ___
Congestion, fever, drooling, and cold symptoms
Suspect anaphylaxis if ___ accompany a sudden onset of dyspnea
Hives, hypotension, nausea, or vomiting
Signs and symptoms that are frequently associated with a partial upper airway obstruction
Hoarse voice, decreased or absent breath sounds, and stridor
Stridor is usually caused by ___
Swelling of the area surrounding the vocal cords or upper airway obstruction
Signs and symptoms of a lower airway obstruction
Wheezing
Best way to auscultate breath sounds in a pediatric patient
Listen on both sides of the chest at the level of the armpit
Condition in which the smaller air passages (bronchioles) become inflamed, swell, and produce excessive mucus, leading to difficulty breathing
Asthma
Common asthma triggers
- Upper respiratory infection
- Exercise
- Exposure to cold air or smoke
- Emotional distress
Breathing sound of asthma
Wheezing
Care for asthma
Supplemental oxygen, keep calm, and maybe administering bronchodilator
If you must assist ventilations in a child having an asthma attack ___
Use slow, gentle breaths
The problem in asthma is getting air ___
Out of the lungs, not into them
Prolonged asthma attack that is unrelieved may progress into ___
Status asthmaticus
Treatment for status asthmaticus
Administer oxygen, ventilate if needed, and provide rapid transport
Pneumonia is often a ___ infection
Secondary
Signs and symptoms of pneumonia
- Tachypnea
- Grunting or wheezing
- Nasal flaring
- Hypothermia
- Fever
- Unilateral diminished breath sounds or crackles
If a child with pneumonia is wheezing ___
Administer a bronchodilator
Laryngotracheobronchitis
Croup
Infection of the airway below the level of the vocal cords, usually caused by a virus
Croup
Croup is typically seen in ___
Children from 6 months to 3 years
Croup starts with ___
A cold, cough, and a low-grade fever that develops over 2 days
Hallmark signs of croup
Stridor and a seal-bark cough
Croup often responds well to ___
Humidified oxygen
___ are not indicated for croup and could make it worse
Bronchodilators
Epiglottis is also called ___
Supraglottis
An infection of the soft tissue in the area above the vocal cords
Epiglottis
Most common cause of epiglottis
Bacterial infection
Sings and symptoms of epiglottis in children
Look very sick, report a sore throat, and have a high fever. Often found in the tripod position and drooling
Specific viral illness of newborns and toddlers, often caused by respiratory syncytial virus that leads to inflammation of the bronchioles
Bronchiolitis
RSV
Respiratory syncytial virus
RSV is spread through ___
Droplets with coughing or sneezing
Infants with RSV often refuse ___
Liquids
Treat Bronchiolitis
Position of comfort, humidified oxygen, and transport
Signs and symptoms of pertussis
- Similar to common cold: coughing, sneezing, and a runny nose.
- As it progresses, coughing gets worse and the whoop sound is heard on inspiration
Infants with pertussis may develop ___
Pneumonia or respiratory failure
Broselow tape
Length-based resuscitation tape
Color coded tool that can estimate weight as well as height in pediatric patients up to 75 lbs
Broselow tape
Oxygen percentage with blow by technique
More than 21%
Oxygen percentage with nasal cannula at 1 to 6 L/min
24% to 44%
Oxygen percentage with nonrebreathing mask at 10 to 15 L/min
Up to 95%
Oxygen percentage with bag mask device with 15 L/min
100%
Pediatric patients with respirations less than ___ or more than ___, ___, and/or ___ should receive assisted ventilation with a bag-mask device
- 12 breaths/min
- 60 breaths/min
- An altered LOC
- An inadequate tidal volume
Bag-mask ventilation rate
1 breath every 2 - 3 seconds (20 - 30 /min)
Signs of shock in infants and children
- Tachycardia
- Poor capillary refill time
- Mental status changes
When assessing for shock, any pulse over ___ (except a newborn)
160 /min
When assessing for shock, ask ___
- Decreased urine output (less than 6 to 10 wet diapers a day for an infant)
- Absence of tears even when crying
- Sunken or depressed fontanelle (infant)
- Changes in LOC and behavior
Positioning of child when transporting for shock
Position of comfort
Pediatric signs of anaphylaxis
- Hypoperfusion
- Stridor
- Wheezing
- Increased work of breathing
- Altered appearance
- Restlessness
- Agitation
- Sense of impending doom
- Hives
How to treat a bleeding pediatric patient with hemophilia
Transport immediately and dont delay tourniquet application
Most common causes of altered mental status in children
- Hypoglycemia
- Hypoxia
- Seizure
- Drug or alcohol ingestion
Management of altered mental status focuses on ___
The ABCs and transport
Seizures in infants may manifest as ___
Abnormal gaze, sucking motions, or bicycling motions
Postictal state muscles and breathing
Flaccid and labored breathing
Some children will have been given ___ to stop the seizure prior to your arrival
A rectal dose of diazepam (Diastat)
Meningitis is caused by ___
An infection of the meninges by bacteria, viruses, fungi, or parasites
Untreated meningitis can lead to ___
Permanent brain damage or death
Pediatric patients at a greater risk of meningitis
- Males
- Newborns
- Compromised immune systems
- History or brain, spinal cord, or back surgery
- Head trauma
- Shunts, pins, or other foreign bodies within the brain or spinal cord
Drain excess fluids around the brain into the abdomen
Ventriculoperitoneal (VP) shunt
The tubing from a VP shunt can usually be seen and felt ___
Just under the scalp
Common symptoms of meningitis in children of all ages
Fever and altered LOC
A ___ may be the first sign of meningitis
Seizure
Infants younger than 2 to 3 months with meningitis can have ___
Apnea, cyanosis, fever, a distinct high-pitched cry, or hypothermia
Describe pain that accompanies movement in children with meningitis by physicians
Meningeal irritation or meningeal signs
With meningitis, bending the neck forward or back increases ___
Tension within the spinal canal and stretches the meninges
An infant with increasing irritability, especially when being handled or with a bulging fontanelle without crying is a sign of ___
Meningitis
Bacterium that causes rapid onset of meningitis symptoms, often leading to shock and death
Neisseria meningitidis
Children infected with N meningitidis typically have ___
Small, pinpoint, cherry-red spots or a larger purple or black rash. May be on part of the face or body
Children infected with N meningitidis are at a serious risk of ___
Sepsis, shock, and death
If you are exposed to saliva and respiratory secretions from a child infected with N meningitidis, you should ___
Receive antibiotics
Appendicitis, if untreated, can lead to ___
Peritonitis or shock
Appendicitis will typically present with ___
A fever and pain on palpation of the RLQ commonly with rebound tenderness
Questions to ask to determine dehydration level in children
- How many wet diapers today?
- Tolerating liquids or able to keep them down?
- How many times of diarrhea and for how long?
- Are tears present with crying?
Questions to ask for poisoning
- What substance?
- How much?
- What time?
- Any changes in behavior or LOC?
- Any choking or coughing after exposure?
Activated charcoal is not indicated for children who have ingested ___
An acid, an alkali, or a petroleum product. Have a decreased LOC and cannot protect airway, or are unable to swallow
Usual form of activated charcoal
Plastic bottle of premixed suspension with up to 50 g of activated charcoal
Common trade names for activated charcoal suspension
- InstaChar
- Actidose
- LiquiChar
Dose of activated charcoal
1 g per kg of body weight
Usual pediatric dose of activated charcoal
12.5 to 25 g
Most common cause of dehydration in children
Vomiting and diarrhea
Infants and children are at a greater risk of dehydration than adults because ___
Their fluid reserves are smaller than adults
Loose skin with no elasticity
Poor skin turgor
Treatment of dehydration includes ___
Assessing ABCs and obtaining baseline vital signs
Treatment of severe dehydration ___
ALS backup to administer IV
All pediatric patients with ___ dehydration should be transported to the ED
Moderate to severe
Mild dehydration
Pulse:
Level of activity:
Urine output:
Skin:
Mouth:
Eyes:
Anterior fontanelle:
LOC:
BP:
Pulse: Normal
Level of activity: Normal or slowed
Urine output: Decreased
Skin: Normal
Mouth: Decreased saliva
Eyes: Normal
Anterior fontanelle: Normal to sunken
LOC: Normal
BP: Normal
Moderate dehydration
Pulse:
Level of activity:
Urine output:
Skin:
Mouth:
Eyes:
Anterior fontanelle:
LOC:
BP:
Pulse: Increased
Level of activity: Slowed
Urine output: Decreased
Skin: Cool, mottled, poor turgor
Mouth: Dry mucous membranes
Eyes: No tears
Anterior fontanelle: Sunken
LOC: Altered
BP: Normal
Severe dehydration
Pulse:
Level of activity:
Urine output:
Skin:
Mouth:
Eyes:
Anterior fontanelle:
LOC:
BP:
Pulse: Increased (160 /min sign of impending shock, except newborns)
Level of activity: Variable, weak to unresponsive
Urine output: No output
Skin: Cool, clammy, poor turgor; delayed capillary refill time
Mouth: Dry mucous membranes
Eyes: Sunken eyes
Anterior fontanelle: Very sunken
LOC: Altered; lethargic
BP: Normal to low
Body temp of ___ is considered abnormal
100.4°F or higher
A fever that occurs in conjunction with a ___, is a signs of a serious illness such as meningitis
Rash
Hyperthermia differs from fever in that it ___
Is an increase in body temp caused by an inability of the body to cool itself
Most accurate temperature in an infant or toddler
Rectal
Febrile fevers are common in ___
Children 6 months to 6 years
Most pediatric seizures are the result of ___
Fever alone
Febrile seizures typically occur on ___
The first day of febrile illness
Febrile seizures are characterized by ___
Generalized (tonic-clonic) seizure, lasts less than 15 minutes with a short or nonexistent postictal phase
When called to a febrile seizure, you will often find the patient ___
Awake, alert, and fully interactive when you arrive
How to treat febrile seizure
Assess ABCs, cool with tepid water, and provide prompt transport
Once a child has been removed from the water ___
Administer oxygen at 100%, be prepared to suction, CPR if needed
Sprains are less common in children because ___
Ligaments are more developed than the growth plates of the bones
Children turn ___ a car approaching
Towards
Children can compensate for significant blood loss ___ than adults
Better
Suspect ___ when a child has burns around the face and mouth
Internal injuries from chemical ingestion
Blood loss in child that increases the risk for shock
Greater than 25%
Blood loss in an adult that increases the risk for shock
Greater than 30% to 40%
Minor pediatric burn
Partial-thickness less than 10% TBSA
Moderate pediatric burn
Partial-thickness 10% to 20% TBSA
Severe pediatric burn
- Any full-thickness burn
- Any partial-thickness greater than 20% TBSA
- Any burn involving the hands, feet, face, airway, or genitalia
Developed for pediatric patients triage
JumpSTART Pediatric MCI Triage
Evaluate ___ first in secondary triage
Infants
The JumpSTART pediatric MCI triage is intended for ___
Children younger than 8 or who appear to weigh less than 100 lbs
Mnemonic for assessing possible child abuse
CHILD ABUSE
CHILD ABUSE
- Consistency of the injury with the child’s developmental age
- History inconsistent with injury
- Inappropriate parental concerns
- Lack of supervision
- Delay in seeking care
- Affect
- Bruises in varying stages
- Unusual injury patterns
- Suspicious circumstances
- Environmental clues
Bruises to the ___ are suspicious
Back, buttocks, ears, or face
Bruise color progression
- Pink or red
- Blue, then green, then yellow-brown, then faded
Suspicious burns
- Penis, testicles, vagina, or buttocks
- Burns that encircle a hand or foot to look like a glove
- Cigarette burns or grid pattern
Syndrome seen in abused infants in children. The patient has been subjected to violent, whiplash-type shaking injuries
Shaken baby syndrome
Shaken baby syndrome effects caused by ___
Bleeding in the head and damage to the c-spine
A baby with shaken baby syndrome will typically be found ___, and the call for help may be ___
- Unconscious, often without evidence of external trauma, may appear to be in cardiopulmonary arrest
- Infant who has stopped breathing or is unresponsive
Any improper or excessive action that injures or otherwise harms a child or infant
Child abuse
Child abuse includes ___
- Physical abuse
- Sexual abuse
- Neglect
- Emotional abuse
Refusal or failure on the part of the parent or caregiver to provide life necessities, such as food, water, clothing, shelter, personal hygiene, medicine, comfort, and personal safety
Neglect
Children who are neglected are often ___
Dirty, or too thin, or appear developmentally delayed because of a lack of stimulation
SUID
Sudden Unexpected Infant Death
Sudden unexpected death where the cause is not known until an investigation is completed
SUID
Death that cannot be explained by another cause
Sudden Infant Death Syndrome (SIDS)
Infants should sleep ___
Placed on their back on a firm mattress in a crib that is free of bumpers, blankets, and toys
Risk factors for SIDS
- Mother younger than 20
- Mother smoked during pregnancy or after birth
- Mother used alcohol or drugs during pregnancy or after birth
- Low birth weight
Three tasks of first provider at the scene of suspected SIDS
- Assess the scene
- Assess and manage the patient
- Communication and support of the family
SIDS is a diagnosis of ___
Exclusion
An infant who has been a victim of SIDS will be ___
Pale or blue, unresponsive, and not breathing
If the child shows post-mortem changes ___
Call medical control
As you assess the suspected SIDS patient, pay special attention to ___
Any marks or bruises on the child prior to starting CPR. Also note any interventions done by the parents before arrival
Infants who have cyanosis and apnea, and are unresponsive that resume breathing and color with stimulation
Apparent life-threatening event
ALTE
Apparent life-threatening event
In addition to cyanosis and apnea, a classic ALTE is characterized by ___
Distinct change in muscle tone (limpness) and choking or gagging
BRUE
Brief Resolved Unexplained Event
BRUE can happen to an ___
Infant less than 1 year old
