Pediatric Emergency Medicine

Question 1

When evaluating a patient, what is the first question you should ask yourself every time?

Answer 1

How does the patient look–sick or not sick?

Question 2

In well-appearing pediatric patients, where should you consider examining the child? What part(s) of the exam should you do first? Last?

Answer 2

In parent’s lap
Least invasive first
Ears and throat last

Question 3

What are the 5 key interventions in a sick child?

Answer 3

O2
Pulse Ox
Cardiorespiratory monitor
IV access
CXR/EKG

Question 4

In a sick child, what should you treat first regardless of complaint/diagnosis?

Answer 4

Treat the greatest threat to life every time, usually airway!

Question 5

Remember the primary survey? What does it consist of?

Answer 5

ABCDE

Question 6

If a child is posturing and leaning forward, what could this indicate?

Answer 6

Issues with the airway (epiglottitis!)

Question 7

What is the quickest and easiest way to assess a patient’s airway?

Answer 7

Ask them their name

Question 8

What are characteristics of a pediatric airway that make it unique? Size, location, length, shape; what does this mean for the child?

Answer 8

Smaller (more prone to obstruction)
More anterior and cephalad (higher up) in location
Shorter (more prone to right main stem intubation)
Funnel shaped (narrowest at sub glottis in kids < 8 yrs)

Question 9

To help align the airway in an infant, how might one position the patient’s head?

Answer 9

Towel roll under the shoulders

Question 10

To help align the airway in an older child, how might one position the patient’s head?

Answer 10

Towel roll under neck, in conjunction with jaw thrust

Question 11

To ensure proper bag mask ventilation, you should observe what movement in the patient?

Answer 11

Chest rise with each breath

Question 12

Do you need to remove the c collar to ventilate?

Answer 12

yes, a second provider will provide stabilization of the c spine during ventilation/intubation

Question 13

If you do not not BMV at an appropriate rate, what does this increase the risk of?

Answer 13

Gastric air, regurgitation, and aspiration

May also result in barotrauma (PTX)

Question 14

If you BMV at a rate that is too fast, this may increase intrathoracic pressure and impair venous return, which will in turn decreases what three things?

Answer 14

Cardiac output, cerebral blood flow, and coronary perfusion

Question 15

What can grunting be indicative of?

Answer 15

Auto PEEP (positive end expiratory pressure) where too much air over inflates alveoli causing progressive air trapping

Question 16

What can you administer to a patient with croup to reduce swelling of the airway around the vocal cords ?

Answer 16

Racemic Epinephrine (Neb)

Question 17

T/F Pediatric arrest is rarely a sudden event

Answer 17

T

Question 18

What are the two most common causes of pediatric arrest?

Answer 18

Respiratory failure and Shock

Question 19

How often is pediatric arrest a primary cardiac event?

Answer 19

Rarely

Question 20

What are potential causes of respiratory failure?

Answer 20

Intrinsic lung dz
Airway obstruction
Inadequate effort

Question 21

Which comes first, respiratory failure or distress?

Answer 21

Distress

Question 22

How can you diagnose respiratory failure?

Answer 22

Clinically

Question 23

Is a blood gas a reliable way to diagnose respiratory failure?

Answer 23

No

Question 24

What are mottled skin and delayed capillary refill signs of?

Answer 24

Poor circulation

Question 25

Normal BP maintained until ____% of the child’s circulating volume is lost

Answer 25

over 30%

Question 26

Hypotension is a late/early finding in children with shock

Answer 26

Late!!

Question 27

___ is a big time sign of shock in children

Answer 27

AMS

Question 28

Shock can occur with normal, increased, or decreased blood pressure?

Answer 28

Yup, all three

Question 29

Mean systolic BP in kids: ___ mmHg + (2 x age in yrs)

Answer 29

90

Question 30

Lower limit systolic BP in kids: ___mmHg + (2 x age in yrs)

Answer 30

70

Question 31

What are three signs of poor tissue perfusion?

Answer 31

Cool or mottled skin Tachycardia ***Altered Mental Status***

Question 32

As part of fluid resuscitation, ___ ml/kg boluses of isotonic fluids, such as ___ or ___, should be administered until there are signs of improved perfusion, and resolution of tachycardia

Answer 32

20 | NS or LR

Question 33

If shock due to hemorrhage, after x2 boluses of isotonic fluids, give ____ at ___ ml/kg

Answer 33

Packed red blood cells (PRBC); 10

Question 34

T/F Large volume resuscitation in the setting of shock is often required in children

Answer 34

True

Question 35

What is the most common cause of death and disability in childhood?

Answer 35

Injury

Question 36

What is the most common cause of death in children?

Answer 36

MVA (followed by drownings, fires, falls, and homicide)

Question 37

What is the leading cause of death in pediatric trauma?

Answer 37

Head injury

Question 38

What are three reasons why head injuries are so common in children?

Answer 38

Large head relative to body = more torque Less myelin = more shearing forces and greater neuron injury Soft cranium may result in intracranial injury without skull fx

Question 39

Sunsetting eyes or one pupil larger than another are signs of ____

Answer 39

Increased ICP

Question 40

Head injuries have a significantly worse outcome when ___ and ___ are present

Answer 40

Hypoxia and hypotension

Question 41

____ of children with chest injury will have other injuries as well. Their___ is very mobile and they are at increased risk of developing a ___ or ___

Answer 41

2/3 Mediastinum PTX or Hemothorax

Question 42

Why is significant thoracic trauma possible without rib fractures in children?

Answer 42

Their ribs are very pliable

Question 43

Most abd trauma occurs secondary to what type of trauma?

Answer 43

Blunt

Question 44

What characteristics/anatomical differences make a child particularly vulnerable to abd injuries?

Answer 44

Children have thin muscular wall and less fat and a lower riding liver and spleen (below ribs)

Question 45

If seatbelt sign is present, what should be ordered?

Answer 45

CT Abd

Question 46

At what age do fontanelles close in infants?

Answer 46

12-18 months

Question 47

Are spine injuries common or uncommon in children? Why?

Answer 47

Uncommon; Interspinous ligaments and joint capsules are much more flexible and pliable Facet joints flat

Question 48

Children have a smaller circulating blood volume compared to adults; a child’s blood volume is ___ ml/kg

Answer 48

70

Question 49

Hypothermia worsens ___ and ___ in trauma patients

Answer 49

Coagulopathy and acidosis