Chapter 8 - Pediatric Emergencies

Question 1

Symptomatic pediatric bradycardia: cool mottled skin, diminished pulses, altered mental status, increased capillary refill time greater than or equal to 3 seconds.

True or false?

Answer 1

True

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Question 2

Pediatric Bradycardia - 8010

TREATMENT: (6)

Answer 2

• Airway/breathing management
▪Monitor SpO2
▪ Administer 100% O2 via NRB
• If signs of severe cardiopulmonary compromise are present:
▪ Administer 100% O2 and ventilate the patient with BVM
▪ Provide advanced airway adjuncts if the patient deteriorates
▪ If patient eight years old or less and has signs of poor perfusion, the heart rate remains
< 60 despite 100% O2 and ventilation, initiate chest compressions
• Look for signs of Airway obstruction
▪Absent breath sounds
▪Tachypnea
▪Intercostal and suprasternal retractions
▪Stridor
▪Choking
▪Cyanosis
• Initiate cardiac monitoring
• Determine blood glucose level
• Assess temperature
▪ Hypothermia - Rewarm patient, ensure patient compartment is warm and administer warm IV fluids

pg. 1

Question 3

Symptomatic pediatric tachycardia: cool mottled skin, diminished pulses, altered mental status, increased capillary refill time greater than or equal to 3 seconds.

True or false?

Answer 3

True

pg. 1

Question 4

Pediatric Tachycardia - 8020

Sinus Tachycardia =

infant < ______ or Child < _____ with narrow QRS

Answer 4

220, 180

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Question 5

Pediatric Tachycardia - 8020

Symptomatic Tachycardia =

infant > ______ or Child > _____ with signs of poor perfusion

Answer 5

220, 180

pg. 1

Question 6

Pediatric Tachycardia - 8020

TREATMENT: (6)

Answer 6

• If the patient is a symptomatic look for underlying causes (fever, dehydration, pain, etc)
• Airway/breathing management
▪Monitor SpO2
▪ Administer 100% O2 via NRB
• if signs of severe cardiopulmonary compromise are present:
▪ administer O2 and ventilate the patient with a BVM

Question 7

Pediatric Tachycardia - 8020

TREATMENT: (6)

Answer 7

• If the patient is a symptomatic look for underlying causes (fever, dehydration, pain, etc)
• Airway/breathing management
▪Monitor SpO2
▪ Administer 100% O2 via NRB
• if signs of severe cardiopulmonary compromise are present:
▪ Administer 100% O2 and ventilate the patient with a BVM
▪ Provide advanced airway adjuncts if the patient deteriorate
• Initiate cardiac monitoring
• Assess temperature
• Consider specific treatment based on evaluation of patient and QRS

pg. 1
* No - Determine blood glucose level *

Question 8

Shock pts may deteriorate rapidly. Sx of poor perfusion incl: cool mottled skin, dimin. pulses, AMS, increased cap refill time (> 3 secs) and tachycardia AND BP < 70 systolic. True or false?

Answer 8

True

pg. 1

Question 9

Pediatric Shock - 8030

TREATMENT: (7)

Answer 9

•   Place patient in SUPINE position
•   Maintain body warmth
•   Airway/breathing management
   ▪Monitor SpO2
   ▪Administer O2 via NRB
•   Assess temperature
•   Determine blood glucose level
•   Initiate cardiac monitoring
•   If unable to intubate after 2 attempts
   ▪Insert supra- glottic airway if child is equal to or greater than 4' tall. Otherwise, ventilate via BVM and airway adjunct(s)

Question 10

Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Conscious infant
▪Mild Obstruction with good air exchange (3)

Answer 10

• Do not interfere with patient’s owns attempts to expel the obstruction.
• Monitorr closely for signs of worsening
• Attempt to keep patient com

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Question 11

Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Conscious infant
▪Severe Obstruction (5)

Answer 11

• If possible, bare the infant’s chest
• support the infant in prone position, deliver up to five back blows in the middle of the upper back
• Continuing to support the infant, rotate to a Supine position with the head lower than the trunk
• Deliver up to 5 quick downward chest thrusts in the same location as chest compressions
• Repeat sequence into obstruction is cleared or the infant becomes unresponsive

pg. 1

Question 12

Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Unconscious infant (3)

Answer 12

• Reposition Airway and remove object by direct laryngoscopy with Magill forceps
• Begin CPR as indicated
• Suction as indicated

pg. 1

Question 13

Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Conscious child
▪Mild Obstruction with good air exchange (2)

Answer 13

• Encourage patients own spontaneous coughing and breathing efforts
• Attempt to keep patient calm

pg. 1

Question 14

Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Conscious child
▪Severe Obstruction: (1)

Answer 14

• Abdominal thrusts (Heimlich maneuver)

pg. 1

Question 15

Ped. Foreign Body Airway Obstruction - 8040
TREATMENT:
Foreign body Airway obstruction Maneuvers as indicated below: Unconscious child (3)

Answer 15

• Reposition Airway and remove object by direct laryngoscopy with Magill forceps
• Begin CPR is indicated
• Suction as indicated

pg. 1

Question 16

Ped. Foreign Body Airway Obstruction - 8040

GENERAL TREATMENT: (2)

Answer 16

• Airway/breathing management
▪Monitor SpO2
▪ Once obstruction is removed, maintain oxygen saturation of 95% or greater
▪ Assist ventilations with BVM if necessary
▪ Premature Neonate in Neonate: 40 to 60 per minute
▪ Infants and children: 12 to 20 per minute (once every 3 to 5 seconds)
• Initiate cardiac monitoring

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Question 17

The following signs/symptoms will be treated as respiratory distress: increased RR, increased work of breathing, retractions, nasal flaring, SpO2 < 95%. True or false?

Answer 17

True

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Question 18

Pediatric Respiratory Distress - 8050

Normal Respiratory Rates

Infant (<1yr) =

Answer 18

30 - 60

pg. 1

Question 19

Pediatric Respiratory Distress - 8050

Normal Respiratory Rates

Toddler (1-3yr) =

Answer 19

24 - 40

pg. 1

Question 20

Pediatric Respiratory Distress - 8050

Normal Respiratory Rates

Preschooler (4-5yr) =

Answer 20

22 - 34

pg. 1

Question 21

Pediatric Respiratory Distress - 8050

Normal Respiratory Rates

School-age (6-12yr) =

Answer 21

18 - 30

pg. 1

Question 22

Pediatric Respiratory Distress - 8050

Normal Respiratory Rates

Adolescent (13-18yr) =

Answer 22

12 - 20

pg. 1

Question 23

Pediatric Respiratory Distress - 8050

TREATMENT (5)

Answer 23

• Airway/breathing management
▪Monitor Spo2
▪Administer O2 via NRB
▪ If unable to maintain oxygen saturation with NRB, provide 100% O2 via BVM and positive pressure ventilations
▪Assess breath sounds
• Initiate cardiac monitoring
• Assess temperature
▪If patient is febrile apply cooling measures
• Determine Blood Glucose Level
• MILD croup (barking cough)
• MODERATE to SEVERE croup (Inspiaratory or expiratory stridor at rest)
• If unable to intubate after 2 attempts
▪Insert supra-glottic airway (Appendix D) of child is equal or greater than 4’ tall. Otherwise, ventilate via BVM and airway adjunct(s)

pg. 1-2

Question 24

Pediatric Asthma - 8060

TREATMENT: (6)

Answer 24

• Airway/breathing management
▪Monitor SpO2
▪Administer O2 via NRB
▪Assess breath sounds
• Initiate cardiac monitoring
• Assess temperature
▪If patient is febrile apply cooling measures
• Treatment should be based on lung sounds and level of distress
▪MILD distress - Wheezes only
▪MODERATE distress - Wheezes/decreased breath sounds/accessory muscle use
▪SEVERE distress - Wheezes/stridor/decreased breath sounds with little to no air movement/accessory muscle use/tripoding
• If unable to intubate after 2 attempts
▪Insert supra-glottic airway (Appendix D) if child is equal or greater than 4’ tall. Otherwise, ventilate via BVM and airway adjunct(s)
• Determine Blood Glucose Level

pg. 1-2

Question 25

Pediatric Non-Fatal Drowning - 8090 TREATMENT (9)

Answer 25

• ALL near drowning patients should be transported • Maintain body warmth • If trauma suspected, immobilize using proper techniques • Airway/breathing management ▪Monitor SpO2 ▪ Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater ▪Apply CPAP (Appendix H) to patients with pulmonary edema • If unable to intubate after 2 attempts ▪Insert supra-glottic airway (Appendix D) if child is equal or greater than 4' tall. Otherwise, ventilate via BVM and airway adjunct(s) • Assess temperature • Determine Blood Glucose Level • ANTICIPATE RAPID DETERIORATION AND THE NEED TO INTUBATE pg. 1-2

Question 26

Pediatric Allergic Reaction/Anaphylaxis - 8100 TREATMENT: (10)

Answer 26

• Airway/breathing management ▪Monitor SpO2 ▪Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater ▪ANTICIPATE RAPID DETERIORATION AND THE NEED TO INTUBATE • Initiate cardiac monitoring • ASSIST WITH THE ADMINISTRATION OF PATIENT'S AUTO-INJECTOR EPINEPHRINE IF PRESENT • Determine blood glucose level • ANTICIPATE RAPID TRANSPORT IN THE SETTING OF ANAPHYLAXIS • Assess temperature • MILD reaction - Without respiratory compromise • MODERATE reaction - Involves respiratory compromise • SEVERE reaction/ANAPHYLAXIS - severe respiratory distress • If unable to intubate after 2 attempts ▪Insert supra-glottic airway (Appendix D) if child is equal or greater than 4' tall. Otherwise, ventilate via BVM and airway adjunct(s) pg. 1-2

Question 27

Pediatric Altered Consciousness - 8110 Treatment: (11)

Answer 27

• Maintain aspiration prophylaxis by placing the patient in the RECOVERY POSITION • If trauma suspected, immobilize using proper techniques • Airway/breathing management ▪Monitor SpO2 ▪ Administer O2 via proper adjunct maintain oxygen saturation 95% or greater • Determine blood glucose level • Initiate cardiac monitoring • Assess temperature • Look for underlying causes ▪ look for signs of abuse, toxins etc. • Hypoglycemia - BGL < 50 mg/dl • Hyperglycemia - BGL > 300 mg/dl • Narcotic use • unknown etiology ▪ Consider other treatable neurological or metabolic disorders and if identified follow the appropriate protocol pg. 1-2

Question 28

Pediatric Diabetic - 8120 TREATMENT: (5)

Answer 28

``` • Airway/breathing management ▪Monitor SpO2 ▪Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater • Determine blood glucose level • Initiate cardiac monitoring • Look for underlying causes ``` pg. 1

Question 29

Pediatric Overdose/Poisoning - 8130 TREATMENT: (8)

Answer 29

• If substance is known, contact Poison Control at 1-800-222-1222. Provide all information requested by poison control representative • do not delay treatment or transport but if possible bring medication or substance ingested • Maintain aspiration prophylaxis by placing the patient in the RECOVERY POSITION • Airway/breathing management ▪Monitor SpO2 ▪Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater • Determine blood glucose level • Initiate cardiac monitoring • Assess temperature ▪If patient is febrile apply cooling measures • Consider specific treatment situations ▪Seizures may develop in many overdoses/poison/ingestion situations pg. 1

Question 30

Pediatric Seizures - 8140 TREATMENT: (6)

Answer 30

• Maintain aspiration precautions by placing a patient in the RECOVERY POSITION • If trauma suspected, mobilize patient using proper technique • If the patient is actively seizing, protect the patient from further injury • Airway/breathing management ▪Monitor SpO2 ▪ Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater • DETERMINE BLOOD GLUCOSE LEVEL IN EVERY PEDIATRIC SEIZURE PATIENT • Assess temperature pg. 1

Question 31

Pediatric Fever - 8150 TREATMENT: (5)

Answer 31

• Airway/breathing management ▪Monitor SpO2 ▪ Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater • Assess temperature ▪ If patient is febrile (rectal >105.0° or tympanic > 104.0°) apply cooling measures • Determine blood glucose level • Initiate cardiac monitoring • If the pediatric patient has a temperature > 102.0° and the patient has Ibuprofen or Acetaminophen: ▪ administer Ibuprofen 10 mg/kg (not for children under 6 months) PO or Acetaminophen 15 mg/kg PO pg. 1 pg. 1

Question 32

Pediatric Fever - 8150 Apply cooling measures if patient's temperature is:

Answer 32

rectal > 105.0° or tympanic 104.0° pg. 1