Pedia Emergencies and Resuscitation

Question 1

2nd leading cause of accidental death in children <5

Answer 1

Drowning

Question 2

3rd major cause of death in adolescents

Answer 2

Drowning

Question 3

Associated with survival rates as high as 70% with good neurologic outcome

Answer 3

Rapid, effective bystander CPR for children

Question 4

Upon arrival at the scene of a compromised child, a caregiver’s first task is

Answer 4

A quick survey of the scene itself

Question 5

Any child with these conditions requires immediate CPR

Answer 5

1) Without a pulse 2) HR <60

Question 6

Normal HR is roughly ___x normal RR for age

Answer 6

2-3x

Question 7

Lower limit of SBP in neonates should be

Answer 7

<60

Question 8

Lower limit of SBP in infants should be

Answer 8

<70

Question 9

Lower limit of SBP in 1-10 yr olds should be

Answer 9

< Age x 2 + 70

Question 10

Lower limit of SBP in any child older than 10 y/o should be

Answer 10

<90

Question 11

MC precipitating event for cardiac instability in infants and children

Answer 11

Respiratory insufficiency

Question 12

First priority in resuscitation of a child

Answer 12

Rapid assessment of respiratory failure and immediate restoration of adequate ventilation

Question 13

Earliest and most reliable sign of shock

Answer 13

Tachycardia

Question 14

In the setting of a pediatric emergency, ___ refers to a child’s neurologic function in terms of the level of consciousness and cortical function

Answer 14

Disability

Question 15

A GCS score of ___ requires aggressive management

Answer 15

≤8

Question 16

Components of a secondary assessment in pediatric emergencies

Answer 16

Focused history and PE using SAMPLE

Question 17

Children of this age group are particularly susceptible to foreign body aspiration and choking

Answer 17

<5

Question 18

MCC of choking in infants

Answer 18

Liquids

Question 19

MCC of choking in toddlers and older children

Answer 19

Small objects and food

Question 20

Management of airway obstruction in an infant

Answer 20

5 back blows and 5 chest thrusts

Question 21

Management of airway obstruction in a child >1 y/o

Answer 21

5 abdominal thrusts (Heimlich maneuver) with the child sitting or standing

Question 22

Upper airway narrowing is most often caused by

Answer 22

Airway edema

Question 23

Lower airway narrowing is most commonly caused by

Answer 23

Bronchiolitis and acute asthma exacerbations

Question 24

As effective as ET intubation and safer when provider is inexperienced with intubation

Answer 24

Bag-valve-mask ventilation

Question 25

A child requires intubation when at least 1 of these conditions exist

Answer 25

1) Unable to maintain airway patency or protect the airway against aspiration 2) Failing to maintain adequate oxygenation 3) Failing to control CO2 levels and maintain safe acid-base balance 4) Sedation and/or paralysis is required 5) Care providers anticipate a deteriorating course that will eventually lead to the first 4 conditions

Question 26

Most important phase of intubation procedure

Answer 26

Preprocedure preparation

Question 27

Goals of rapid sequence intubation (RSI)

Answer 27

1) Induce anesthesia and paralysis 2) Complete intubation quickly minimizing elevations of ICP and BP

Question 28

T/F Chest radiography is necessary to confirm appropriate tube position

Answer 28

T

Question 29

Shock occurs when

Answer 29

O2 and nutrient delivery to tissues is inadequate to meet metabolic demands

Question 30

MC type of shock among children worldwide

Answer 30

Hypovolemic shock

Question 31

MCC of distributive shock

Answer 31

Sepsis and burns

Question 32

Type of shock associated with closure of ductus arteriosus in a child with ductus-dependent systemic blood flow

Answer 32

Obstructive shock

Question 33

Type of shock associated with massive pulmonary embolism

Answer 33

Obstructive shock

Question 34

Type of shock associated with tension pneumothorax

Answer 34

Obstructive shock

Question 35

Type of shock associated with pericardial tamponade

Answer 35

Obstructive shock

Question 36

MC pre-arrest rhythms in young children

Answer 36

Bradyarrhythmias

Question 37

HR that is an indication to begin chest compression

Answer 37

<60bpm

Question 38

Factors known to cause bradycardia

Answer 38

6 Hs and 4 Ts: Hypoxia, hypovolemia, hydrogen ions, hypo- or hyperkalemia, hypoglycemia, hypothermia, toxins, tamponade, tension pneumothorax, trauma

Question 39

Narrow QRS complex is objectively how many sec

Answer 39

≤0.08 sec

Question 40

Wide QRS complex is objectively how many sec

Answer 40

>0.08 sec

Question 41

Narrow complex tachycardia may either be

Answer 41

Sinus tachycardia and SVT

Question 42

Sinus tachycardia vs SVT: History and onset are consistent with a known cause of tachycardia

Answer 42

Sinus tachycardia

Question 43

Sinus tachycardia vs SVT: Onset is often abrupt without a prodrome

Answer 43

SVT

Question 44

Sinus tachycardia vs SVT: P waves are consistently present, of normal morphology, and occur at a rate that varies somewhat

Answer 44

Sinus tachycardia

Question 45

Sinus tachycardia vs SVT: P waves are absent or polymorphic, and when present is often fairly steady at or above 220/min

Answer 45

SVT

Question 46

Management for SVT

Answer 46

Adenosine rapid push and flush; if without line or adenosine failed, do synchronized cardioversion using 0.5-1 J/kg

Question 47

Management for wide complex tachycardia

Answer 47

Immediate cardioversion: 1J/kg then 2J/kg if 1J/kg is ineffective

Question 48

Most important treatment of cardiac arrest

Answer 48

Anticipation and prevention

Question 49

Unwitnessed pediatric cardiac arrest in an outpatient setting should be treated as ___ in nature

Answer 49

Asphyxial

Question 50

Witnessed pediatric cardiac arrest in an outpatient setting should be treated as

Answer 50

Primary arrythmia

Question 51

Management for asphyxial cardiac arrest

Answer 51

Initiate CPR immediately

Question 52

Management for cardiac arrest from an arrythmia

Answer 52

Activate EMS immediately and obtain AED

Question 53

When a LONE rescuer provides CPR, the universal ratio of ___ is used

Answer 53

30 compressions: 2 ventilations

Question 54

When a second care provider arrives at the scene, ratio of ___ is used in children ≤8 years old

Answer 54

15:2

Question 55

Emergency defibrillation is indicated for

Answer 55

Vfib or pulses Vtach

Question 56

Meds to maintain cardiac output and for post-resuscitation stabilization: Inamrinone

Answer 56

Inodilator

Question 57

Meds to maintain cardiac output and for post-resuscitation stabilization: Dobu

Answer 57

Inodilator

Question 58

Meds to maintain cardiac output and for post-resuscitation stabilization: Dopa

Answer 58

Inotrope, chronotrope, renal and splanchnic vasodilator

Question 59

Meds to maintain cardiac output and for post-resuscitation stabilization: Epi

Answer 59

Intrope, chronotrope, vasodilator at low doses, vasopressor at high doses

Question 60

Meds to maintain cardiac output and for post-resuscitation stabilization: Mil

Answer 60

Inodilator

Question 61

Meds to maintain cardiac output and for post-resuscitation stabilization: Norepi

Answer 61

Inotrope, vasopressor

Question 62

Meds to maintain cardiac output and for post-resuscitation stabilization: Na nitrprusside

Answer 62

Vasodilator

Question 63

Often the largest and easiest vein to access for cannulation in the upper extremities

Answer 63

Median antecubital vein

Question 64

T/F IO is recommended for patients for whom IV access proves difficult or unattainable, even in older children

Answer 64

T

Question 65

If venous access is not attainable within ___ with CP arrest, an IO needle should be placed in the anterior tibia

Answer 65

1 min

Question 66

T/F Any and all medications and fluids may be administered via IO

Answer 66

T

Question 67

Most common cannulated artery

Answer 67

Radial artery