volume 1 Flashcards
Which of the following regarding automatic external defibrillators is false?
a) AEDs with paediatric systems should be used for children
d) IV and cardioresp monitor are not on the list because basic life paramedics don’t have training in them
the main change to what pre-hospital providers should have is the addition of AED
children with sudden witnessed collapse - at risk of pulseless ventricular tachycardia or ventricular fibrillation ->need AED
other equipment:
- see the list, includes airway equipment, defibrillation, immobilization, infection control, ob/neonatal supplies, other miscellaneous
- statements are for basic life support trained paramedics, so no IV or Cardioresp monitor is included on the list, since they are not trained in this, don’t have intubation equipment on the list either but do have oral airway, O2 and bag mask, nasopharyngeal airway, suction (special paramedics are but this statement doesn’t cover them) this is to basic minimum equipment needed to transport neonates and children , C spine as well
should have appropriate training and checking of equipment
Which of the following is the most common side effect of ondansetron when used for gastroenteritis?
a) diarrhea
b) drowsiness
c) hallucinations
d) extra-pyrimidal side effects
a) diarrhea is the most common side effect when used for gastro, usually mild and self limiting
no drowsiness with ondansetron (hence the appeal)
selective serotonin receptor antagonist , peak within 1-2 hours rapidly absorbed
safe and effective in cancer patients as well as post-op
low risk of SEs in this population
Which of the following is not true of gastroenteritis?
a) most commonly caused by rotavirus or norovirus
b) most common cause of ER by young children
c) incidence of acute gastroenteritis in children
c)false - 1-2 episodes per year in the industrialized world
20% of all outpatient hospital visits by younger children, 200000 hospitalizations per year
meds that are commonly prescribed, promethazine, metoclopramide, dimenhydrinate and domperidone rare (but scary) side effects include drowsiness, extra-pyrimidal symptoms, hallucinations, convulsions, neuroleptic malignant syndrome
3 main studies looking at ondansetron and gastroenteritis (over past 20 years)
Which of the following is not one of the things that ondansetron has been shown to do in RCTs?
a) reduce need for IV fluids in children age 6 months-12 years with gastroenteritis causing mild-moderate dehydration or who have failed ORT
b) reduce frequency of vomiting children age 6 months-12 years with gastroenteritis causing mild-moderate dehydration or who have failed ORT
c) reduce symptoms in patients age 6 months-12 years with gastroenteritis presenting with severe diarrhea
d) may be helpful to reduce hospital admissions of children with gastroenteritis
c) is the answer - the only side effect was diarrhea, generally resolved within 48 hours
therefore, shouldn’t use for patients with gastro where moderate-severe diarrhea is the main presenting symptom
single dose
in hospital setting - need more studies to assess its role out of hospital
studies
#1: Freedman - reduced IV fluids, reduced vomiting, no difference in hospital admission
#2: Roslund - less likely to receive iv fluids or get admitted to hospital
#3: Ramsuck - vomited less, less IV fluids, less likely admitted to hospital
meta-analysis by Decamp of these studies and 3 others: decreased risk for further emesis in the ED, IV fluid administration and hospital admission
Which of the following is an appropriate one time dose of oral ondansetron for a 30kg child?
a) 2 mg
b) 4 mg
c) 6 mg
d) 8 mg
b) 4 mg
one time dose
8-15 kg - 2 mg
15-30kg - 4 mg
>30 kg 6-8 mg
(dose 0.15 mg/kg is what we usually order, these are estimates)
oral rehydration should be given 15-30 minutes after oral ondansetron
Which of the following is the most common identified trigger for anaphylaxis?
a) food
b) hymenoptera stings
c) medications
d) infection
a) food is the most common identified trigger, then hymenoptera stings (wasps/bees) and medications
a trigger is only identified in 1/3 of cases
cause of anaphylaxis - release of mediators from mast cells and basophils often in response to an allergen
incidence 1-4/1000
when food identified, trigger, peanuts, tree nuts, fish, milk, eggs and shellfish (eg, shrimp, lobster, crab, scallops and oysters) most commonly implicated in fatal and near fatal reactions
Which of the following is the most predominant symptom of anaphylaxis in children?
a) GI involvement
b) cardiovascular involvement
c) respiratory involvement
d) cutaneous manifestations
d) cutaneous symptoms are the most common in 80-90%
(urticaria, angioedema, prutitus and flushing)
respiratory involvement 60-70% includes upper and lower airway symptoms including obstruction and bronchospasm
CV 10-30% include dizziness, hypotension, syncope
Which of the following patients does not meet the criteria for anaphylaxis?
a) child with urticaria and hypotension presenting acutely
b) child with hives and persistent vomiting after exposure to a likely allergen for that child (known allergy)
c) child with stridor and nausea/vomiting that occurs acutely after exposure to a likely allergen for that child (known allergy)
d) reduced BP by 20% after exposure to a known allergen
d) needs to be reduction in 30% of the BP or low BP based on age norms
the 3 criteria for anaphylaxis:
FOR NEW PATIENT
1. acute onset of illness (minutes to several hours) with involvement of skin/mucosal tissue and at least one of either resp compromise or hypotension
FOR KNOWN PATIENT
2. 2 or more of the following occurring rapidly after exposure to likely allergen:
- urticaria
- resp sx
- GI sx
- reduced BP or end organ dysfunction
3. reduced BP after exposure to KNOWN allergen for that patient
Which is the recommended body weight for the epipen Jr?
c) epipen Jr 10-25 kg
doses of epipen Jr: 0.15 mg and epipen 0.3 mg
does for 10-25kg and >25 kg person
risk of epipen vs drawing up dose for smaller person, is risk of delay and wrong dose; need to balance these
physicians should air on the side of caution, inject epinephrine early
for greater than 25 kg, use epipen 0.3 mg dose
Which of the following should be the first step in the acute management of anaphylaxis in the hospital?
a) IV access
b) IM epinephrine
c) cardioresp monitor
d) NS 20 cc/kg bolus
e) intubation
b) IM epi is first and most important
dose is 1:1000 epi dose of 001 mg/kg into the lateral thigh
and initiate ABCs at the same time, O2, monitor, IV access (don’t delay epi to get IV)
if severe airway signs, then prepare for intubation **early preparation for airway management is crucial cause it may be a difficult airway
if cardiovascular compromise then give 20 cc/kg NS bolus to replenish volume; up to 35% of blood volume can be lost in first 10 minutes because of increased vascular permeability
Which of the following is false?
a) only anaphylactic patients presenting with hypotension need an IV
b) an IO should be placed if you can’t get an IV and the patient is hypotensive and poorly perfused
c) ideally patients with anaphylaxis should be placed supine or in the Trendelenburg position
d) cetirizine is one of the second line medications for the treatment of anaphylaxis
a) false - because you can lose your up to 35% of blood volume can be lost in first 10 minutes because of increased vascular permeability, ALL patients with anaphylaxis should get 2 large bore IVs
the rest are true
b) if no IV and poor perfusion/hypotension, then IO
c) helps to increased blood return to the heart/prevents pooling of blood in the extremities
d) true - second line includes H1 and H2 blockers, salbutamol, corticosteroids
Please match up the effect of epi and the mechanism of action
a) alpha adrenergic
b) beta-1-adrenergic effects
c) beta 2 adrenergic effects
d) concentration used for anaphylaxis
- bronchodilation and reduction of inflammatory mediator release
- 1:1000
- increased vascular resistance
- chronotropic and inotropic cardiac effects
- 1:10000
a) 3: alpha adrenergic - increases vascular resistance and decreases vasodilation, while decreasing angioedema and urticaria (i.e. alpha tightens it all up) - alpha is arteries
b) 4 beta -1 adrenergic : chronotropic and inotropic cardiac effects (beta one is number 1 and speeds it all up) - you have one heart
c) 1 beta 2 adrenergic: bronchodilation and reduction of inflammatiory mediator release from mast cells and basophils (i.e. like for asthma) - you have 2 lungs
d) 2 1:000 epi dose is 0.01mg/kg (max total dose is 0.5 mg) can repeat every 5-15 minutes
Which of the following is correct
a) cetirazine is a non drowsy H2 blocker
b) H2 blockers such as ranitidine are given primarily when there are GI manifestations of anaphylaxis
c) IM epi works better when given in the deltoid in the arm
d) steroids have shown a proven benefit in the treatment of anaphylaxis in RCTs
e) inhaled salbutamol should only be used for patients with known asthma presenting with anaphylaxis
e)true - (not the greatest question I have made here), salbutamol for known asthma and wheezing , can considered inhaled epi for stridor but certainly not proven
c) false, better to give it in the anterolateral thigh - results in higher peak plasma concentrations and peak concentrations achieved sooner than when given in the arm
can repeat ever 5-15 minutes depending on condition
a) false - it is a H1 blocker, it is non drowsy, therefore if the patient isn’t vomiting, it should be your first line choice of H1 blockers
b) false - not according to statement, giving both H1 and H2 blockers together reduces the cutaneous manifestations of anaphylaxis compared to using H1 blockers alone
no RCTs for H1/H2 blockers or steroids
d) false - no RCTs have shown proven benefit, most experts will recommend it steroids onset of action is slow (4 h to 6 h), and that there will likely be little benefit in the acute phase of management (thought to prevent rebound from what I know). oral steroids, if severe, then IV
e) use for patients with bronchospasm/wheezing, known asthma, upper airway obstruction (i.e. stridor)(even though no proof for this indication)
A patient has refractory hypotension after repeated doses of IM epi and fluid boluses, what should you do?
a) give IV glucagon
b) continue giving multiple fluid boluses
c) continue giving IM epi as hypotension will likely improve
d) start IV epi infusion
d) start IV epi infusion
- no evidence that repeated IM epi helps with hypotension
- IV infusions of epi have more sustained effect, whereas boluses have more immediate effect
IV boluses of epinephrine may have an immediate effect that is often short lived, accompanied by coexisting concerns for induced cardiac arrhythmias when administered too rapidly
- also co-existing concerns that epi can cause arrythmias with lots of doses
- IV glucagon - for patients who are on a beta blocker, since these patients can have anaphylaxis with persistent hypotension, glucagon activates adenylate cyclase independent of the beta receptor, bolus dose then infusion
How long is the minimum you should you observe patients after anaphylaxis?
a) until symptoms resolve
b) 2 hours
c) 4-6 hours
d) 12 hours
c) reasonable amount of time to observe is 4-6 hours, most biphasic reactions will occur within this time
can happen up until 72 hours so may be reasonable in more rural situations to observe longer (12 hours) or to admit to hospital overnight
patients who are more likely to have biphasic reaction : have delayed epi admin, more severe initial reaction, or who needed more than one dose of epi
5-20% of patients can have biphasic reaction, 3% of children have a severe reaction
more severe reaction esp with hypotension or resp symptoms or biphasic reaction should be admitted to hospital, patients with high risk features - asthma, peanut allergy, use of beta blockers, should consider for overnight observation or admission
IV epi/glucagon or major airway symptoms should go to the ICU
Which of the following is not part of the discharge instructions for anaphylaxis?
a) leave the ER with epi auto injector if possible
b) only administer epi after being sure that it is anaphylaxis
c) child should always carry epi with them
d) consider 3 day course of oral H1 and H2 blockers and oral steroids at discharge
e) referral to allergist/immunologist
b)false should err on the side of caution and administer whenever symptoms occur after exposure to individuals known trigger
the rest are true
a) should give them a prescription for epi pen, if possible give them an auto injector since they could have a reaction on the way to the pharmacy (biphasic)
c) home and school, ideally two doses at each place (i guess in case the first dose is given wrong)
d) most experts suggest this even though limited data since unlikely to cause harm and may help with faster resolution of symptoms
trict instructions to avoid the allergen
also give them online resources as well as discuss the importance of medic alert bracelet
allergist can provide additional testing
counsel detailed about symptoms of anaphylaxis
Which of the following patients with minor allergic reaction does not need to be prescribed epinephrine?
a) generalized urticaria after bee sting
b) child with mild reaction to cats living in an urban area
c) allergic reaction to peanuts
d) on propanolol
e) asthma
b) should consider for people in remote areas
specific food triggers that are knob to be high risk - seafood, peanuts, etc.
generalized urticaria after insect venom
non selective beta blockers
repeat exposures likely
initial history unclear, possible anaphylaxis
Which of the following is the most common trigger for asthma in children?
a) allergens
b) suboptimal control at baseline
c) pets
d) viral infection
d) viral infection is the most common trigger, other common ones are allergens, suboptimal baseline control.
asthma - most common reason for hospitalization in children
lifetime prevalence in Canada 11-16%
exacerbation - acute or subacute deterioration of control
9% of children with asthma ER visit, asthma is 3-7% of Er visits
Which age group is the most likely to present to the hospital with asthma exacerbation?
a) <5 year old
b) 5–9 year old
c) 9-12 year old
d) 13-17 year old
a) more than 50% who present to ED with asthma exacerbate are preschool age < 5 year old.
A 5 year old girl presents with an asthma exacerbation, her O2 saturations are 91% on R/A, she has intercostal and subcostal retractions, and has decreased feeding. She is speaking in phrases. What is the severity of her asthma exacerbation?
a) mild
b) moderate
c) severe
d) impending respiratory failure
B) moderate
classification based on the presence of several parameters, can overlap
look at clinical features, mental status, activity, speech, WOB, chest auscultation, SpO2 on R/A, peak flow vs personal best
mild exacerbation: sats>94%, mild WOB, moderate wheeze, peak flow >80% personal best
moderate: sats 91-94%, moderate WOB (intercostal and subcostal retractions), may be agitated, talks in phrases, biphasic wheeze, decreased feeding
severe: severe WOB - paradoxical breathing, nasal flaring, all accessory muscles used (may have nasal flaring and abdo movement), agitated, speaks in words , stop feeding, wheeze without stethoscope
impending respiratory failure: silent chest, drowsy, sats
What is the peak flow result vs personal best in a severe asthma exacerbation?
a) >80%
b) 60-80%
c) <60%
d) none of the above
c) <60% is the flow in a severe exacerbation
in impending resp failure, unable to do
Which of the following is not associated with sats<92% on presentation?
a) more morbidity
b) greater risk of hospitalization
c) improved outcome
c) not associated
sats <92% before treatment is associated with more morbidity and more hospitalization
Which of the following is not a risk factor for ICU admission and death?
a) previous ICU admissions
b) previous life threatening events
c) previous need for oxygen
d) deterioration while already on systemic steroids
c) not one of the risk factors, but previous intubation is a risk factor
death - Alberta - 10% resulted in hospital, 1 death/25000 ER visits
also should ask about any previous meds
Which of the following provides can provide the best objective measurement of disease severity in an asthma exacerbation in an 11 year old?
a) chest X ray
b) blood gas
c) peak flow meter
d) spirometry
d) spirometry
when children able to perform, it is an objective measure of airway obstruction: HOWEVER, difficult to do in t usually recommend other tests
CXR: only if suspect other processes such aspneumothorax, pneumonia (bacterial, foreign body, or lack of improvement with treatment
blood gases - only if not improving with maximal therapy
Which of the following is a sign of impending respiratory failure?
a) sats 91%
b) speaking in single words
c) normal CO2 on blood gas with ongoing resp distress
d) agitation
c) normal CO2 with ongoing resp distress is a sign of resp failure
scores that are used (based on previous criteria that categorize severity) include PRAM score and Clinical assessment score (CAS)
Which of the following is the suggested treatment for moderate asthma exacerbation?
a) back to back salbutamol/ipratropium, IV steroids
b) back to back salbutamol/ipratropium, PO steroids
c) back to back salbutamol, inhaled steroids
d) back to back salbutamol, PO steroids, consider ipratropium x3 in 1 hour
d) is the answer
for mild exacerbation - salbutamol q20 minutes x 1-3 doses, consider PO steroids
moderate: back to back salbutamol x 3 q20, PO steroids, consider ipratropium x 3 in one hour
severe: back to back salbutamol/ipratropium, give oral steroids, consider IV steroids, consider MgSO4
Which of the following is not part of the management of a severe asthma exacerbation?
a) must give IV steroids
b) back to back salbutamol/ipratropium x 3
c) consider continuous ventolin neb
d) consider MgSO4
e) NPO
a) false - give oral steroids, CONSIDER IV steroids
the rest are part of the management
sats should be >94% for all asthma exacerbation (non rebreather with 100% O2)
Which of the following is not part of the management options for asthma exacerbation with impending resp failure?
a) NPO
b) back to back salbutamol and ipratropium
c) get IV access
d) 100% O2
e) IV steroids
f) consider SC epi
b) should give continuous neb of salbutamol and 3 doses of ipratropium consider: aminophylline, MgSO4, IV salbutamol do blood gas and lytes consider SC epi if deteriorating consider RSI call PICU
sat target: no great evidence to suggest a particular sat target; in general>94% with resp distress makes sense
hypoxemia is considered
Which of the following is false of B agonist?
a) should not be used as MDI when there is impending respiratory failure
b) MDI is more likely to to provoke hypoxemia and tachycardia than a nebulizer
c) MDI with spacer is the best way to delivery B agonist
d) when there is hypoxia, should give O2 by nebulizer
b) opposite, when there is no initial O2 need, then MDI is less likely to provoke hypoxemia and tachycardia than a nebulizer
MDI always better to deliver bronchodilator, except when impending respiratory failure
even with hypoxia can give MDI with spacer and nasal prongs at the same time
in children without O2 need, then MDI and spacer less likely to provoke tachycardia and hypoxemia
severe act, might be better to give constant beta-agonist
Which of the following is not a common side effect of beta agonist use in children?
a) tachycardia
b) hypokalemia
c) hyperglycemia
d) arrythmias
d) arrythmia - no evidence of this being an issues in children
the other 3 are side effects of beta agonist use, generally well tolerated
doses of meds are listed in the statement
salbutamol 20 kg 10 puffs every 20 min in first hour
pred or dex are listed as steroids - one single dose in the AM will reduce risk of adrenal suppression
ipratropium 20 kg 6 puffs **use with caution in soy allergy
Which of the following drugs should be used with caution in children with soy allergy?
a) flovent
b) salbutamol
c) ipratropium bromide
d) MgSO4
c) ipratropium - use with caution in children with soy allergy
MgSO4 can cause hypotension
Which of the following evidence is not correct?
a) ipratropium - reduced hospital admission, improved lung function, useful when used beyond first hour
b) steroids should be used for moderate -severe exacerbation and reduces the risk of hospitalization and risk of relapse
c) IV MgSO4 may improve lung function and decrease hospitalization in children with severe asthma
d) IV salbutamol in severe attacks has been shown to improve pulmonary function and gas exchange
e) mechanical ventilation in the context of severe asthma is associated with increased risk of death
a) false - no evidence that useful when used beyond first hour, the other 2 are benefits that have been shown when used with beta agonist in the first hour
severe exacerbation- should get IV steroids; methylpred or hydrocortisone
there rest are true, MgSO4 should monitor for hypotension and bradycardia, consultation with ICU or respirologist recommended
In general, inhaled drugs may have a limited effect in patients with nearly complete airway obstruction and have practical limitations in ventilated patients.
IV salbutamol- cardiac effects include tachycardia and arrhythmia, so should have continuous cardiac monitoring
intubation for asthma - increased risk of bad outcomes from pneumothorax and/or from increased intrathoracic pressure leading to cardiovascular collapse
26% of children intubated for asthma have these severe side effects, so should talk to ICU for these
other for severe ICU who don’t respond to anything: aminophylline, heliox
Which of the following is false of inhaled corticosteroids for asthma?
a) impairs final adult height
b) should be prescribed for patients with moderate -severe exacerbation
c) should not be given intermittently
d) potential risk of adrenal suppression when used for prolonged periods
a) false - does not impair growth or final adult height
the rest are true
adrenal suppression - less likely when proper monitoring and with the new inhaled corticosteroids
ICS reduces exacerbations and chronic morbidity
doses of steroids are in a chart
remember doses are based on severity and not on weight
**statement has discharge criteria (includes sats>94%)
course of oral steroids 3-5 days depending on severity
continue using inhaled CS q4 hour until resolve then as needed
What is the minimum age that budesonide (pulmoicort) nebulizer is used for?
a) 3months
b) 6 months
c) 12 months
d) 6 years
a) 3 months
the others:
flovent (fluticasone) 12 months by MDI if doing high dose should do with resp
budesonide (pulmicort ) by dry powder - 6 years
ciclesonide (alvesco) 6 years (*remember it’s a pro-drug, so less systemic effects I believe - double check)
Which of the following is false of acute hyponatremia?
a) decrease in Na over 48 hours
b) causes acute cerebral edema
c) negative outcomes from acute hyponatremia more likely with
d) false, has 154 mmol/L NaCl, because this is more than body, it has raised the theoretical risk of hypernatremia and water overload, but mostly seems to be theoretical unless the child has renal concentrating defect, significant water loss, or prolonged fluid restriction.
hyperchloremic metabolic acidosis - has been reported preoperatively, not as much when used for maintenance
headache, lethargy and seizures, and potentially even respiratory and cardiac arrest secondary to brain stem herniation ->because of higher brain/intracranial ratio children more likely to have this consequence
hospitalized children - release more ADH, impaired ability to excrete free water, and also get more free water in hypotonic fluids
What of the following is false?
a) isotonic fluids (vs. hypotonic fluids) were shown to be safer to present post operative hyponatremia
b) only IV fluids need to be accounted for when assessing the Na content of IV maintenance fluids
c) children undergoing surgery are at particular risk of hyponatremia
d) children with respiratory or neurological infections (such as bronchiolitis, meningitis) are at particular risk of hyponatremia
b)false, oral fluids have low Na, need to account for oral and IV fluids when looking at IV intake (TFI)
one study showed the type of fluid but not the rate affected the degree of Na fall
young kids, low glycogen stores so should have dextrose in fluid
A patient’s serum Na is 150 mmol/L, what type of fluid should be used?
a) D5NS at maintenance
b) D50.45NS at maintenance
c) D50.2 NS at maintenance
d) D5 Ringers at maintenance
b) D50.45 NS at maintenance and very closely monitor the sodium
in general, always do D5NS(for kids with normal Na can consider 0.45 according to statement but prefer D5NS)
when normal at baseline but when high risk of ADH then should use D5NS for sure
never use s not great because no sugar and have presence of lactate (so not great in young kids)
preoperative should always use isotonic fluids
Which of the following is not required monitoring for IV fluids?
a) electrolytes prior to starting
b) bid electrolytes for kids with impaired renal excretion
c) monitor urine output
d) daily monitoring of weight
b) only daily electrolytes is fine in these kids
statement says do lytes before starting in hospitalized kids , should check lutes daily (more often if risk of renal problems/excretion)
need daily monitoring of urine output and input
should be aware of symptoms of hyponatremia
headache, nausea and vomiting, irritability, decrease in level of consciousness, seizures and apnea.
How much Na is in 2/3 1/3 IV fluid?
a) 33 mmol/L
b) 45 mmol/L
c) 66 mmol/L
d) 77 mmol/L
b) 45 mmol/LNa dextrose is 33 gram/L the others: 0.45NS is 77 mmol/L 0.2NS is 33 mmol/L NS 154 mmol/L RL 130mmol/L only ringers and NS are considered isotonic Ringers has less chloride (110 vs 154 for NS) so less risk of hyperchloremic metabolic acidosis
Which of the following is not a reason that children more likely to sustain intracranial injury from head trauma than adults?
a) more myelinated tissue
b) larger heads
c) thinner cranial bone
a) opposite, less myelinated tissue
Which of the following is relatively uncommon in children compared to adults?
a) diffuse axonal injury
b) cerebral edema
c) hematoma needing evacuation
c) hematomas and other lesions that need evacuation comparatively less common in children than adults, more common to get DAI then cerebral edema secondary to it
Which of the following frequently leads to intracranial injury?
a) fall from less than twice the height of the individual
b) fall from 80 cm
c) MVC
d) low velocity projectile
c) MVC
common causes of head injury include:
- falls, MVC, sports, being hit on the head or running into obstacle, bicycles, being hit by a car
- for falls, increased frequency of intracranial injury if >3 feet (91cm or >2 x height/length of the individual)
- high velocity projectile commonly leads to intracranial injury
Which of the following signs is not particularly associated with intracranial injury?
a) prolonged LOC
b) disorientation, confusion, amnesia
c) worsening headache
d) vomiting after the impact
d) in fact repeated or persistent vomiting is associated with intracranial injury, lots of people might vomit once at the impact
the others are listed as symptoms of head injury
Which degree of head trauma does the following person have based on their glasgow coma scale? eye opening to verbal stimuli, speaking but using inappropriate words, flexion to pain
a) minor
b) moderate
c) severe
b) severe
GCS is 8 (3/3/2)
severe is GCS
Which degree of head trauma does the following person have based on their glasgow coma scale? eye opening spontaneously, speaking but confused, following commands
a) minor
b) moderate
c) severe
a) minor
GCS 14 (3/5/6)
severe is GCS
Which degree of head trauma does the following person have based on their glasgow coma scale?
withdraws from pain, incomprehensible sounds, opens eyes to pain
a) minor
b) moderate
c) severe
c) severe GCS 8
eye - 2/4
verbal - 2/5
withdraws from pain - 4/6
all severe injury needs a CT scan as well as all the other management (see question below)
What is the GCS of the following 1 year old child?
withdraws to touch, irritable/crying, eye opening to speech
a) 11
b) 12
c) 13
d) 14
b) 12 -
pediatric GCS for pre-verbal children
eye opening 3/4 (spontaneous/to speech/to pain)
verbal 4/5 (coos babbles/irritable and cries/cries to pain/moans to pain
motor 5/6(normal, withdraws to touch, withdraws to pain, abnormal flexion/abnormal extension)
**remember table has GCS of 3
see chart for all details
