Systematic Approach to the Seriously Ill or Injured Child

Question 1

Most cardiac arrests in infants and children result from

Answer 1

1) Progressive respiratory failure 2) Shock 3) Both

Question 2

In the out-of-hospital setting, only ___% of children who experience cardiac arrest survive to hospital discharge

Answer 2

4-13%

Question 3

If cardiac arrest occurred at the hospital, ___% survive to hospital discharge

Answer 3

33%

Question 4

Parameters to assess to make an initial impression

Answer 4

1) Consciousness 2) Breathing 3) Color

Question 5

Start CPR even if there is a pulse if the rate is ___

Answer 5

Less than 60/min with poor perfusion despite oxygenation and ventilation

Question 6

Components of primary assessment

Answer 6

ABCDE: Airway, breathing, circulation, disability,

Question 7

Components of secondary assessment

Answer 7

Focused medical history and focused PE

Question 8

Measures to open and maintain a patent upper airway

Answer 8

1) Allow child to assume position of comfort 2) Head tilt-chin lift or jaw thrust 3) Foreign body airway obstruction relief techniques 4) Airway adjuncts

Question 9

Measure of choice in opening and maintaining upper airway in a patient with suspected cervical spine injury

Answer 9

Jaw thrust

Question 10

Technique to relieve foreign body obstruction in children less than 1 y/o

Answer 10

5 back slaps, 5 chest thrusts

Question 11

Technique to relieve foreign body obstruction in children 1 y/o or older

Answer 11

Abdominal thrusts

Question 12

Normal RR: Less than 1 year

Answer 12

30-60

Question 13

Normal RR: Toddler (1-3 years)

Answer 13

24-40

Question 14

Normal RR: Preschooler (4-5 years)

Answer 14

22-34

Question 15

Normal RR: School age (6-12 years)

Answer 15

18-30

Question 16

Normal RR: Adolescent (13-18 years)

Answer 16

12-16

Question 17

Often the first sign of respiratory distress in infants

Answer 17

Tachypnea

Question 18

Define apnea

Answer 18

Cessation of breathing for at least 20 seconds or less than 20 seconds if accompanied by 1) bradycardia 2) cyanosis 3) pallor

Question 19

Classifications of apnea

Answer 19

1) Central 2) Obstructive 3) Mixed

Question 20

Refers to inspiratory effort without airflow

Answer 20

Obstructive apnea

Question 21

Coarse, high-pitched sound typically heard on inspiration

Answer 21

Stridor

Question 22

Short, low-pitched sound typically heard during expiration

Answer 22

Grunting

Question 23

Normal HR: NB to 3 months

Answer 23

85-205

Question 24

Normal HR: 3 months to 2 years

Answer 24

100-190

Question 25

Normal HR: 2-10 years

Answer 25

60-140

Question 26

Normal HR: >10 years

Answer 26

60-100

Question 27

MCC of bradycardia in children

Answer 27

Hypoxia

Question 28

Cyanosis is not apparent until at least ___ of hen are desaturated

Answer 28

5 g/dL

Question 29

When measuring BP, the cuff bladder should cover about ___% of the MUAC

Answer 29

40

Question 30

When measure BP, the cuff should extend at least ___% to ___% of the length of the upper arm

Answer 30

50-75

Question 31

Hypotension in neonates (0-28 days)

Answer 31

Less than 60mmHg

Question 32

Hypotension in infants (1-12 months)

Answer 32

Less than 70mmHg

Question 33

Hypotension in children (1 year to 10 years)

Answer 33

5th percentile BP; Less than 70+(age in years x 2)

Question 34

Hypotension in children >10 years

Answer 34

Less than 90

Question 35

Standard evaluations of disability in pediatric patients

Answer 35

1) AVPU 2) GCS 3) Pupil response to light

Question 36

AVPU

Answer 36

Alert, responsive to voice, responsive to pain, unresponsive

Question 37

3 levels of head injury as defined by the GCS

Answer 37

Mild - GCS 13-15; Moderate - GCS 9-12; Severe GCS 3-8

Question 38

Triad consistent with poor myocardial contractility or extrinsic cardiac compression

Answer 38

Low arterial BP, high CVP, tachycardia

Question 39

O2 consumption in infants

Answer 39

6-8 mL/kg/min

Question 40

O2 consumption in adults

Answer 40

3-4 mL/kg/min

Question 41

When airflow is laminar, what is the relationship of resistance to airway radius

Answer 41

Inversely proportional to 4th power of radius

Question 42

When airflow is laminar, what is the relationship of resistance to airway radius

Answer 42

Inversely proportional to 4th power of radius

Question 43

Mechanisms involved in breathing

Answer 43

1) Brainstem 2) Central and peripheral chemoreceptors 3) Voluntary control

Question 44

Central chemoreceptors for control of breathing respond to

Answer 44

Hydrogen ion concentration

Question 45

Peripheral chemoreceptors for control of breathing respond to

Answer 45

Arterial O2

Question 46

Clinical state characterized by abnormal RR

Answer 46

Respiratory distress

Question 47

Clinical state of inadequate O2, ventilation, or both

Answer 47

Respiratory failure

Question 48

Classifications of respiratory distress or failure

Answer 48

1) Upper airway obstruction 2) Lower airway obstruction 3) Lung tissue disease 4) Disordered control of breathing

Question 49

Intervention for mild croup

Answer 49

Consider Dexamethasone

Question 50

Intervention for moderate to severe croup

Answer 50

1) Humidified O2 2) Nebulized epi (then observe for 2 hours for recurrence of stridor) 3) Dexamethasone 4) Consider heliox

Question 51

Intervention for impending respiratory failure in croup

Answer 51

1) High O2 concentration (nonrebreathing mask) 2) IV/IM Dexa 3) Intubate if indicated using ET half a size smaller than predicted for age 4) Prepare for surgical airway if needed

Question 52

Intervention for anaphylaxis

Answer 52

1) IM epi q10-15min prn 2) If wheezing, salb neb or MDI; continuous neb if w/ severe bronchospasm 3) Prepare for intubation 4) Diphen and H2 blocker (ranitidine) IV 5) Methylpred or equivalent corticosteroid IV

Question 53

Intervention for hypotension in anaphylaxis

Answer 53

1) Trendelenburg position 2) Isotonic crystalloid @ 20cc/kg 3) If unresponsive to fluids, IM epi; if still unresponsive, epi infusion titrated to achieve adequate BP for age