Question 1

Assessment of an alert and oriented 9-year-old child with a history of asthma reveals him to be breathing 20 times a minute with adequate chest rise and fall. You also note that he exhibits nasal flaring and has slight retractions of the intercostal muscles. His heart rate is 100 beats per minute and his blood pressure is 102/64 mmHg. On room air, he has a pulse oximeter reading of 98%. The EMT would recognize:

Accepted Answer

The child is exhibiting signs of respiratory distress, but his oxygen saturation is still within normal limits on room air. The presence of nasal flaring and retractions indicate that he is working harder to breathe, but he is still able to maintain adequate oxygenation. This is considered compensated respiratory distress. If the child's oxygen saturation were to decrease or if his respiratory effort were to become even more labored, he could progress to hypoxic respiratory failure or decompensated respiratory failure. However, at this point, the best choice is A, compensated respiratory distress.

Question 2

An infant is short of breath and has rhonchi in both lungs. He is alert with adequate respirations at a rate of 38 per minute. His skin color is pink but cool to the touch. When EMRs place a pediatric mask on his face, he becomes very upset and physically struggles to remove it. In this situation you would:

Accepted Answer

Placing a nasal airway may exacerbate the infant's distress and struggling, further compromising breathing. Securing the mask to the face using tape can also cause distress and potentially cause injury to the infant's delicate skin. Positive pressure ventilation may be necessary but should be done with caution and appropriate equipment. Transporting the infant with no further attempt at oxygen therapy is not appropriate in this situation. Allowing the mother to hold the infant and provide blow-by oxygen can provide comfort and assistance with breathing while avoiding further distress from the mask.

Question 3

You have been called for a 4-year-old female who is short of breath. Her mother informs you that she has had a fever and runny nose for two days and today began to have difficulty breathing. Furthermore, she is having a difficult time waking her up. Your assessment reveals her to be responsive to painful stimuli and breathing at 12 times a minute with minimal chest and abdominal rise and fall. Her skin is warm to the touch with cyanosis around the lips. Your partner informs you that her heart rate is 124 beats per minute. You find the girl lying in bed with snoring respirations despite use of the head tilt,-chin lift airway maneuver. Your immediate action in caring for this child next is:

Accepted Answer

The answer of You have been called for a 4-year-old...

Question 4

You have been called to a preschool for a child in seizure activity. On your arrival, staff direct you to a bed in which a 4-year-old boy is lying. Staff state that the child began making "funny" noises in his sleep then began to seize for approximately 60 seconds. Your assessment indicates that the boy is responsive to painful stimuli and is breathing, but has gurgling sounds coming from the upper airway. His radial pulse is rapid and strong and his skin is cool and diaphoretic. Your immediate action in caring for this child would be to:

Accepted Answer

The gurgling sounds from the upper airway indicate that the child's airway may be obstructed. The first action should be to suction the airway to clear the obstruction and ensure adequate breathing. Oxygen and positive pressure ventilation may be necessary after the airway is cleared, but should not be the first action taken. A cervical collar is not necessary in the care of a seizure and may not be appropriate for a child of this age.

Question 5

The mother of a 2-year-old has called EMS because her son has an axillary temperature of 103.2°F. On scene, your assessment reveals the boy to be confused and lethargic with a rectal temperature of 104.1°F. When caring for this child, you would:

Accepted Answer

The best choice would be to remove the child's clothes and sponge with tepid water. This will help reduce the child's temperature, and the tepid water will help the child cool down without causing any shivering or chill. Applying washcloths soaked in cold water may cause shivering, which can increase the child's temperature. Administering oxygen is not necessary in this scenario, and sponging with alcohol is not recommended as it is not safe for young children. The mother can administer Tylenol as prescribed by a medical professional, but sponging with tepid water is still the best choice for immediate cooling.

Question 6

On scene at a school cafeteria, you are presented with a 9-year-old boy who attempted to eat a small plum whole. He is conscious with stridorous respirations and unable to cough when instructed to do so. His skin color is gray and cyanotic. Your immediate action would be to:

Accepted Answer

Given the child's age, conscious state, and inability to cough with signs of severe airway obstruction (stridorous respirations, gray and cyanotic skin color), the immediate action should be to deliver five abdominal thrusts (Heimlich maneuver) to relieve the airway obstruction caused by the foreign body (the plum).

Question 7

When you are assessing a 9-month-old boy who had a fever for the past two days, which of the following assessment findings would most strongly suggest that the fever has caused dehydration?

Accepted Answer

The fact that the baby is wetting very few diapers suggests that he is not taking in enough fluids, indicating dehydration. The bulging of the anterior fontanelle, increased heart rate, and rapid respirations can also be signs of dehydration, but they are not as specific as decreased urine output.

Question 8

You have been asked to speak to a group of new mothers regarding the emergency treatment of a fever. During your presentation, one of the mothers asks you what temperature would cause a child to seize. Your response would be:

Accepted Answer

While a high fever can increase the risk of seizures in children, it is not a specific temperature that causes seizures. The rate at which the fever rises is a more important factor. It is important to monitor a child's fever and seek medical attention if it rises rapidly.

Question 9

Your partner informs you that the 3-year-old boy you have been called to care for is breathing 28 times per minute. As a knowledgeable EMT, you would recognize:

Accepted Answer

A respiratory rate of 28 breaths per minute is considered normal for a 3-year-old child. Pediatric respiratory rates vary significantly with age, and for toddlers, a range of 20-30 breaths per minute is typically normal.

Question 10

You have been called to a local day care for a sick child. On scene, panicked day care workers inform you that the 4-year-old child was lethargic all morning and wanted to sleep. After resting for several minutes, she began to "shake all over." This lasted for approximately 30 seconds. Your assessment reveals her to be responsive to painful stimuli and breathing adequately. Her airway is open and her radial pulse is strong and bounding. Her skin is hot and moist to the touch with no signs of cyanosis. You are told that she has no medical history. En route to the hospital, the patient's mental status improves. Based on this presentation and information, you assume that the seizure occurred secondary to:

Accepted Answer

The child's presentation, including lethargy, fever, and seizure activity, is consistent with febrile seizures, which are common in young children with fevers. This does not appear to be a hypoxic, hypoglycemic, or altered mental status-related event.

Question 11

Which of the following statements made by another EMT regarding treatment of the pediatric patient in the prehospital setting would you agree with?

Accepted Answer

Respiratory distress is a common cause of acute deterioration in pediatric patients and should be closely monitored and addressed. A thorough assessment of the patient's respiratory status is critical.

Answer: D 
 This statement is not accurate. Lights and sirens should only be used for pediatric patients in very specific situations, such as if there is an imminent threat to the patient's life or if transport time is significantly reduced. Otherwise, lights and sirens should not be used as they can cause further distress to the patient and increase the risk of accidents during transport.

Therefore, the correct answer is C.

Question 12

You have been called to a lower-income housing complex for a 4-year-old who is short of breath and has a fever. When assessing this patient, what technique would be best?

Accepted Answer

Determining the respiratory rate before laying hands on the child is crucial as it allows for an accurate assessment without causing the child distress, which could alter their breathing pattern.

Question 13

You are assessing a 6-year-old girl with possible pneumonia. She has labored breathing and a fever of 102°F. When you are assessing and classifying her respiratory status, which of the following signs would provide the strongest evidence that she is in decompensated or late respiratory failure?

Accepted Answer

Altered mental status is a late sign of respiratory failure and indicates that the body is not receiving enough oxygen. The other signs (respiratory rate of 36, fever of 102°F, nasal flaring) may indicate respiratory distress, but they do not provide as strong evidence of decompensation or late respiratory failure.

Question 14

On the scene of a medical emergency, you are directed to a 5-month-old baby in his crib. He responds to painful stimuli by whimpering and he is breathing at a rate of 50 breaths per minute. His airway is open and his brachial pulse is fast, weak, and difficult to locate. Assessment of his skin reveals it to be cool and pale in color. According to the mother, he has had vomiting and diarrhea for four days. She also reports that the father of the baby is a diabetic. Based on this information, the EMT would recognize what condition?

Accepted Answer

The symptoms described suggest the baby is in shock, likely due to severe dehydration and possibly sepsis from the vomiting and diarrhea. The weak, fast pulse and cool, pale skin are signs of inadequate circulation, and the fast breathing is likely due to the body's attempt to compensate for the low oxygen levels caused by poor circulation. The EMT should initiate treatment for shock, including supplemental oxygen, fluid resuscitation, and transport to a hospital for further evaluation and treatment. Hypoglycemia, cardiac arrest, and heart failure are less likely causes of the baby's symptoms based on the information provided.

Question 15

You have been summoned to a grocery store for a 6-year-old girl who has collapsed. On scene, you find the girl lying unresponsive on the floor. Quickly you open the airway and determine that she is not breathing. When you try to ventilate her with the bag-valve mask, you are unable to do so. Repositioning the head and reattempting ventilation is not successful in passing air into the lungs. Your next action would be to:

Accepted Answer

Since the patient is unresponsive and not breathing, the first step is to start CPR. Since ventilation via bag-valve mask is not successful, chest compressions should be started immediately. The obstructed airway can be dealt with later after the initial measures to maintain circulation have been taken. Therefore, administering 30 chest compressions is the best choice in this scenario.

Question 16

When providing care to the pediatric patient who has been injured or ill, the EMT must recognize that the most important aspect of care normally revolves around:

Accepted Answer

Airway and respiratory support are crucial in pediatric patients, who have smaller airways and are more prone to respiratory distress. Injuries or illnesses can quickly lead to respiratory failure in this patient population.

Question 17

An 8-year-old boy is unresponsive following the accidental ingestion of his father's high blood pressure medications. His airway is open and his breathing is labored and inadequate. The pulse rate is 56 beats per minute and his skin is cool and diaphoretic. Your partner states that his lungs have crackles in them and the blood pressure is 62/40 mmHg. Which of the following represents the most important care that you will provide to the patient?

Accepted Answer

The patient's inadequate breathing and low pulse rate indicate that the patient is in respiratory distress and possibly in shock. Positive pressure ventilation will help to increase oxygenation and assist the patient's breathing. Activated charcoal may be indicated to absorb any remaining medication in the stomach, but positive pressure ventilation takes priority in this situation. Determination of the exact medication taken is important for long-term treatment, but not an immediate priority in this critical situation. An oral airway and high-concentration oxygen may be necessary to support ventilation, but positive pressure ventilation is the best choice for this patient's current condition.

Question 18

You are caring for an 8-month-old boy who is unresponsive after choking on a piece of hard candy he managed to find. As you look into his mouth, you can see the candy in the back of his oropharynx. Your next action would be to:

Accepted Answer

Attempting to retrieve and remove the hard candy is the best next action. However, it is important to be careful not to push the object further down the airway. Abdominal thrusts (option A) may be necessary if the object cannot be removed or if the infant becomes unresponsive. Checking the brachial pulse (option C) is not helpful in this situation, as the issue is airway obstruction rather than a circulatory problem. Blind finger sweeps (option D) are not recommended because they may push the object further down the airway and cause further obstruction.

Question 19

Which of the following would be the most appropriate instructions to give to another EMT concerning the ventilation of an unresponsive and apneic 3-year-old boy?

Accepted Answer

The appropriate ventilation rate for a 3-year-old child is one breath every 3 seconds, which is equivalent to 20 breaths per minute. Option A is not appropriate as it exceeds the recommended ventilation rate. Option B is not accurate as each ventilation should be delivered over 1 second, not 2 seconds. Option D is not relevant to the question.

Question 20

After placing a small rock in her mouth, a 7-month-old girl begins to choke. You are on scene within minutes and find her unresponsive in her mother's arms. You attempt to provide ventilation with the bag-valve mask, but are unsuccessful. Your next action would be to:

Accepted Answer

If a child is unresponsive and you cannot ventilate, the next step is to start CPR, which includes chest compressions that may help dislodge the obstruction.

Quiz 38: Pediatrics