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AIR METHODS PEDIATRICS CRITICAL CARE
REVIEW EXAM QUESTIONS
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Q&A
You have arrived on the scene to transport a pediatric trauma patient. The patient has an obvious deformity to the left forearm. The parents are present and state that the child fell off the backyard swing after swinging too high and sustained a broken forearm. As a medical provider you understand this: this is likely a non-accidental trauma this is consistent with accidental trauma this is likely parental abuse this is consistent with possible underlying bone disease - ANSWER: This is likely non-accidental trauma. Non-accidental traumatic arm fractures is among the pediatric population are typically in the upper arms. Forum trauma is more common among active pediatrics rather than abuse, and this is not isolated to patients with underlying bone disease A pediatric patient has just informed you that they have been sexually assaulted. The patient is covered in blood, but there are no apparent injuries. You should: Clean up all blood before transporting Gather any additional possible evidence to transport with a patient Only clean away the blood necessary for physical assessment
Avoid covering the patient - ANSWER: Only clean away the blood that is necessary for physical assessment. any potential evidence should be left as undisturbed as possible for a collection in a controlled environment with the appropriate collection methods by train to professional. Potential evidence should be disturbed to the extent needed to provide appropriate medical care, including assessment. In this case the blood could be evidence without any source of bleeding on the patient. patients should be covered as necessary for transport. Which assessment is most reliable as an indicator of adequate fluid resuscitation in a severely burned pediatric patient? Increased fluid noted weeping from the burn. Your an output of 1.4 mL/kg/hr Skin turgor noted to be tenting ABG base deficit/excess changes from -6 to 0 - ANSWER: Urine output of 1. mL/kg/hr Increase loss of fluid from weeping from the burn is an indication of further fluid loss must be taken into consideration when evaluating the patient's food status. Appropriate urine output that indicates adequate fluid resuscitation on a pediatric burn patient is one to 1-1.5 mL/kg/hr. Your an output that is below this threshold may indicate the need for additional fluid bolus. Based deficit/excess may improve with increasing fluid resuscitation but is not feasible in transport environment and is not gold standard for evaluating fluid resuscitation. Flight team responds to a local emergency department for four-year-old male patient.. During report the clinician tells you that they have diagnosis of Epiglottitis. You know the main symptoms of epiglottitis are what?
Place the nasal gastric tube Administer a weight appropriate dose of analgesia - ANSWER: Place a nasogastric tube He is diagnosed with a diaphragmatic rupture, indicating that his abdominal contents protrude into his chest cavity. The placement of the chest tube would not alleviate this issue and it would likely cause injury to the intestines. Therefore, chest tube should be avoided in the diaphragmatic rupture patient until the damage is repaired. While energies is important in the patient with a traumatic injury on a ventilator, decompression of the bowel is priority to prevent further distention of the abdominal contents, which is likely the cause of further cardiorespiratory compromise Trauma is the leading cause of death in pediatric patients over the age of one year old in the United States. The flight condition understands that the leading mechanism of mortality and severe injury in the pediatric patient is which of the following? Abuse and neglect penetrating injuries burn injuries motor vehicle accidents - ANSWER: Motor Vehicle Accidents Well if you send neglect are a mechanism of mortality and severe injury, it is not the leading cause. Head injuries typically cause mortality from abuse and neglect injuries. Motor vehicle accidents are the leading cause of death and severe injury in pediatric patients greater than one year of age
A transport condition is caring for a two year old pediatric patient with a blood pressure of 80/40 mmHg, a heart rate of 140 beats/min, respiration rate of 38, an oxygen saturation of 95% on nonrebreather mask. The patient is fussy, skin is flushed with uticaria, and audible wheezing is noted. You also note what appears to bee sting on the patient's arm. The clinician should expect what type of shock? - ANSWER: Distributive shock The patient presents iwth an anaphylactic shock, a type of distributive shock. Uticaria all over the skin, audible wheezing, and a bee sting should clue you in on the type of shock Pediatric trauma patients of all ages need packed red blood cells due to hypokalemia. What is the weight-based dosage for a 1 year old child? - ANSWER: 20mL/kg Children under 4 months: 10mL/kg Children 4 months and older: 10-20mL/kg You are called for a six year old male riding in the vehicles backseat wearing a seatbelt when the car struck a tree. Which of the following injuries is most common due to seatbelt sign (syndrome)? A hollow abdominal organ Injury a solid abdominal organ Injury a spinal cord Injury pelvic injury - ANSWER: A hollow abdominal organ injury
management of heart failure but not as effective in cereal measurements as a prognostic favor. In addition, this value does not indicate tissue perfusion or organ perfusion. A pH < 7.3 should indicate signs of acidosis or DKA. You were transporting a four-year-old pediatric patient with a history of hypoplastic left heart syndrome. As a medical provider you should: only rely on medical records for specific patient information. Assess the patient and rely on sound of clinical judgment. Request detailed information from the parents on scene. Ask the patient for information. - ANSWER: Request detailed information from the parents on scene. Parents are often the best source of information that can go to medical providers in their care of the patient, and they should be as involved as possible during care. Medical records may not be available. In addition, patients with specific medical problems may respond adversity to treatments based on their presentation, which could be avoided with accurate information from a parent. You're Kultura facility for five year old patient complaining of high fever, sore throat, noisy breathing, and an inability to tolerate secretions. Your primary goal after your rapid assessment should be: obtain IV access in intubate. Administer racemic epi Lay the tile down and secure to transport cot. Maintain a position of comfort and do not agitate. - ANSWER: Maintain a position of comfort and do not agitate.
Trying to get IV access can further agitate and upset the patient making the patient worse and requiring intubation. Racemic epi-is a bronchodilator that contemporarily relieve chest tightness, shortness of breath, and upper respiratory infection. I forgot Titus is a bacterial infection, and the patient may get anxious and agitated while receiving the treatment. Lang the child down can cause a complete obstruction requiring immediate airway protection and difficult intubation. Placing the patient in a position of comfort without further agitation is the key to providing care. Have suction or a towel available for secretions. Unseen, a two year old is unconscious secondary to a foreign body aspiration. Using a laryngoscope to transport nurse notes a coin below the glottis. The critical care clinician should: Use the ET tube to push the coin into the bronchus. Place the oropharyngeal airway and ventilate the patient. Use Magill forceps to remove the coin. Immediately perform a cricothyrotomy - ANSWER: Use Magill forceps to remove the coin. The flight clinician should use Magill forceps to remove the foreign body. As a foreign body can be visualized by laryngoscope, then attempt to remove it should be made. The other options are to be tried after this attempt. You are caring for a 13 year-old patient with a long-term tracheostomy and a fever and chest congestion for several days. The patient began having respiratory distress that progressed into respiratory arrest. A local EMS provider has deep suction to the tracheostomy and is providing ventilation's with a bag valve mask but is reporting poor chest rise and an SPO that is not rising above 80%.
epiglottitis RSV bronchiolitis - ANSWER: Croup A steeple sign on an anterior chest x-ray is indicative of croup. In epiglottitis, you will see what resembles a thumb on an x-ray. RSV is identified through lab testing, not x-ray. Tests or X-rays do not identify bronchiolitis. A three year old mail is being transferred to a pediatric intensive care unit with rib fractures due to a motor vehicle collision. Which of the following is accurate? The size of the thoracic cavity in pediatric patients make a rib fractures relatively common. It only takes a small amount of force to cause a rib fracture. Positive pressure ventilation may worsen the patient's condition and should be avoided. Pain with breathing is more severe on inspiration than it is on expiration. - ANSWER: Pain with breathing is more severe on inspiration that it is on expiration The patient's thoracic cavity size does not correlate with the risk of bread factors. It takes a significant force to cause rib fractures in a normal pediatric patient. Pediatric ribs are more flexible and take greater power to fracture. Positive pressure ventilation does not worsen condition and may be necessary to provide adequate ventilation to the patient. Pain is more severe during inspiration. This is essentially a result of the use of intercostal muscles during the act of inspiration. However, during expiration, the pain is less since expiration is mostly passive and results from muscle relaxation. You were caring for a pediatric patient on scene with an extensive congenital cardiac history that experienced an episode of unresponsiveness and cyanosis. The
patient's parents state that the child specialist are located at a children's hospital that is 45 minute flight away. There is another Children's Hospital that is a 15 minute flight away. The child is currently stable and in no distress. Given the situation, you should tell the parents: Their child should be transported to the nearest children's hospital. Their child should be transported to the children's hospital, where their specialist is located. Their child should be transported to a local emergency department that is five minutes away. Their child is now stable and should not be transported. - ANSWER: Their child should be transported to the children's hospital, where their specialist is located. Typically, pediatric patients with extensive medical history should be transported to their specialty facility unless an emergent problem is present that needs stabilization. You are ready to intubate a 10 month old child. To avoid vagal-mediated bradycardia, what medication would you administer? Epinepherine 0.01 mg/kg Rocuronium 0.6g/kg Etomidate 0.3 mg/kg Atrophine 0.02 mg/kg - ANSWER: Atropine 0.02 mg/kg Epinepherine dose is used for cardiac arrest. Eppinette friend is not used for RSA or induction. Rock Aronian is used for intubation but for paralysis. It is not used to blunt bradycardia. Tami Oday is used for intubation but for Saturday purposes. It is not used to blunt bradycardia. Atropine is the correct answer, it enhances sinus node automaticity and AV conduction
Obtain a blood glucose. Initiate oxygen therapy. - ANSWER: Initiate oxygen therapy The patient may need fluids for tachypnea and fever, but oxygen needs to be addressed first This bacterial infection of the supraglottic larynx is rare and potentially life- threatening. It is characterized by dwelling of the structure, strider, drooling, fever, and the inability to maintain secretions. A real airway emergency is also known as: Tonsillitis Croup Epiglottitis RSV - ANSWER: Epiglottitis. Tonsillitis is a viral infection and inflammation of the tonsils. Croup is an upper airway viral infection with low-grade fever, barky cough, and some stridor. Epiglottitis is rare bacterial infection involving the swelling of the supraglottic larynx and is accompanied by strider, fever, and inability to maintain secretions. RSV is a common respiratory virus with cold like symptoms that can progressed into severe lung infections You are assessing your seven-year-old asthma patient. He has gone from speaking into word sentences, being to tachycardic and tachypneic, to lethargic, bradycardic, and apneic. Your patient has progressed into: A cardiac arrhythmia.
Respiratory arrest. Cardiac arrest. Respiratory failure. - ANSWER: Respiratory failure Cardiac arrhythmia is the improper beating of the heart, to Sloan, too fast, or a regular. Respiratory arrest is the cessation of breathing completely. Cardiac arrest is when the heart stopped beating and no longer provides oxygen rich blood throughout the body. Respiratory failure is an adequate breathing due to hypoxia, carbon dioxide build up, and respiratory muscle fatigue. An airway disease characterized by bronchospasms, airway constriction, obstruction, and airway inflammation with increased mucus production in the lungs is called: Pneumonia. RSV. Bronchiolitis. Asthma. - ANSWER: Asthma Pneumonia can be a viral or bacterial with non-specific clinical signs but can be present with some symptoms of lung disease. RSV is a common respiratory virus with cold like symptoms that can regress into severe lung infection. Asthma is a chronic disease in children that involves airway inflammation, intermittent and resolvable airway obstruction, and bronchoconstriction Your patient presents with a cough, wheezing, chest tightness, and dyspnea. The patient has an oxygen saturation of 92% and is tachypneic and tachycardic. What is your treatment plan?
loss. Passive rewarming can occur without any advanced equipment. All patients should be assessed in necessary care provided before rapidly transporting. There is no mention of the local hospital as the most appropriate. A five-year-old male has sustained blunt trauma to the chest after being struck by a car. The patient has difficulty breathing, no lung sounds on the left side, and it is decreasing pulse. The flight crew is preparing to perform a needle decompression. The flight crew explains to the ground EMS team that the preferred site for a needle decompression or a pediatric patient is: Between the second and third rib at the midclavicular line on the left chest. In the third intercostal space at the midclavicular line on the left chest. Directly under the nipple on the left side of the chest. In the fourth intercostal space at the anterior axillary line on the left chest. - ANSWER: Between the 2nd and 3rd rib at the mid-clavicular line on the left chest Recommended safe needle decompression sites for all ages of patience include the second intercostal space between the second and third rib at the midclavicular line and the fifth intercostal space between the fourth and fifth rib anterior mid-axillary line on the afffected side In children younger than three this structure is large and floppy. Utilizing a straight blade, such as a Miller blade, is often more effective in getting an optimal due for direct laryngoscopy? The epiglottis. The tongue. The larynx.
The vocal cords. - ANSWER: The epiglottis The epiglottis is large and floppy. It can be manipulated better with the straight blade during intubation. The tongue is also large and floppy. It is not generally in view while intubating. The larynx is not large, floppy, or in view while intubating. The vocal cords are not large and floppy. This common upper respiratory infection is predominantly seen in the pediatric population during cooler months. Characteristics of this infection include inspiratory stridor, low-grade fever, nasal flaring, and barky cough. What is the name of the infection based on the information provided? Pneumonia Croup RSV Epiglottitis - ANSWER: Croup Pneumonia can be viral or bacterial with nonspecific clinical signs but can be present with symptoms of lung disease. Croup is an upper respiratory airway viral infection with low-grade fever, barky cough, and some stridor. RSV is common respiratory virus with cold like symptoms that can progressing to severe lung infection. Epiglottitis is a rare bacterial infection involving swelling of the supraglottic larynx and is accompanied by strider, fever, and inability to maintain secretions. You are assessing a 10 month old with previous diagnosis of RSV five days ago. The patient was brought in today for a two day history of cough. Low-grade fever, congestion, and wheezing that started today.
Tracheomalacia Bronchiolitis - ANSWER: Epiglottitis Primary indications of epiglottitis include sore throat, difficulty swallowing, drooling, dyspnea, and tripod positioning. In addition, epiglottitis is commonly caused by influenza B. Diagnostically these conditions may present with the thumbprint sign showing an enlarged soft tissue on XR. Remember, keep these patients calm, avoid stressful procedures, anticipate a difficult airway, use the most experienced airway clinician, and have an ET tube 0.5 to 1.0 mm smaller prepared. Tracheomalacia involves the collapse of the trachea on itself during inspiration. This condition is detected just after birth within three months after.. You arrive at a small critical access hospital to transport a 10 year old 68 pound male that fell from a cliff stroking his head neck and upper body. During the report the flight nurse reviews the lab results and notes following values: Na 112mEq/L, serum osmolarity 580mOsm/kg, and urine output of 700 mL in the past hour. The critical care for clinician should expect to administer which of the following medications:
- mannitol
- dopamine -lactated ringers -vasopressin - ANSWER: Vasopressin
The patient's diabetes insipidus is likely caused by severe head trauma; administration of a osmotic diuretic will only worsen the patient's condition. There is no indication for dopamine. Administration may assist in replacing the fluids loss but will not replace the sodium lost. Therefore it will not correct diabetes insipidus. Vasopressin is a synthetic form of an antidiuretic hormone. The central issue in diabetes insipidus is insufficient secretion of ADH or failure of the kidneys to respond to ADH. Replacement of ADH will allow the kid needs to concentrate urine and decrease the loss of electrolytes. You are called to transport a 16-year-old that was involved in an SUV rollover accident after drinking with her friends. Her injuries include a fractured pelvis, a large laceration to her left lower leg with controlled bleeding, a head injury, a tension pneumothorax, and a left femur fracture. Which injury is immediate life- threatening and requires immediate intervention? - ANSWER: Tension pneumothorax While a pelvic fracture is a critical injury that may result in severe blood loss, I'm more serious immediate option was provided. A large laceration may result in bleeding resulting in decompensation. However, bleeding is controlled at this time, and attention pneumothorax will rapidly result in death. An unrestrained four-year-old was in the front seat passenger of a vehicle that struck another vehicle traveling approximately 30 mph. The child was found in the front seat floor board and is suspected to have struck the dashboard. EMS transports the child to a rural County Hospital. Upon arrival at the bedside, the flight clinician reviewed the chest x-ray identifying an abnormality in the right mainstem bronchus. Based on the chest x-ray findings which would be the suspected injury?
