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CPEN COMPREHENSIVE STUDY
GUIDE
when assessing the capillary refill of a child 5 years old or younger - ANSWERS-peripheral perfusion is considered satisfactory if the color returns in less than 2 seconds. Loss of Consciousness - ANSWERS-is not a sign of a mild airway obstruction in an infant or child. It is a sign of severe respiratory distress. A child with a severe airway obstruction or severe partial one - ANSWERS-cannot cry and is moving very little air. The cough becomes ineffective. Hypoxia - ANSWERS-Slows heart rate and alters mental status for infants or a children. BSI/PPE - ANSWERS-Always Use the Proper Infection Control Barriers even when Ventilating infants and children. Guidelines to use when Ventilating Infants and Children - ANSWERS-Include avoiding breathing too hard through the pocket mask or using excessive bag pressure and volume, and use properly sized masks to ensure a good mask seal. Also remember that, if ventilation is not successful in raising the patients chest, perform
procedures for clearing an obstructed airway, then try to ventilate again. The Flow-restricted, Oxygen-powered Ventilation device - ANSWERS-is contraindicated in infants and children. Common Causes of shock in a child - ANSWERS-Include Infection, trauma, Blood loss, and Dehydration. Croup - ANSWERS-Is not a cause of shock. Less common causes of shock in a child - ANSWERS-Include: Allergic Reactions, Poisoning, and Cardiac events (rare) is Approximately 8% of the total body weight - ANSWERS-The Blood Volume of Infants and children Children in Shock - ANSWERS-Compensate well, appear better than they actually are. Decompensate very rapidly, go sour quickly. When child is Bleeding Internally - ANSWERS-Avoid waiting for signs of decompensated shock before treating for shock. At this point the Child has lost 30% Blood Loss.
Always attempt to communicate with the older patient first - ANSWERS-rather than assuming the patient will give an unreliable history and asking others about the patient. Do not assume that confusion is caused by dementia unless someone else who knows the patient can confirm this is a chronic condition. Make sure the patient can see and hear you. - ANSWERS-Speaking loudly, slowly, or very clearly to a patient does not mean speaking down to a patient. Treat the patient with respect and dignity. Begin by calling the patient by a title and last name (for example, "Mrs. Sanchez"). Ask the patient how she would like to be addressed before assuming that you may use her first name. Whenever possible, speak to the patient at eye level. This may involve crouching or even kneeling. History and Assessment of Older Adult Patient - ANSWERS-Assessment of an older patient is very similar to the typical patient assessment; however, EMTs must account for particular issues associated with aging. Scene Size-up and Safety - ANSWERS-Look inside and outside residence for clues to physical and mental abilities Condition of residence Half-eaten food House dirty or clean Items left out that patient can trip on
Primary Assessment - ANSWERS-General impression Mental status Airway Breathing Circulation General impression. What is the level of distress? Mental status. This can be challenging because some older people have abnormal mental status as part of their baseline condition. Airway. You may find it difficult to extend or flex the neck due to arthritic bone changes. Also consider dentures. Breathing. Elderly are at risk for FBAO: two major risks are poorly chewed food and dentures. Circulation. Finding a radial pulse is usually no different than for other patients; however, the pulse is often irregular. because children have a large skin surface area - ANSWERS-in proportion to their body mass, they can easily become victims of hypothermia Avoid inserting a tongue blade into the mouth of a child that has an airway respiratory disease - ANSWERS-it could stimulate a Laryngospasm. Administering blow-by oxygen is an appropriate action. Stridor on inspiration - ANSWERS-is an upper airway problem. Signs of an Airway Disease in a child - ANSWERS-Include Breathing effort on exhalation, rapid breathing, and wheezing.
Adolescent: 12 - 18 years Normal pulse rate ranges - ANSWERS-kids are born with a pulse of - 140bpm; take 20 for each age group as they age to get approximate normal; Pediatric pulse rates Newborns: 120 - 160/minute toddler/preschool; 120 school age ; Adolescents: 60 - 105/minute Normal respiration rate ranges - ANSWERS-kids are born with a respiratory rate of - 40per minute. take away 10 for each age group as they get to approximate normal. From 30 - 50/minute in newborns 30 - 40 toddler/preschool; 20 - 30school age 12 - 20/minute in adolescents Normal blood pressure ranges - ANSWERS-50th% (90 + 2xage) 5% (70+2x age) average 99/65 in preschoolers to average 114/76 in adolescents.
Consider a Child's head size - ANSWERS-A child's head is proportionately larger than an adult's until age 4. Because of this, children often fall head first. As a result you should suspect head injury whenever there is a serious MOI. Up to 12-18 months infants will have a soft spot just to the anterior center of the skull called the anterior fontanelle. A sunken fontanelle may indicate dehydration and a bulging fontanelle may indicate elevated intercranial pressure. Pediatric Assessment Triangle (PAT) - ANSWERS-is a method of pediatric assessment from two viewpoints. The first is the general impression formed as you approach the child, often referred to as an assessment "from the doorway." The second is the impression based on the remainder of the primary assessment that is done next to the patient. Each of the three sides of the triangle represents a different patient presentation that should be evaluated:
- Appearance
- Work of breathing
- Circulation to skin Appearance - ANSWERS-For the first side of the triangle, look at the patient's appearance. Consider the child's mental status using the "AV" part of AVPU (alertness, verbal response). Is the child acting appropriately? How is the patient's muscle tone and general interactiveness? Is the child consolable by a parent or caregiver? Is his look or gaze and speech or cry appropriate? For appearance, you look at mental status us- ing the "PU" part of AVPU (response to pain or unresponsiveness).
Epiglottitis - ANSWERS-Caused by a bacterial infection that produces swelling of the epiglottis and partial airway obstruction. Should be suspected in any child with stridor. Fever - ANSWERS-An illness usually accompanied by infections. Above-normal body temperature is one of the most important signs of an existing acute illness. Fontanelle - ANSWERS-A soft spot on an infant's anterior scalp formed by the joining of not yet fused bones of the skull. Sunken: may indicate dehydration. Bulging: May indicate elevated intracranial pressure. Forms of Child Abuse - ANSWERS-Psychological (emotional) abuse, Neglect, Physical Abuse, Sexual Abuse Gastronomy Tubes - ANSWERS-Tubes placed through the abdominal wall directly into the stomach, used when a patient is not able to be orally fed. Hyperextension/Flexion of the Neck - ANSWERS-Tipping the head too far back or letting it fall forward. Infant - ANSWERS-Birth to 1 year of age. Lower Airway - ANSWERS-Begins at the opening of the trachea and ends at the alveoli. Common disorders affect the large and small
bronchiole tubes and the alveoli themselves. Common disorders include asthma, pneumonia, and other respiratory infections. Typically cause difficulty breathing/wheezing lung sounds. Meningitis - ANSWERS-Potentially life-threatening infection of the lining of the brain and spinal cord (the meninges) Commonly seen in children 1 month to 5 years old. Neglect - ANSWERS-The failure of a caretaker to provide for basic needs, such as food, clothing, or love. Pediatric Assessment Triangle (PAT) - ANSWERS-Method of pediatric assessment from both the general impression formed as you approach the child ("from the doorway") and from the remainder of the primary assessment. Triangle made up of appearance, work of breathing, and the circulation to skin. Pediatric - ANSWERS-Of or pertaining to a patient who has yet to reach puberty. Physical Abuse - ANSWERS-Abuse causing physical damage to the victim. Preschool - ANSWERS- 3 to 6 years of age.
In children and infants, their tongues are proportionally larger than the tongue of an adult. What is the potential impact on assessment and care? - ANSWERS-tongue is more likely to partially obstruct the airway Children and infants have smaller airway structures, which could result in..... - ANSWERS-the airway being more easily blocked. The abundant secretions in children and infants can cause... - ANSWERS-a blocked airway Decidous (baby) teeth in children and infants can be... - ANSWERS- easily dislodged, which could block the airway Children and infants have a flat nose and face, which makes it difficult to... - ANSWERS-obtain a good face mask seal The head of a child is heavier relative to body and less-developed neck structures and muscles. What is the potential impact on assessment and care? - ANSWERS-Head may be propelled more forcefully than the body, creating a higher incidence of head injury Infants and some children have fontanelle and open structures (soft spots) palpable on top of their head. What is the significance of both a sunken and bulging fontanelle? - ANSWERS-Bulging fontanelle can be a sign of intracranial pressure.
Sunken fontanelle may indicate dehydration Since children and infants have a thinner, softer brain tissue, they are more susceptible to....... - ANSWERS-serious brain trauma What are the hazards of the children's/infant's head being so large in proportion to their bodies? - ANSWERS-Head tips forward when supine, causing flexion of the neck, making neutral alignment of spine and airway difficult The shorter, narrower, and more elastic trachea can result in : - ANSWERS-the trachea closing off with hyperextension of the neck The children/infant's short neck makes it difficult to... - ANSWERS- stabilize or immobilize What type of breathers are children and infants, and what does it mean? - ANSWERS-They are abdominal breathers. they depend on their diaphragm for breathing which makes it difficult to evaluate What is the significance of children/infant's faster respiratory rate? - ANSWERS-muscles easily fatigue or get tired, causing respiratory distress Newborns/Infants are typically nose breathers. What is the danger in this? - ANSWERS-Nasal obstruction can impair breathing
Normal pulse rate for an adolescent 13 - 18 years - ANSWERS- 60 - 105 Normal respiration rate for a newborn - ANSWERS- 30 - 50 Normal respiration rate for an infant 0 - 5 months - ANSWERS- 25 - 40 Normal respiration rate for an infant 6 - 12 months - ANSWERS- 20 - 30 Normal respiration rate for a toddler 1 - 3 years - ANSWERS- 20 - 30 Normal respiration rate for a preschooler 3 - 5 years - ANSWERS- 20 - 30 Normal respiration rate for a school aged child 6 - 12 years - ANSWERS- 15 - 30 Normal respiration rate for adolescent 13 - 18 years - ANSWERS- 12 - 20 Normal blood pressure for preschoolers 3 - 5 - ANSWERS-Systolic: avg 99 Diastolic: avg 65 Normal blood pressure for school age 6 - 12 years - ANSWERS- Systolic: avg 105 Diastolic: avg 69
Normal blood pressure for adolescent 13 - 18 years - ANSWERS- Systolic: avg 114 Diastolic: avg 76 What three things make up the Pediatric Assessment Triangle (PAT) - ANSWERS-appearance, work of breathing, and circulation to the skin "Blow-By" Technique - ANSWERS-Holding, or having a parent hold, the oxygen tubing or the pediatric nonrebreather mask 2 inches from the patient's face so that the oxygen will pass over the face and be inhaled. Typically used for infants and children that fear the oxygen mask. Adolescent - ANSWERS- 12 to 18 years of age. Child - ANSWERS- 1 year of age to puberty. Croup - ANSWERS-Caused by a group of viral illnesses that result in inflammation of the larynx, trachea, and bronchi. Tissues in the airway (typically upper airway) become swollen and restrict the passage of air. Commonly seen in children 6 months to 4 years old. Epiglottitis - ANSWERS-Caused by a bacterial infection that produces swelling of the epiglottis and partial airway obstruction. Should be suspected in any child with stridor.
Meningitis - ANSWERS-Potentially life-threatening infection of the lining of the brain and spinal cord (the meninges) Commonly seen in children 1 month to 5 years old. Neglect - ANSWERS-The failure of a caretaker to provide for basic needs, such as food, clothing, or love. Pediatric Assessment Triangle (PAT) - ANSWERS-Method of pediatric assessment from both the general impression formed as you approach the child ("from the doorway") and from the remainder of the primary assessment. Triangle made up of appearance, work of breathing, and the circulation to skin. Pediatric - ANSWERS-Of or pertaining to a patient who has yet to reach puberty. Physical Abuse - ANSWERS-Abuse causing physical damage to the victim. Preschool - ANSWERS- 3 to 6 years of age. Psychological Abuse - ANSWERS-Emotionally harming a person by threatening, scaring, humiliating, intimidating, isolating, insulting, or treating him or her as a child; also includes verbal abuse.
Retractions - ANSWERS-Pulling in of the skin and soft tissue between the ribs when breathing. This is typically a sign of respiratory distress in the child. School Age - ANSWERS- 6 to 12 years of age. Seizures - ANSWERS-A sudden change in sensation, behavior, or movement. Most commonly caused by a feven in infants and children. Sexual Abuse - ANSWERS-Ranges from adults exposing themselves to children to sexual intercourse or sexual torture. Often accompanied by physical or emotional injury. Shunt - ANSWERS-A drainage device that runs from the brain to the abdomen to relieve excess cerebrospinal fluid. Reservoirs will be on either side of the skull. Toddlers - ANSWERS- 1 to 3 years of age. Upper Airway - ANSWERS-Starts at the mouth and nose and ends at the trachea. Common disorders affecting this area include foreign body obstructions, trauma, and swelling from burns and infections. (Commonly identified by stridor or difficulty breathing) Placed patient on side - ANSWERS-If the patient has no possibility of spinal injury
