PEARS Pediatric Emergency Stabilization, Exams of Medicine

PEARS Pediatric Emergency Stabilization PEARS Pediatric Emergency Stabilization

Typology: Exams

2025/2026

Available from 01/28/2026

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PEARS Pediatric Emergency
Stabilization
Which pulses should be assessed to monitor systemic perfusion in
a child? - ANSWER-peripheral and central
What should the first rescuer arriving on the scene of an
unresponsive infant or child do? (in order) - ANSWER-1. verify
scene safety
2. check for responsiveness
3. shout for help
4. activate the emergency response system
Why may excessive ventilation during CPR be harmful? -
ANSWER-- it increases intrathoracic pressure
- it impedes venous return
If you cannot achieve effective ventilation (ie, the chest does not
rise), do the following: - ANSWER-- reposition/reopen the airway
(sniffing position)
- verify mask size and ensure a tight face-mask seal
- suction the airway if needed
- check the O2 source
- check the ventilation bag and mask
- treat gastric inflation (NG/OG)
- consider 2-person bag-mask ventilation and inserting an OPA
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PEARS Pediatric Emergency

Stabilization

Which pulses should be assessed to monitor systemic perfusion in

a child? - ANSWER -peripheral and central

What should the first rescuer arriving on the scene of an

unresponsive infant or child do? (in order) - ANSWER -1. verify

scene safety

  1. check for responsiveness
  2. shout for help
  3. activate the emergency response system Why may excessive ventilation during CPR be harmful? -

ANSWER -- it increases intrathoracic pressure

  • it impedes venous return If you cannot achieve effective ventilation (ie, the chest does not

rise), do the following: - ANSWER -- reposition/reopen the airway

(sniffing position)

  • verify mask size and ensure a tight face-mask seal
  • suction the airway if needed
  • check the O2 source
  • check the ventilation bag and mask
  • treat gastric inflation (NG/OG)
  • consider 2-person bag-mask ventilation and inserting an OPA

Ventilation rate - ANSWER -1 breath every 2-3 seconds

delivered over 1 second (20-30 breaths per minute)

Early signs of tissue hypoxia - ANSWER -- tachypnea

  • increased respiratory effort (nasal flaring, retractions)
  • tachycardia
  • pallor, mottling, cyanosis
  • agitation, anxiety, irritability

Late signs of tissue hypoxia - ANSWER -- bradypnea, inadequate

respiratory effort, apnea

  • increased respiratory effort (head bobbing, seesaw respirations, grunting)
  • bradycardia
  • pallor, mottling, cyanosis
  • decreased level of consciousness What is the role of the diaphragm during normal breathing in

infants? - ANSWER -pulls the ribs slightly inward

S/S mild respiratory distress - ANSWER -- mild tachypnea

  • mild increase in respiratory effort (nasal flaring, retractions)
  • abnormal airway sounds (stridor, wheezing, grunting)

S/S Severe respiratory distress - ANSWER -- marked tachypnea

  • marked increase in respiratory effort
  • single rescuer (30:2)
  • two rescuer (15:2) How should 1-rescurer child compressions be delivered? -

ANSWER -either one or two hands

  • compress at least 1/3 the chest diameter (approximately 2 inches) Guidelines for rescue breathing for infants and children -

ANSWER -- give 1 breath every 2-3 seconds (about 20-30/min)

  • given each breath in 1 second
  • visible chest rise
  • check pulse every 2 minutes
  • use oxygen as soon as it is available 2-person bag mask ventilation may be necessary when: -

ANSWER -- making a seal is difficult

  • the provider's hands are too small
  • significant airway resistance (asthma) or poor lung compliance)
  • restricting spinal motion is necessary

Best position to maintain an open airway - ANSWER -- infant:

place padding underneath shoulders

  • child: place padding underneath occiput

Evaluate-Identify-Intervene Sequence - ANSWER -evaluate

(primary assessment, secondary assessment, diagnostic assessment)

Evaluate - Primary Assessment - ANSWER -a rapid hands-on

ABCDE approach to evaluate respiratory, cardiac, and neurologic function; includes assessment of vital signs and pulse ox

Evaluate - Secondary Assessment - ANSWER -a focused medical

history and focused physical exam

Evaluate - Diagnostic Assessment - ANSWER -laboratory,

radiographic, and other advanced tests that help to identify the child's physiologic condition and diagnosis The evaluate-identify-intervene sequence should be continued

until - ANSWER -the child is stable

Flow rate for pediatric nebulizer - ANSWER -5-6 L/min

Causes of upper airway obstruction - ANSWER -- foreign body

aspiration

  • airway swelling (anaphylaxis, tonsillar hypertrophy, coup, epiglottitis)
  • masses
  • thick secretion
  • congenital airway abnormality
  • frequent barking cough
  • easily audible stridor at rest
  • retractions at rest
  • little or no agitation
  • good air entry in the peripheral lung fields treatment:
  • administer humidified O
  • NPO
  • administer nebulized epinephrine (observe for 2 hours after)
  • administer dexamethasone
  • consider using heliox

Severe Croup - ANSWER -S/S:

  • frequent barking cough
  • prominent inspiratory and occasional expiratory stridor
  • marked retractions
  • significant agitation
  • decreased air entry by auscultating the lungs treatment:
  • administer humidified O
  • NPO
  • administer nebulized epinephrine (observe for 2 hours after)
  • administer dexamethasone
  • consider using heliox

Severe Croup Treatment - ANSWER -- administer high

concentration of O2 (nonrebreather)

  • administer dexamethasone
  • provide assisted ventilation
  • perform ET intubation (use a half size smaller than predicted for the childs age ET tube)
  • prepare for surgical airway if needed

Mild allergic reaction interventions - ANSWER -- remove the

offending agent

  • get help
  • ask the child/caregiver about history of allergy
  • look for a medical alert bracelet or necklace
  • consider an oral dose of antihistamine

Moderate to severe allergic reaction interventions - ANSWER --

administer IM epinephrine every 10-15 minutes as needed, repeat doses as needed

  • treat bronchospasm (wheezing) with albuterol MDI or neb
  • give continuous nebulization if indicated
  • for severe respiratory distress anticipate airway spelling and prepare for intubation to treat hypotension:
  • place supine

treatment:

  • administer humidified O
  • administer MDI or neb albuterol
  • administer oral corticosteroids

Severe Asthma - ANSWER -S/S:

  • talks in single words
  • usually agitated
  • accessory muscle use and retractions
  • usually loud wheezing
  • pulse >
  • pulsus paradoxus often present
  • SpO2 on room air <90% treatment:
  • administer O
  • administer albuterol MID or neb
  • administer ipratropium neb
  • administer IV/PO corticosteroids
  • consider mag bolus over 15-30min

Asthma progressing to imminent respiratory arrest - ANSWER -

S/S:

  • drowsy or confused
  • paradoxical thoracoabdominal movement
  • absence of wheeze
  • bradycardia
  • respiratory muscle fatigue treatment:
  • admin O
  • continuous albuterol neb
  • IV corticosteroid
  • terbutaline
  • bilevel positive airway pressure
  • intubate for refractory hypoxemia and worsening clinical condition

Lung Tissue Disease - ANSWER -- involves the parenchyma or

tissue of the lung

  • the lungs become stiff because of fluid accumulation in the alveoli and or interstitium causes:
  • pneumonia
  • pulmonary contusion (trauma)
  • allergic reaction
  • toxins
  • vasculitis
  • infiltrative disease