ob/gyn and pediatrics quizlet
paramedic fisdap quizlet
trauma fisdap quizlet
apgar score
which of the following are classic signs of preeclampsia?
hypertension, proteinuria, and visions changes
Braxton-hicks contractions
occur in the second trimester and are false labor.
a 4 year old male slammed his right hand in a door. His index finger is completely severed, and his middle finger is hanging by flap of skin. What should you do?
apply a dressing over the partially amputated finger
what size endotracheal tubes is generally used when orally intubating a full term newborn?
3:0-3.5 mm tube
A restrained 23 years old pregnant female in her third semester, was involved in a head-on motor vehicle collision. She is complaining of abdominal pain. Initials vitals sign B\P 110/70, P90, and R20. After rapid extrication and spinal immobilization via long spine board. Her vital signs B/P 90/40, P110, and R28. What is the most likely explanation for her changes in vital signs?
supine hypotension syndrome
A ten year old patient stops talking and stares straight ahead. He is unresponsive for about 15 seconds. Which of the following conditions is most likely?
petit mal seizure absent Seizure
a newborn has just delivered. He is limp and apneic. What should you do?
dry him and suction the airway as needed
a 22 year old female, primigravida, with no prenatal care, has just delivered a healthy baby, now she begins to have forceful contractions and to push. Additional amniotic fluid expelled. You should
rapid transport to the patient and neonate
A 23 year old pregnant female is in her third trimester. She complains of painless, bright red vaginal bleeding. What should you do?
prepare for transport and obtain IV access
a mother tells you her four year old boy has had cold-like symptoms for several days and now has developed trouble breathing and a barking cough. You should
administer nebulized epinephrine
how many and what types of blood vessels are in the umbilical cord?
two arteries and one vein
a unresponsive two months old infant has had a runny nose, slight fever, diarrhea, and decreased appetite for the past three days. The child whimpers to painful stimuli, is breathing 50R, has a weak brachial P180, and his fontanelle is sunken. You should suspect.
dehydration
an unresponsive 4 month female has had diarrhea for 3 days. She has sunken anterior fontanelle and skin tenting. Vitals signs are P188, R46, capillary refill 5 seconds. What should you do?
Administer 20 mL/kg saline bolus
A 24 year old female in her second trimester is complaining of bright red vaginal bleeding without pain. What should you suspect?
placenta previa
a 6 year old states that he tripped and hurt his arm. He has marked edema of the right upper extremity and bruises in various stages of healing on his child’s cheek and neck. what should you do?
report detail findings to the hospital
a 27 year old female in her 8th month pregnancy complains of ankle swelling. Vitals signs are BP 100/70, P90, R20. At this stage of pregnancy, what do these vitals signs indicate?
natural changes
a pregnant patient is experiencing contractions. Upon examination, you notice the infant head’s bulging from the perineum and the patient has an urge to push. What stage of labor is
second
a 31 year old female complains of heavy vaginal bleeding and generalized weakness. She is conscious and alert. Visit signs 85/P and P120 weak. After applying 100% oxygen, you should
place absorbent dressings over the vaginal and administer isotonic crystalloid to maintain perfusion
A 24 years old female primipara, 8 weeks gestation, is describing right lower quadrant abdominal pain, periumbilical pain, and fever. Her knees are drawn to her chest, and her pain increases when she jarred. Vital signs are BP120/76, P100, R20. What is the most likely cause
Appendicitis
a history of pelvic inflammatory diseases the risk of what pregnancy related complication?
Ectopic pregnancy
a 20 year old female complains of diffuse, lower quadrant abdominal pain. When questioned, she indicated having multiple sex partners. She also complains of fever, chills, nausea and vomiting over the last 12 hours and foul-smelling vaginal discharge.
Pelvic inflammatory disease
a 24 year old female just given birth to a newborn. What sign indicates imminent delivery?
loss of the mucus plug
what is the most common way a newborn loses heat?
evaporation
a patient is 9 months pregnant and entrapped in a vehicle. She is in tremendous pain from obvious bilateral femur fractures. Vital signs are B/P 80/62, P130, R24. You have minimal access to her. To address her pain, you should?
administer Valium
a 26 year old female is in labor with her first child. When you access for crowning you see a foot presenting. You are 15 minutes from the nearest hospital. What should you do?
reassure the mother and Have her breath during contractions
which patient is experiencing the most normal breathing?
A two week old with belly breathing
during transport of a mother and her recent newborn to the hospital, the mother complains of sudden onset of difficulty breathing and excruciatingly sharp chest pain. She becomes unresponsive, has noted jugular venous distension, and is hypotension, you should suspect
pulmonary embolism
a 5 year old female has been sick with low grade fever for the past 2 days. Her irritability increases with movement, and she had a 30 second seizure prior to EMS arrival. What should you suspect?
febrile seizure
the second stage of lab\or concludes when
the baby is delivered
five minutes after delivery, a baby has strong cry, peripheral mottling, active movement of arms and legs, and pulse of 140. The APGAR score is
9
A toddler pulled a pot of boiling water from the stove on herself, sustaining partial thickness burns to her chest, abdomen and the anterior surfaces of both legs. What percentage of body surface area is involved?
32
a 6 year old fell out of a tree. He is now lethargic and complaining of abdominal pain. His belly is rigid and distended. You should suspect
lacerated liver
a 25 year old female is 32 weeks pregnant with profound facial edema. She fell and complained of left hip pain with an externally rotated and shortened left leg. Vitals signs are BP 162/104, P129, R20. What should you do?
place the patient on her right side and monitor vital signs
a 29-year-old female in her third trimester is bleeding vaginally. She is G3P1 and has lost approximately 750 mL of blood prior to your arrival. She denies any pain. You suspect
placenta previa
a four-year-old male complains of rapid onset sore throat and muffled speech. Respirations are rapid and non-labored. You should
place the child in a position of comfort and provide humidified oxygen
when evaluating a woman in labor, who is gravies 5 and para 4, you should
expect a relatively short second stage of labor
A 6-month-old male was found lying face down in the crib. He is cyanotic and apneic; a weak brachial pulse is present. You are unable to see a chest rise with your second attempt at rescue breathing after repositioning the head. What should you do?
start CPR
a 40 year old full-term multipara pregnant is in labor with crowning. You should
deliver the baby on scene and transport before the delivery of the placenta
A 33 LB child is experiencing fever, malaise, poor appetite, and vomiting. Capillary refill is 4 seconds and he has tachycardia. You should administer
300 mL of crystalloid
a six year old female is lethargic to respond and presents with dyspnea, respiration 34, palpable peripheral pulses. She has a history of upper respiratory infection(URI). You should
transport her as high priority patient
because of anatomical differences, which laryngoscope blade is preferred for intubating infants and children?
straight
a five year old child ingested an undetermined amount of amitriptyline sometime in the last hour. Your treatment should include
ECG monitoring with rapid transport
an APGAR calculation at the 1-minute post delivery mark is an 8. What does this indicate?
active and vigorous newborn
over vigorous massaging of the fundus post-delivery can result in
inverted uterus
you are working during inclement weather in a remote location. The nearest hospital is more than two hours away. Your patient just delivered a healthy baby boy but has inverted her uterus. What order should you expect from an online physician?
replace the inverted uterus with a gloved hand
a 29 year old female in her third trimester is bleeding vaginally. She is G3P1 and has lost approximately 750mL of blood prior to your arrival. She denies any pain. You suspect
placenta previa
a five year old has a sudden onset of high fever and now complains of a sore throat and pain on swallowing. His voice is muffled and he is drooling. You should suspect.
epiglottis
A 40 year old multipara pregnant female is in labor with crowning. You should
deliver the baby on scene and transport before the delivery of the placenta
a six year old female is lethargic to respond and presents with dyspnea, respiration 34, rapid palpable peripheral pulses. She has a history of upper respiratory infection (URI). You should
transport her as high priority patient
A one year old patient has fever and a cough that sounds like a bark. He has a temperature 101 degrees and is experiencing increased shortness of breath and intercostal muscles retractions. You should administer
racemic epinephrine 0.5 with NS via nebulizer
a pregnant patient is experiencing contractions. Upon examination, you notice that the infant’s head is bulging from the perineum and the patient has the urge to push. What stage of labor is this?
second
a 6 month old male was found lying face down in the crib. He is cyanotic and apneic; a weak brachial pulse is present. You are unable to see a chest rise with your second attempt at rescue breathing after repositioning the head. What should you do?
start CPR
a 22 old female, who is 36 weeks pregnant, is experiencing abdominal discomfort. During evaluation, you notice the umbilical cord is presenting from the vaginal canal. How should the patient be positioned?
Knee chest position
successfully intubation of a newborn is assisted by placing padding under the
shoulders
a 22 year old pregnant woman experiences a significant amount of painless, bright, red bleeding shortly after sexual intercourse. The most likely cause is
placenta previa
management of all newborns includes
prevention of heat loss, open the airway, and evaluation of the infant.
a 2 year old male has been ill for several days with respiratory track infection. Yesterday he developed a severe headache, high fever and extreme lethargy. You should suspect
meningitis
a six year old female has suffered blunt trauma to her right upper quadrant. She responds to painful stimuli and her vital signs are BP 50/30, P132, and R32. The organ likely involved is the
liver
a 38 year old female is 34 weeks pregnant, experience a sudden sharp tearing pain in her abdomen and develops a rigid abdomen. What should you suspect?
Abruptio placentae
you are assisting with a vaginal delivery. The infant’s head has been delivered, the mouth and nose suctioned to deliver the anterior shoulder
gently guide on the infant’s head downward
you are dispatched to a playground for a patient with difficulty breathing. Upon arrival you find a 5 years old who appears anxious with noted circumoral cyanosis and intercostal retraction. Vitals signs are BP86/P, P150, and R46. You should suspect?
anaphylaxis
A six years old female has suffered blunt trauma to her right open quadrant. She respond to painful stimuli. Vital signs are BP 50/30 pulse 132 and respiratioun 32. She is most likely suffering from
hypovolemic shock
a restrained 23 year old pregnant female in her third trimester was involved in a head-on motor vehicle collision. She complains of abdominal pain. Initial vitals signs are BP 110/70, P90, R20. After rapid extrication and spinal immobilization via long spine, board, her vitals signs are BP 90/40, P110, R28. What is the most likely explanation for her change in vitals?
supine hypotension syndrome
a seven year old is having difficulty breathing. He is lethargic with central cyanosis and poor muscle tone. Vital signs are P70, and R10. You should suspect respiratory
arrest
Braxton-Hicks contractions
occur in the second trimester and are False labor
a one year old child has been ill with multiple episodes of emesis and diarrhea. Assessment shows a lethargic 35 pounds child who has mottled skin, dry mucous membranes, capillary refill >2 seconds and P220. After securing the airway, providing high concentration oxygen and establishing an IV, you should
give a 320cc fluid bolus
a seven month old is breathing at a rate of 60 breaths/min, has nasal flaring, and intercostal retractions. You hear stridorous noises on inspiration. This is most likely caused by a/an
bronchospasms associated with asthma
a three year old female has suffered burns to both her hands after grabbing a hot exhaust pipe. The injured areas show charred, dark brown and white patches of skin with little pain. Those burns should be considered
critical
a seven year old is having difficulty breathing. He is lethargic with central cyanosis and poor muscle tone. Vitals signs are P70 and R10, you should suspect respiratory
failure
an 11 year old male has been skateboarding in 100 degree temperatures and has been drinking caffeinated soft drinks. He complains of palpitations. The cardiac monitor displays a narrow-QRS tachycardia at a rate of 160 beats/minute. Vitals signs are BP110/60, P160, R20. What should you do?
transport the patient by ambulance, monitor closely, and administer fluids en route
a 50 pound child is unresponsive, pulseless l, and apneic. The cardiac monitor displays ventricular fibrillation. CPR is in process. The initial defibrillation should be at,
50 joules
a 3 month old infant who weight 6kg has an history of congenital of heart disease. Vitals sign are R60, the ECG show a narrow complex tachycardia at a rate of 240 beats/minute, cyanotic, nailbeds and SPO2 88%. What should you administer?
30 mg amiodorine, IV push
the terminal of pregnancy for maternal health reasons is called a/an
therapeutic abortion
a 22 year old female, who is 36 weeks pregnant, is experiencing abdominal discomfort. During evaluation, you note the umbilical cord is presenting from the virginal canal. How should the patient be positioned
knee chest position
a 19 year old female is 25 weeks pregnant. She has severe headaches, blurred vision and edema. She has not regularly seen a physical during her pregnancy. What other symptoms should you expect
hypertension
Where would you apply pressure to assess the mother for contractions?
The fundus
Placenta Previa
Placenta is implanted low in the uterus and covering part of or all of the cervix/ Leads to painless bright red vaginal bleeding in the 2nd or 3rd trimester.
Best indicator to assess circulation in children
Cap refill.
A female that is child bearing age who is complaining of abdominal pain with an abnormally low blood pressure, you should suspect?
Ectopic pregnancy
A patient with deformity and no pulse to his extremity do to an injury, you should?
Attempt to reduce fracture ONCE to restore pulses.
supine hypotensive syndrome
The uterus compresses the inferior vena cava reducing blood return. Occurs when the patient is left in supine position, place patient on left side.
Nuchal cord
when the cord is wrapped around the fetal neck
The most common reason why newborns lose heat when exposed to cold air or draughts is loss by :
Convection, dry them, wrap them in a blanket and put a hat on them if you are able to.
Signs and Symptoms of Meningitis in pediatric patients
Infants: Fever, localizing signs as lethargy, poor feeding, bulging fontanel.
Children: Nuchal rigidity ( stiff neck) headaches, back pain, fever, ams, vomiting and photosensitivity & Kernig sign ( cannot extend legs at the knee.)
Pre-eclampsia
When a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy. Hypertension 140/90
Eclampsia
most serious form of toxemia during pregnancy, Pre-eclampsia symptoms ( hypertension) along with seizures
What should you do if a newborn patient has cyanosis and a heart rate of 60?
Chest compressions and ventilate.
What would be helpful if you had a 4 year old patient who drank household cleaning products?
Poison control & what substance & time of consumption & how much
How would you transport a small pediatric patient with a head injury who is stable
Emergency to level 1 trauma patient, keep patient calm.
What should you do if you have a pediatric patient seizing for several minutes.
Administer a benzo, such as versed.
primigravida
a woman who is pregnant for the first time
gestation
period from fertilization of the ovum to birth
Gravida
number of times a woman has been pregnant, regardless of outcome of pregnancy.
primipara
first birth/pregnancy
epiglotitis
in child, drooling, high fever, stridor, tripod position, inability to swallow, SUDDEN ONSET (put nothing in mouth, transport immediately and quietly, 02 it tolerated, do not intervene if not necessary- crying may cause further obstruction of airway)
Bronchitis
inflammation of the bronchi Common cause of RSV
Croup
an acute respiratory syndrome in children and infants characterized by obstruction of the larynx, hoarseness, and a barking cough. Accompanied by a low grade fever, symptoms worsen at night. ( Upper airway infection)
Discovery of sunken fontanelle is an indication of?
Dehydration
How and when do you suction a newborns airway
Mouth first then nose second ( remember M before N )
You should suction if you notice the newborn is lethargic and there is meconium staining present.
What should you do with an unresponsive choking child
Start chest compressions/ cpr
Where does fertilization occur?
fallopian tubes
What is the most likely cause of febrile seizures in children
Fever or infection
What is the definition of a seizure that the child is unresponsive for no more than 15 seconds and is looking straight ahead
Absent seizure
What is menopause?
the cessation of ovarian activity/ menstruation
What is the preferred intubation blade for a small pediatric
Miller blade
Whats the difference between a pediatric airway versus an adult airway
Airway is much smaller and more flexible larger tongues
Excessive traction on the umbilical cord during placental delivery can cause?
Uterine Inversion
How should you manage a small child conscious with a complete airway obstruction
Back blows/thrusts
Why do we assess a newborn APGAR score
It helps record the condition of the newborn in the first few minutes of birth
When do we assess the APGAR score in newborns
1 and 5 minutes after birth
A pediatric patient with different stages of bruises healing may indicate?
Child abuse
gestational diabetes
a form of diabetes mellitus that occurs during some pregnancies/ usually resolves after delivery
When do you provide chest compression in a newborn/ at what heart rate
60 and under
A female who is term and complaining of tearing abdominal pain, you should suspect?
Abruption Placenta
What should you do once the infants head has been delivered.
Guide the head upward and allow delivery of the shoulders.
How do you manage vaginal bleeding in a female who was sexually assaulted
comfort patient, apply trauma pade to the exterior of the vagina
ectopic pregnancy
A pregnancy outside of the womb, usually in a fallopian tube
Prolapse cord
A situation in which the umbilical cord comes out of the vagina before the infant.
How do you manage a prolapse cord
Position the mother supine with her hips elevated, administer 02 via NRB, have mother breathe/pant through contractions to prevent her from bearing down. Insert two fingers with a gloved hand and gently push the presenting part (not the cord) back into the vagina. Maintain pressure on the part, cover the cord with moist warm saline and transport emergent
What do you do for a child who has a delay in cap refill
Warm their hands and administer 02
Reasons why you are unable to obtain a blood pressure on a 38 week pregnant female who is lying supine on stretcher
Possible supine hypotensive syndrome, have mother lay on left side
An unresponsive pediatric patient who is tearless and has dry mucous membranes is more than likely suffering from?
Dehydration
Whats the normal respiratory rate of an infant
30-60
Whats the normal respiratory rate of a child
18-30
Braxton Hicks contractions
false labor contractions preparing the body for labor
Why is hypertension a pre-delivery emergency (Pre-eclampsia or eclampsia
)
They can lead to seizures for the mother and affect oxygen delivery to the fetus. Also signifies that toxins are building up in the mothers body and baby
What indicates fetal distress
A low apgar score & meconium staining
Vaginal bleeding within the first 20 weeks of her pregnancy, you would suspect?
Miscarriage or spontaneous abortion
Multiple contusion in different stages of healing on a child may indicate?
Abuse
What are the signs and symptoms of PID
Abdominal pain, fever, fatigue, chills, NVD, Dysuria
Injuries from scalding water may indicate?
Abuse
A 40 year old female states her water has broken and is full term, what should you do?
Ask if this is her first pregnancy, obtain history, time her contractions, check for crowning, if so prepare for delivery
What is the location to assess a pulse on an infant
Brachial
Whats the difference between eclampsia and pre-eclampsia
Eclampsia is accompanied by AMS and seizures
Indication of imminent delivery of the placenta
Contractions begin again, the umbilical cord lengthens and blood excretes from the vagina.
Signs and symptoms of abruptio placenta
sudden onset of severe abdominal pain radiating to back, decreased fetal movement, decreased fetal heart tones, patient may report vaginal bleeding.
Bright red vaginal bleeding without pain during the second half of pregnancy is the main sign of
Placenta previa
Female with no prenatal care delivered a baby and now has additional amniotic fluid coming out
You should prepare for a second delivery
How would you manage an arterial bleed to the extremities
Apply direct pressure, if bleeding continues use a tourniquet
A young child who is tachycardic with a fever and altered mental status, what should you do
02, iv, fluids, emergent transport
What is the fluid dose for children
20ml/kg
Which delivery presentation would you put the mother in a knee to chest position
breech presentation or limb presentation
1st stage of labor
Onset of contractions -> ends with full effacement/dilation
2nd stage of labor
starts w/ full dilation / effacement of cervix
ends with delivery of baby
3rd stage of labor
Begins with Delivery of baby –> ends with delivery of placenta
Over hydration or inflammation of a childs head can lead to
Edema and swelling of fontanels
How do you manage a partial amputated finger of a child
Direct pressure, wrap it with sterile dressings, transport
Apgar scale
appearance, pulse, grimace, activity, respiration
APGAR Appearance
0 = blue/pale
1 = pink core with blue extremities
2 = All pink
APGAR Pulse
0 = absent
1 = under 100
2 = over 100
APGAR Grimace
0 = No Response
1 = grimace
2= vigorous cough, cry, sneeze
APGAR Activity
0 = limp
1 = some flexion/extension
2 = active motion
APGAR: Respiration
0=absent
1=slow// irregular cry
2=strong cry
Treatment for croup
humidity, oxygen, and, if necessary, racemic epinephrine treatments or steroids, or both.
nuchal cord
Umbilical cord around the fetal neck.
Slip fingers under cord and gently slip over shoulders and neck. If cord is too tight place umbilical cord 2 inches apart and cut between the clamps going away from the infant.
treatment for Prolapsed cord
Knee to chest or Trendelenburg
oxygen 8 to 10 L
joules for 1st defibrillation in children
2j/kg
Initial joules for cardioversion in children
1j/kg
Hypoglycemia in kids is
45 bgl and under
Epi dose for cardiac arrest in children is
0.01mg/kg OF 0.1 – 1:10,000
Epi dose for asthma in peds
0.01mg/kg
Initial dose for adenosine for svt
0.1mg/kg
Treating Eclamptic seizures
2g of mag sulfate, diluated in 50 to 100ml slow iv push
Treatment for Hypoglycemia in children
25% dextrose 0.5-1g/kg iv/io
Treatment for bradycardia in children
Epi 0.01mg/kg
Epi for anaphylaxis in children
0.01mg/kg 1:10,000
chorioamnionitis
Infection of the amniotic sac & contents
Pyelenephritis
inflammation of the kidney
2 year old female is lethargic to respond. She has dry mucous membranes and a tearless cry. What should you suspect?
Hypovolemia
just delivered a baby girl who remains cyanotic and not responding to stimulation and oxygen therapy. Heart rate is 90. You should
Begin positive pressure ventilations
6 month old is febrile, cyanotic, and grunting with labored breathing. You should
Apply blow by O2 and transport
Before assessing the respiratory adequacy of an unconscious infant or child, you should
Ensure the airway is patient and clear of obstructions
Febrile seizures in children are most often the result of a/an
Abrupt rise in body temperature
4 year old patient has sustained blunt trauma to the chest. Based on the MOI you should suspect
Minimal external signs with serious internal injury
mother has just delivered a newborn with central cyanosis. The newborn vitals are P 82, R 30. You should?
Begin positive pressure ventilations
37 year old female in the later stages of pregnancy has been experiencing abdominal pain and vomiting for the last two days. She responds to verbal stimulus. Vital signs are BP 100/70, P116, R24, skin cool and dry, how should you position her?
Left lateral recumbent
What is the proper way to size an OPA for a child?
Corner of mouth to the angle of the mandible
6 year old is shy and withdrawn. He has multiple contusions in various stages of healing. His mother states “he fell on the playground.” What should you suspect?
Physical abuse
Where should you apply pressure to access for uterine contractions?
Abdomen below the navel
14 year old jumped off a 4 foot wall, landing on her feet. She is complaining of tingling below the waist, lower back pain, and cramping in both feet. Vital signs are BP 106/74, P 112, and R 20. You should
Immobilize to a long spine board
Which of the following indicates decompensated shock in a pediatric patient?
Loss of consciousness
3 year old is unresponsive and apneic on the floor of a restaurant. He was choking, turned blue, and collapsed. What should you do?
Begin chest compressions
In centimeters, what is the correct depth of chest compressions for a 7 year old child?
5
What is the proper method for suctioning a newborn’s airway with a bulb syringe?
Squeeze before placing in the mouth
3 year old drank some drain cleaner. It would be most helpful to?
Transport immediately
cord is wrapped around a baby’s neck during childbirth. This is called
Nuchal cord
Scald injuries to a child’s lower extremity can be indicative of?
Abuse
You have assisted a mother in delivering a premature newborn. Assessment after 5 minutes shows newborn has central cyanosis and heart rate of 90. What should you do?
Provide ventilatory assistance
3 month old apneic patient with a pulse of 110. In preparing to ventilate this infant, you should
Place a small towel under their shoulders
Normal response for a healthy 9 month old infant
Gaze follows the parents
2 year old is restless, irritable, and febrile with a distinct cough. The parent states that the child is calmer in a steam shower. You should suspect?
Croup
13 month old lying supine in crib, crying. Fever 104.5, rash on body and some spots are purple. You should?
Put on surgical mask
20 year old female is pregnant for the first time with twins. What is she considered?
Primigravida
Initiate CPR on infant if heart rate is less than?
60 beats/min
Neonatal 2 weeks old female is dyspneic and lethargic to respond. Vitals are P 58, R 4 and irregular. What should you be concerned about?
Cardiac arrest
During assessment of crying infant, you discover a sunken fontanelle. Your next question should be?
How many wet diapers has the baby produced
When assessing distal circulatory function in a 3 year old, a reliable indicator is?
Capillary refill
neighbor has asked you to check on her 2 month old baby. The baby is sleeping and vitals are P 130, R 40, and he continues to sleep even when you try to wake him up. What should you do?
Call for emergency medical services
4 year old is having trouble breathing. He is drooling and sitting forward in a chair with his mouth wide open. He has a 103.2 temperature, you should suspect?
Epiglottitis
3 year old child involved in a motor vehicle collision needs to be secured on an adult backboard. You should?
Place padding under the child’s torso
When inserting an OPA in a child you should?
Hold the tongue in position with a tongue depressor
Pediatric airways differ from adult airways in that
All structures are smaller and can be more easily obstructed
10 year old patient was injured while skateboarding, upon assessment you note a visible deformity of the forearm. The fingers are pale and cool without a palpable pulse. You should apply?
Gentle manual traction
7 year old presents with a pencil in his left cheek, you should?
Check for airway patency
37 week pregnant woman with tearing abdominal pain and weak, vitals are 90/60, 140, and 26 with pale, cool, diaphoretic skin, you should suspect?
Abruptio placentae
Which may indicate that a fetus was in distress before delivery?
Meconium
2 year old child presents with a fever, lethargy, and screaming upon neck flexion. You should suspect?
Meningitis
conscious child has a significant airway obstruction due to an illness. You should?
Give O2 and transport immediately
With pediatric patient, your assessment should begin?
At first sight
child is postictal. You should?
Ensure open airway
Shortly after delivery, a mother experiences dyspnea and comes hypotensive. No excess bleeding is noted and the uterus seems firm. You should suspect?
Pulmonary embolism
Compared to adults in shock, pediatric patients?
Stay in compensated shock longer
Preeclampsia becomes eclampsia when
A seizure occurs
38 year old female reports left sided abdominal pain that radiates to the back. Vitals are 90/64, 118, 20. You should suspect?
A ruptured ectopic emergency
33 year old female was in a motor vehicle collision. She is 36 weeks pregnant. First responders have removed the patient from the vehicle and immobilized her and they cannot obtain a blood pressure. You should?
Tilt the backboard to the left immediately
5 year old is actively seizing, his respirations are slow and skin is pale. His parents say he has seized several times in the last 15 minutes without waking up. You should suspect that the?
Child is in status epilepticus and medication is required
Nausea, vomiting, vaginal discharge, irregular periods and abdominal pain are signs and symptoms of?
Pelvic inflammatory disease
What effect can excessive traction have on the umbilical cord during placental delivery?
Abruptio placenta; umbilical bleeding
cessation of menses with associated decrease of estrogen secretion is called?
Menopause
24 year old female in her second trimester of pregnancy presents with mild contractions. There is no regular pattern to the contractions, and they have not increased in intensity since they began. She denies vaginal bleeding or any other symptoms. This patient is most likely experiencing?
Braxton hicks contractions
20 year old female feels faint and has severe pain between her shoulder blades. Her skin is cool and clammy. Vital signs are BP 82/48, P 134, R 22, and SPO2 92%. What should you suspect?
Rupture ectopic pregnancy
woman is 36 weeks pregnant and complaining of painless vaginal bleeding. The most likely cause is?
Placenta previa
4 year old male is sitting upright and drooling. He has swallowed a marble that is completely blocking his airway. What should you do?
Perform abdominal thrusts
To relieve pressure on the vena cava when transporting a pregnant patient, you should?
Place on left side
maternal condition that occurs when the placenta separates from the uterine wall and is a cause of a pre-birth bleeding is?
Abruptio placenta
32 week pregnant female complaining of facial swelling, headache, vomiting, and experiencing visual disturbances last 12 hours. You should suspect?
Preeclampsia
35 week pregnant woman. Following scenarios most life threatening?
Hypertension and experiencing visual disturbances
One sign of respiratory distress in a neonate?
Grunting
Assess on infant. Which artery should you take for pulse?
Brachial
50 year old fell from her bicycle after hitting a bump in the road. She is now bleeding from her vagina. You should
Apply external sterile bulky dressing
If a patient presents vaginal bleeding within the first 20 weeks of pregnancy you should suspect?
Spontaneous abortion
Placenta previa occurs when the placenta…
Is abnormally positioned
Assisting home birth and baby’s head just delivered. You should?
Examine for nuchal
Alert & oriented 4 year old patient has possible head injury from a fall. Vitals are P 120, R 18. How should you transport?
Fully immobilize with towels under his scapulae
Painless bright red vaginal bleeding late in the third trimester. You should suspect?
Placenta previa
Signs or symptoms of a pre delivery emergency?
Hypertension
24 year old woman presents with vaginal bleeding following sexual assault, controlling bleeding would best be done by
Placing a dressing at the vaginal opening
patient is in labor and has a strong urge to push. The baby’s head is not yet visible, but the umbilical cord is protruding, you should?
Place her in knee-chest position and transport
2 year old male turns his face away and hides when you approach. Vital signs are P 150 R 32 with audible wheezing what should you be most concerned about?
Skin color
Which signs and symptoms most suggest preeclampsia?
Hypertension and excessive water retention
Period of time during which intrauterine fetal development occurs is called?
Gestation
Assisting a vaginal delivery and the mom is crowning. The infant’s head suddenly disappears and the mother begins to complain of sharp, intense, constant abdominal pain. You should suspect?
Uterine rupture
2 year old patient has a respiratory rate of 30 breaths per minute. This is considered?
Normal
A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect:
foreign body airway obstruction
Management for a woman who presents with a prolapsed umbilical cord includes all of the following, EXCEPT:
relieving pressure off of the cord by gently pulling on it. does include: lifting babies head off of the umbilical cord, ensuring that the cord stays moist, high flow O2 to mother, and placing mother in a position that elevates her hips
You arrive at the scene shortly after a 3-year-old female experienced a seizure. The child, who is being held by her mother, is conscious and crying. The mother tells you that her daughter has been ill recently and has a temperature of 102.5°F. What is the MOST appropriate treatment for this child?
Oxygen via the blow-by technique, remove clothing to help reduce her fever, and transport with continuous monitoring.
You are dispatched to a residence for a 4-year-old female who is sick. Your assessment reveals that she has increased work of breathing and is making a high-pitched sound during inhalation. Her mother tells you that she has been running a high fever for the past 24 hours. Your MOST immediate concern should be:
assessing the need for ventilation assistance
Following delivery of a newborn and placenta, you note that the mother has moderate vaginal bleeding. The mother is conscious and alert, and her vital signs are stable. Treatment for her should include:
administering oxygen and massaging the uterus (fundus)
The purpose of the pediatric assessment triangle is to:
form a general impression of the child without touching him or her (appearance, work of breathing, and circulation)
Which artery should you palpate when assessing for a pulse in an unresponsive 6-month-old patient?
brachial; carotid or femoral for over 1 yo
After drying, warming, and suctioning a newborn’s mouth and nose, assessment reveals central cyanosis, a weak cry, and a heart rate of 60 beats/min. The EMT should:
ventilate with a BVM at 40-60 b/min (first treatment is PPV); reassess HR after 30 sec then chest compressions
While performing a visual inspection of a 30-year-old woman in labor, you can see the umbilical cord at the vaginal opening. After providing high-flow oxygen, you should:
relieve pressure from the cord with your gloved fingers
Following the initial steps of resuscitation, a newborn remains apneic and cyanotic. You should:
begin ventilations with a BVM
A 30-year-old woman has severe lower abdominal pain and light vaginal bleeding. She tells you that her last menstrual period was 2 months ago. On the basis of these findings, you should suspect:
an ectopic pregnancy
Which of the following statements regarding the length-based resuscitation tape measure is correct?
The tape measure can be used in children who weigh up to 75 pounds; length is more reliable than age when coming to weight
In which of the following situations would the EMT MOST likely deliver a baby at the scene?
a tornado has struck and blocked the only route to the hospital
You arrive at a residence shortly after a 4-year-old boy experienced an apparent febrile seizure. The child is alert and crying. His skin is flushed, hot, and moist. His mother tells you that the seizure lasted about 2 minutes. You should:
provide supportive care and transport
Supplemental oxygen via the blow-by technique is MOST appropriate for a child who presents with respiratory difficulty and:
is agitated, tachycardia, and clinging to his parent; always give the least threatening mode of O2 to children if possible
A 4-year-old boy ingested an unknown quantity of drain cleaner. He is alert, has a patent airway, and has adequate breathing. You should:
contact poison control and give him O2 (8002221222)
The function of the uterus is to:
house the fetus as it grows for 40 weeks; contracts during labor and expels baby from birth canal
You are caring for a 6-year-old child with a possible fractured arm and have reason to believe that the child was abused. How should you manage this situation?
advise the parents that the the child needs to be transported;
When is it MOST appropriate to clamp and cut the umbilical cord?
as soon as the cord has stopped pulsating
A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and administer supplemental oxygen. En route to the hospital, you should be MOST alert for:
convulsions; high fever and altered mental status indicate sepsis; rash could be meningitis which could cause seizures
Appropriate treatment for an 18-year-old woman with severe vaginal bleeding may include all of the following, EXCEPT:
placing sterile dressings into the vagina
Oxygen and other nutrients are transferred to the developing fetus via the:
umbilical vein; fetus is attached to the placenta by umbilical cord
Treatment for a responsive 4-year-old child with a mild airway obstruction, who has respiratory distress, a strong cough, and normal skin color, includes:
supplemental oxygen and transport; attempts to relieve a mild airway obstruction may cause a severe one
A 5-year-old child in compensated shock secondary to severe vomiting and diarrhea would be expected to have:
a slow cap refill time (poor perfusion) and week peripheral pulses and pallor; tachycardia and tachypnea
You are dispatched to a residence for a child having a seizure. When you arrive at the scene, the 4-year-old child’s grandfather tells you that he has had several full body seizures over the past 20 minutes, but never woke up in between the seizures. The child’s skin is hot and flushed. This is MOST indicative of:
status epilepticus which is a prolonged (greater than 20 minutes) seizure or multiple seizures with no return of consciousness
Which of the following statements regarding two-rescuer child CPR is correct?
compress the chest with one of two hands to a depth that is equal to 1/3 the diameter of the chest; 15:2 ratio
A child typically begins to develop stranger anxiety when he or she is a/an:
toddler
A prolapsed umbilical cord is dangerous because the:
Baby’s head may compress the cord, cutting off its supply of oxygen
Which of the following statements regarding crowning is correct?
gentle pressure should be applied to the baby’s head during crowning
A 30-year-old woman is 22 weeks pregnant with her first child. She tells you that her rings are not fitting as loosely as they usually do and that her ankles are swollen. Her blood pressure is 150/86 mm Hg. She is MOST likely experiencing:
preeclampsia
Which of the following is a sign of an altered mental status in a small child?
inattention to the EMT’s presence
Which of the following statements regarding pediatric anatomy is correct?
The occiput is proportionally larger when compared to an adult
Which of the following is a more reliable indicator of perfusion in children than it is in adults?
cap refill
You will know that the third stage of labor has begun when:
the entire baby has been delivered
Upon delivery of a baby’s head, you see that the umbilical cord is wrapped around its neck. Initial treatment for this condition should include:
trying to remove the cord from around the neck; if unsuccessful then clamp and cut
When you begin to assess a woman in labor, she states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be MOST appropriate to ask next?
How many week’s are you?
A 29-year-old woman, who is 38 weeks pregnant, presents with heavy vaginal bleeding, a blood pressure of 70/50 mm Hg, and a heart rate of 130 beats/min. She is pale and diaphoretic, and denies abdominal cramping or pain. Her signs and symptoms are MOST consistent with a/an:
placenta previa (little pain, lot of bleeding)
Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What is the MOST appropriate initial management for this newborn?
intitiate PPV
You have just delivered a baby girl. Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should:
keep the newborn warm, give O2 to mom if needed, and transport; do not wait till placenta delivers and do not pull on it
You are assessing a 26-year-old woman who is 38 weeks pregnant and is in labor. She tells you that she was pregnant once before, but had a miscarriage at 19 weeks. You should document her obstetric history as:
gravida 2 para 0
A woman who is 39 weeks pregnant is unresponsive, apneic, and pulseless. When treating her, the EMT should:
manually displace her uterus to the left; needs to be supine for CPR but baby cannot be on heart
After an advanced airway device has been inserted in a 6-month-old infant in cardiopulmonary arrest, you should deliver ventilations at a rate of:
10 breaths/min
You are treating a 5-year-old child who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. You should:
lower the extremities and reassess
The appropriate technique for performing two-rescuer CPR on a 4-year-old child includes
15 compressions to 2 ventilations, compressing the sternum with the heel of your hand, and ventilating until visible chest rise occurs.
During your assessment of a woman in labor, you see the baby’s arm protruding from the vagina. The mother tells you that she needs to push. You should:
cover the arm with a sterile towel and transport immediately
Which of the following is the MOST common cause of seizures in children?
an abrupt rise in body temp
Following an apparent febrile seizure, a 4-year-old boy is alert and crying. His skin is hot and moist. Appropriate treatment this child includes:
offering oxygen and transport
You and your partner are performing CPR on an infant with suspected sudden infant death syndrome (SIDS). An important aspect in dealing with such cases is:
carefully inspecting the environment in which the infant was found
Which of the following techniques represents the MOST appropriate method of opening the airway of an infant with no suspected neck injury?
tilt the head back without hyperextending the neck
Which of the following injuries is MOST indicative of child abuse?
bruising to the upper back
Prevention of cardiac arrest in infants and small children should focus primarily on:
ensuring adequate ventilation
Of the following, the MOST detrimental effect of gastric distention in infants and children is:
decreased ventilatory volume
The MOST important initial steps of assessing and managing a newborn include:
clearing the airway and keeping the infant warm
A 4-year-old girl fell from a third-story window and landed on her head. She is semiconscious with slow, irregular breathing and is bleeding from her mouth and nose. You should:
open her airway with the jaw-thrust maneuver while manually stabilizing her head, suction her oropharynx, and assist her ventilations.
Your assessment of a mother in labor reveals that a fetal limb is protruding from the vagina. Management of this situation should include:
positioning the mother with her hips elevated, administering high-flow oxygen, and providing transport
When assessing a 30-year-old female who was sexually assaulted, it is MOST important for you to:
ensure that all life threatening injuries are treated
The preferred method for inserting an oropharyngeal airway in a small child is to:
depress the tongue with a tongue blade and insert the airway with the downward curve facing the tongue
Which of the following parameters is the LEAST reliable when assessing the perfusion status of a 2-year-old child?
systolic BP
Which position is MOST appropriate for a mother in labor with a prolapsed umbilical cord?
supine with hips elevated
During transport of a woman in labor, the patient tells you that she feels the urge to push. You assess her and see the top of the baby’s head bulging from the vagina. You should:
advise your partner to stop and assist with the delivery
A 34-year-old woman, who is 36 weeks pregnant, is having a seizure. After you protect her airway and ensure adequate ventilation, you should transport her:
on her left side
Which of the following would MOST likely occur in conjunction with a breech presentation?
prolapsed umbilical cord
Which of the following signs is MOST indicative of inadequate breathing in an infant?
expiratory grunting
You should assist with the delivery of the baby’s head by:
placing your fingers on the bony part of the skull and applying gentle pressure
After clearing the airway of a newborn who is not in distress, it is MOST important for you to:
keep them warm
The 5-minute Apgar assessment of a newborn reveals a heart rate of 130 beats/min, cyanosis of the hands and feet, and rapid respirations. The infant cries when you flick the soles of its feet and resists attempts to straighten its legs. These findings equate to an Apgar score of:
9;
Which of the following is an abnormal finding?
Heart rate of 80 beats/min in a 3-month-old infant
A 9-year-old girl was struck by a car while she was crossing the street. Your assessment reveals a large contusion over the left upper quadrant of her abdomen and signs of shock. Which of the following organs has MOST likely been injured?
spleen
Your assessmment of a newborn reveals cyanosis to the chest and face and a heart rate of 90 beats/min. What should you do first?
begin artificial ventilations
A 5-year-old child experienced partial-thickness burns to his head, anterior chest, and both upper extremities. What percentage of his total body surface area has been burned?
0.45; 0.18 for head, 0.9 for anterior chest, and 0.9 for each extremity
A 5-year-old boy was struck by a car when he ran out into the street. When you arrive at the scene and approach the child, you see him lying supine approximately 15 feet from the car. Based on the child’s age and mechanism of injury, which of the following should you suspect to be his PRIMARY injury?
pelvic injury
A 6-year-old boy complains of pain to the right lower quadrant of his abdomen. Assessment of this child’s abdomen should include:
palpating the left upper quad first
After the baby’s head delivers, it is usually tilted:
posteriorly, to one side
If a woman is having her first child, the first stage of labor:
is usually the longest and lasts an average of 16 hours
A 6-year-old boy presents with a high fever, a headache, and a stiff neck. He is conscious, but is not acting as a normal 6-year-old boy should. His mother told you that he vomited once before your arrival. You should be MOST concerned with:
the risk of permanent neurologic damage; symptoms consistent with meningitis
Your assessment of a 5-year-old child reveals that he is unresponsive with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Treatment for this child should include:
PPV, chest compressions, and rapid transport
A 3-year-old female presents with respiratory distress. She is conscious, crying, and clinging to her mother. She has mild intercostal retractions and an oxygen saturation of 92%. The MOST effective way of delivering oxygen to her involves:
asking the mom to hold the oxygen mask near her face
You are responding to a call for a 2-year-old child who fell from a second-story window. With the mechanism of injury and the age of the patient in mind, you should suspect that the primary injury occurred to the child’s:
head; their head is proportionally larger than the rest of their body
Which of the following is the MOST common cause of shock in infants and children?
dehydration
The MAIN reason why small children should ride in the backseat of a vehicle is because:
they can experience severe injury or death if the air bag deploys
A 4-year-old boy with a tracheostomy tube is experiencing respiratory distress. He has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should:
carefully suction his tube
In contrast to the contractions associated with true labor, Braxton-Hicks contractions:
do not increase in intensity and are allocated by a change in position
You should suspect physical abuse of a 4-year-old child if you observe:
purple or yellow bruises to the thighs
General guidelines when assessing a 2-year-old child with abdominal pain and adequate perfusion include
examining the patient in the parents arms
Following delivery of a newborn, the 21-year-old mother is experiencing mild vaginal bleeding. You note that her heart rate has increased from 90 to 120 beats/min and she is diaphoretic. In addition to administering high-flow oxygen, treatment should include:
treating for shock and performing uterine massage during transport
Immediately upon delivery of a newborn’s head, you should:
suction the mouth
Which of the following signs or symptoms is/are more common in children than in adults following an isolated head injury?
nausea and vomiting
A 3-year-old child experienced a seizure that lasted about 10 minutes. He has a fever of 103.5°F, his skin is hot to the touch, and he has a rash on his trunk. The EMT should suspect:
meningitis
You receive a call for a 3-year-old girl with respiratory distress. When you enter her residence, you see the mother holding the child, who does not acknowledge your presence. This finding indicates that the child:
has severe hypoxia
You are assessing a 5-year-old boy with major trauma. His blood pressure is 70/40 mm Hg and his pulse rate is 140 beats/min. and weak. The child’s blood pressure:
indicates decompensated shock
To maintain neutral alignment of an 18-month-old child’s airway, you should:
place padding in between the shoulder blades
A 24 yof is 10 weeks pregnant. she is responsive to your voice but her husband states that she has been vomiting constantly for the last three days. Vitals: BP 88/48; P 130; R 22. What should you suspect?
Hyperemesis gravidarum; extreme nausea and vomiting that leads to dehydration which presents as hypovolemic shock.
After assisting a 36 yof with the delivery of a healthy baby, she continues to bleed heavily. What should you do?
massage her uterus over the lower abdomen
an 18 yof is crying and complains of being sexually assaulted. she has dry blood on her face and hands. she wants to use the bathroom and wash off the dry blood. what should you do?
comfort her and wrap her in a blanket. don’t let her use the bathroom
a febrile 28 yof complains of bloody urine and lower abdominal pain that increases when she urinates. Vitals are BP 130/86, P 98, R 18. What should you suspect?
UTIu
Which is a possible complication for infants born prematurely?
underdeveloped lungs
What is the definition of abruptio placentae?
the placenta separates from the uterine wall
A 30 yof has nausea, vomiting, and lower, left-sided abdominal cramping. She tells you that she has been dizzy and light-headed. What should you suspect?
ectopic pregnancy
A full term pregnant 30 yo is in active labor. The baby’s limb is presenting. How should you position the mother>
head down, pelvis elevated
A newborn’s head just delivered and a nuchal cord is present. What should you do?
attempt to slip the cord over the infant’s head
Which is a sign of pre-eclampsia?
hypertension, nausea, and headaches
A 31 yof is actively seizing at a dr office. she is 28 weeks pregnant and has no history of seizures. What should you suspect?
eclampsia
A 29 yof is 32 weeks pregnant. She complains of excessive vaginal bleeding but no pain. what should you suspect?
placenta previa
A 27yo female is 36 weeks pregnant. She has 2 children and this is her third pregnancy. She complains of lower back pain and tells you that she wet herself and has to make a bowel movement. What should you suspect?
imminent delivery
What is a prolapsed cord?
an umbilical cord that presents first during delivery
Which condition has a sign of vaginal bleeding that occurs early in the pregnancy?
spontaneous abortion
A 21 yof is in labor. She is lying flat on her back and the newborn’s head has already delivered. What should you do?
make sure the cord is not wrapped around the neck
Which is the term for an umbilical cord that is wrapped around an infant’s neck
nuchal
A 27 yof delivered an infant 15 minutes ago. She now states that she feels contractions again. What should you do?
prepare to deliver the placenta.
In which position should a 3 week pregnant female be transported?
left lateral recumbent
A newborn is apnea immediately after delivery. How should you deliver ventilations?
neonatal BVM with small puffs at a rate of 40-60/min
Your initial attempt to ventilate an unconscious 6 month old male infant is unsuccessful. What should you do?
reposition his head and reattempt to ventilate
A 5 yom appears jaundiced and complains of right upper quadrant pain. What is the most likely cause?
Hepatitis
A 7 yof is in cardiac arrest. You have just administered your first shock with an AED. What should you do?
resume chest compressions
An 11 yom is slow to respond and speaks incomprehensible words. his teacher tells you that he has been playing outside and has not checked his blood sugar in 4 house. He has a diabetic medical alert bracelet. what should you do?
administer one tube of oral glucose
A ventilator dependent 2 yof is not breathing. Her caregiver is having difficulty operating the vent. What should you do??
ventilate with a BVM
an 18 month old has partial thickness burns to 40% of his body. What type of dressing should you apply?
dry
A 3 yom has a complete airway obstruction after swallowing a marble. He is now unresponsive. What should you do?
start chest compressions
For a 6 yo child, what happens when an oral airway is inserted with the curvature towards the roof of the mouth and then rotated as it is inserted?
risk of trauma to the soft palate
A febrile 4 yom is sitting upright and drooling and crying. Vitals are BP 100/40, P 120, and R 24 with stridor. What should you do?
administer blow-by oxygen
A 7 yof was stung by a bee. She has hives and a “lump in her throat” Vitals are BP 66/40, P 154, R 26 w stridor. What should you do?
administer epi
A 12 yom is bleeding uncontrollably from a deep laceration on the palm of his hand. His mom tells you that is hemophiliac. What should you do?
apply a tourniquet above his elbow
A 12 yof face and arms twitched for 15 seconds during a seizure. She reports tingling in her fingertips and numbness near her mouth. She was alert and oriented during the incident. What type of seizure did she have?
focal motor (simple partial); this type just affects muscles and nerves, it doesn’t affect mental status.
A 6 yof complains of pain in her left arm. she landed on her hands after jumping off a swing. Her left radial pulse is absent. Vitals are BP 96/70, P 120, R 16. What should you do?
reposition her arm and recheck the pulse.
A 6 yof complains of fatigue and decreased urine output. Vitals are BP 76/50, P 140, and R 40. What should you suspect?
hypovolemic shock
A male newborn is kicking his legs, breathing normally, and has a loud cry. His extremities are blue and his pulse is 140. What is his APGAR?
9
A 4 yof has an acute onset of a harsh, barking cough and complains of a sore throat and fever for 1-2 days. What should you suspect?
croup
A 6 month old male is pale and limp. Vitals are P 56, R 24, with a 4 sec cap refill. What should you do?
start chest compressions
After drying off a newborn, he has a weak cry and poor muscle tone. What should you do?
administer blow-by oxygen
A 4 month old male is lethargic with a heart rate of 70. You have been assisting ventilations with a BVM, but there is no change. What should you do?
continue ventilations and transport emergently
Signs/Symptoms of female reproductive tract infection
…PID?
placenta previa
the placenta develops over and covers the cervix
Causes of first trimester bleeding
spontaneous abortion
Complications of traction on an umbilical cord
tearing or occlusion of the cord which can cause hypoxia to infant
abruptio placentae
patient often complains of severe pain and vaginal bleeding later in pregnancy
Medical terminology for abnormal delivery complications
complicated delivery: Breech delivery, Presentation complication, Spina Bifida, Abortion
Medical terminology for describing a pregnant female
primigravida (1st pregnancy) or multigravida (previous pregnancies experienced)
Signs and symptoms of an ectopic pregnancy
sudden stabbing and usually unilateral pain in the lower abdomen. A history of pelvic inflammatory disease, tubal ligation, or previous ectopic pregnancies should make you suspicious
Signs and symptoms of a uterine rupture
severe abdominal pain, severe bleeding, hemorrhagic shock
Signs and symptoms of placenta previa
vaginal bleeding later in pregnancy without pain
Signs and symptoms of postpartum complications
Vaginal bleeding that exceeds 500mL & shock (usually due to prolonged labors or multiple births), pulmonary embolism w/ sudden difficulty breathing (due to mothers increase in clotting
ability while pregnant).
breech delivery
Butt first
presentation complication
Limb presentation, prolapsed umbilical cord
spina bifida
exposed spine on infants back
abortion (usually early in pregnancy)
vaginal bleeding
Signs of abuse
bleeding, miscarriage, premature births, low birth weight, infection, uterine rupture
Signs of substance abuse
fetal alcohol syndrome, meconium in amniotic fluid
Other signs of pre-delivery emergencies
multiple gestation, premature infant
Signs and symptoms of pre-eclampsia
pregnancy induced hypertension; headache, seeing spots, swelling of hands & feet, anxiety
difference between eclampsia and preeclampsia
eclampsia includes seizures that occur as a result of hypertension
Supine Hypotensive Syndrome
Dizziness and a drop in blood pressure caused by the weight of pregnant uterus compressing the inferior vena cava, reducing return of blood to the heart and cardiac output.
Transporting a female with supine hypotensive syndrome
on left side
Assessing uterine contractions
sign of the onset of labor; initially not at regular intervals & may feel like back pain
true labor
contractions that last 30-60secs at regular intervals, pain starts in lower back wraps around lower abdomen, bloody show is pink or red with mucus, amnioic sac breaks before or during contractions with a sweet smelling fluid that continues to leak
Braxon-Hicks labor
contractions are not regular and do not increase with intensity, contractions come and go, pain starts and stays in lower abdomen, bloody show is brownish, some leakage of fluid but is usually urine and smells like ammonia.
Methods for suctions a newborns airway
Suction mouth 1st then each nostril. Always squeeze bulb before entering airway then release when inside airway then expel fluid away from infant and mother.
Methods for measuring Ped oral airway
place the airway next to the face with the flange at the level of the central incisors or corner of the mouth and the tip of the airway should reach the angle of the jaw
The Broselow Tape
can also be used to determine all the appropriate sized equipment for peds
Resuscitating a bradycardic newborn
bradycardia is <120bpm. place infant with head down and suction airway, stimulate infant by flicking the feet or rubbing back, BVM with ratio 3:1, Chest compressions with ratio 15:2, transport quickly
Signs and symptoms of respiratory distress in a neonate
skin is blue or pale, no crying or reaction to stimulus, limp w/ no muscle tone, absent resp
Pelvic inflammatory disease (PID)
Generalized lower abdominal abnormal and foul smelling discharge from the vagina. Increased pain with intercourse, fever, general malase and nausea and vomiting
Toxemia
characterized by pre-eclampsia then eclampsia.
Signs and symptoms of toxemia
Severe persistent headache, vomiting, abdominal pain, pregnant, not eating, low urination, high blood pressure
Infant birth complications
Infant heart rate should be above 100 beats/min and not breathing adequately begin ventilations 40-60/min. If heart rate does not improve to greater than 80 beats/min begin CPR
Imminent birth
Contractions closer than 2 mins apart are intense and last from 30-90 secs
Signs and symptoms of Epiglottitis
Fever, pain on swallowing, Drooling, mouth breathing
Signs and symptoms of Croup
fever, coughing
CPR for 6 year old child
Chest wall should be compressed 1/3-1/2
Infants and children 0-8
assess pulse at the brachial Artery
Children
1-8 years old
Infants
0-1 years old
New born Heart Rate
140-160
Infant Heart Rate
120-140
Children Heart Rate
100-120
Adults Heart Rate
60-100
Geriatric Heart Rate
80-100
Pediatric Assessment Triangle
Appearance, Work of Breathing, Circulation. Quick assessment tool (less than 30 sec)
Pregnant Spinal Immobilization
To avoid Supine Hypotensive Syndrome; Left Lateral Recumbent
Pediatric Spinal Immobilization
Pad voids around PT; neck especially. Do not press down on head if in carseat; pad sides only.
Geriatric Spinal Immobilization
Be wary of fragile bones, voids
Anatomical Differences in Pediatrics
Smaller airway, tongue larger in ratio to pharynx than adult, smaller reserve of everything (blood volume, O2, electrolytes, glucose, homeostasis), more flexible (don’t break bones as often), compensate better but for a shorter time and decompensate quicker, more susceptible to febrile seizure, weaker
immune system
Indications for suctioning a newborn
Meconium (suction aggressively), amniotic fluid after birth, anything in airway
Expected Anatomical Physiological Changes for First Trimester
Menstruation ceases, increased fluid in uterus, hormone changes, ectopic pregnancy
Expected Anatomical Physiological Changes for Second Trimester
Decreased depth of breathing/increased respirations, increased blood volume, increased urination, uterus is at/above belly button; increases danger of fetal injury.
Expected Anatomical Physiological Changes for Third Trimester
Mother’s heart rate increases up to 20% or 20 beats more/minute, cardiac output significantly increased, increased chance of cardiac complications, GI tract under pressure causes increased chance of vomiting, joints less stable and increased bodyweight causes increased chance of falling
Dysfunctional bleeding in a Pregnant Patient
Ectopic pregnancy, abruptio placenta, placenta previa, miscarriage (spontaneous abortion)
Dysfunctional pregnant bleeding Tx
Shock, left side, hi flow O2, sterile pad, transport
Meningitis Signs/Symptoms
Stiff neck in children (stretches meninges; causes pain), fever, ALOC (mild/severe headache, lethargy, confusion, inability to understand commands/interact appropriately), child may experience seizure, infants younger than 2 to 3 months can have apnea, cyanosis, fever, distinct high-pitched cry, hypothermia. Infants may have bulging fontanelle without crying, irritability when being handled. All Pediatric PTs with possible meningitis should be considered highly contagious (if in close contact (airway), antibiotics).
Pathophysiology of a Febrile Seizure
Most common in ages 6mo-6y/o, usually generalized tonic-clonic seizures that last less than 15 min and has short/no post-dictal state. Can be a sign of a more serious problem like Meningitis.
Febrile Seizure Tx
ABCs, cool with tepid (room temp) water. Cool until PT begins to shiver. Transport.
First stage of Delivery
Dilation of cervix (positioning of baby into birth canal)
Second stage of Delivery
Delivery of baby
Third stage of Delivery
Delivery of placenta
Abruptio Placenta Signs/Symptoms
Vaginal bleeding, signs of shock
Abruptio Placenta Tx
O2, apply sterile pad, Transport ASAP
Placenta Previa Signs/Symptoms
Placental presentation
Placenta Previa Tx
Transport ASAP
cardiac arrest situations for the pediatric population
Absence of central pulse indicates CPR
Treating a child with foreign body airway obstruction
Encourage coughing, provide O2 NRB if tolerated, abdominal thrusts if severe.
Depth of chest compressions; infant
1/3 diameter; about 1.5″
Depth of chest compressions; child
1/3 diameter; about 2″
See Saw Respirations
chest and abdominal muscles alternately contract
Treating a cyanotic newborn
Blow-by O2
Complications from newborn respiratory arrest
Cardiac arrest. BVM at 40-60 breathes/min
Indications for resuscitation of a newborn
Heartrate is most important; RR, skin color, movement of extremities.
Special considerations for obtaining vital signs
Brachial artery/umbilical; increased normal rates
Treatment for a pulseless extremity
Do not use specialized splinting equipment i.e. traction unless PT is large enough
Special considerations for the pediatric airway
Smaller, tongue larger, head must be lower if PT supine to be open
Pathophysiology of Pediatric abnormal breath sounds
Grunting; “Uh” sound during exhalation; indicative of inadequate oxygenation.
Treating a child with a toxic ingestion
Call Hazmat, poison control; find out what substance was.
Assessing a dehydrated infant
Ask how many wet diapers vs. normal
Treating an infant with respiratory distress
Do NOT put anything in their mouth
Signs and symptoms of an upper airway infection
Tripoding, drooling (epiglottitis)
Purpura
purple/red discolorations (meningitis)
Pathophysiology of a febrile seizure
Typically occur on first day of febrile illness, last less than 15 min, short/no postictal state
Treating a postictal child
Check airway, cool with tepid water, c-spine, O2, transport, check BS, check temp