Nokea
Following the initial steps of resuscitation, a newborn remains apneic and cyanotic. What should you do next?
- A. begin ventilations with a bag-mask device.
- B. gently flick the soles of their feet for up to 60 seconds.
- C. immediately suction their mouth and nose.
- D. start CPR if the heart rate is less than 80 beats/min.
Correct Answer: A
Rationale: If a newborn remains apneic and cyanotic after the initial resuscitation steps, the next appropriate action is to begin ventilations with a bag-mask device. This helps provide oxygen to the newborn and can be crucial in supporting their respiratory efforts. Option B of flicking the soles of their feet is not recommended in this scenario as the priority is addressing the respiratory distress. Option C of suctioning their mouth and nose is not the immediate next step if the newborn is not spontaneously breathing. Option D of starting CPR based only on the heart rate is not the first-line intervention for an apneic and cyanotic newborn.
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When assessing a 30-year-old female who was sexually assaulted, what is the MOST important action for you to take?
- A. Have a female healthcare provider perform the assessment.
- B. Advise against showering or changing clothes.
- C. Acknowledge that the patient is a potential crime scene.
- D. Ensure that all life-threatening injuries are treated.
Correct Answer: D
Rationale: In cases of sexual assault, the priority is to address any life-threatening injuries first before proceeding with other aspects of care. Although preserving evidence and approaching the situation with sensitivity are crucial, immediate treatment of life-threatening conditions takes precedence to ensure the patient's well-being and safety. Having a female healthcare provider, advising against showering or changing clothes, and acknowledging the patient as a potential crime scene are important but secondary considerations compared to addressing any life-threatening injuries promptly.
Your assessment of a newborn reveals cyanosis to the chest and face and a heart rate of 90 beats/min. What should you do first?
- A. Dry the infant briskly.
- B. Suction the mouth.
- C. Begin artificial ventilations.
- D. Begin chest compressions.
Correct Answer: C
Rationale: In a newborn with cyanosis to the chest and face and a heart rate of 90 beats/min, the priority action is to begin artificial ventilations. A heart rate below 100 beats/min with cyanosis indicates a need for immediate respiratory support to improve oxygenation. Drying the infant briskly or suctioning the mouth may be necessary later but are not the initial priority. Chest compressions are not indicated as the heart rate is above 60 beats/min.
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:
- A. high-flow oxygen via non-rebreathing mask and rapid transport.
- B. assisted ventilation with a bag-mask device and rapid transport.
- C. positive-pressure ventilation, chest compressions, and rapid transport.
- D. back slaps and chest thrusts while attempting artificial ventilations.
Correct Answer: C
Rationale: In a 5-year-old child who is unresponsive with severe bradycardia and bradypnea, the priority is to provide positive-pressure ventilation to support breathing and perform chest compressions to support circulation. This child is in cardiac arrest, and the recommended treatment according to pediatric basic life support guidelines involves a combination of positive-pressure ventilation and chest compressions to maintain oxygenation and circulation. Rapid transport to a medical facility for further advanced care is crucial in this critical situation. Choices A, B, and D are incorrect because high-flow oxygen via non-rebreathing mask, assisted ventilation with a bag-mask device, and back slaps with chest thrusts are not sufficient in a cardiac arrest situation where the child requires immediate positive-pressure ventilation and chest compressions to maintain oxygenation and circulation.
You are dispatched to a residence for a 5-year-old child who is not breathing. Upon arrival, you find the child supine on the floor, cyanotic, and unresponsive. You should first:
- A. begin chest compressions.
- B. open the airway and give two rescue breaths.
- C. apply an AED and analyze the rhythm.
- D. ask the parent for the child's medical history.
Correct Answer: B
Rationale: When encountering an unresponsive and not breathing child, the initial step is to open the airway and provide two rescue breaths. This action helps to deliver oxygen to the child's lungs and body, which is crucial in attempting to restore breathing and circulation. Chest compressions are not initiated first in pediatric cases unless the child has no signs of circulation after delivering rescue breaths. Applying an AED and analyzing the rhythm is not the initial step in a pediatric cardiac arrest scenario, as the primary focus should be on providing oxygenation. Asking the parent for the child's medical history is not the immediate priority when the child is unresponsive and not breathing, as interventions to support breathing and circulation should be the primary concern.
When 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:
- A. indicates decompensated shock.
- B. reflects adequate compensation.
- C. suggests increased intracranial pressure.
- D. is appropriate based on his age.
Correct Answer: A
Rationale: In a 5-year-old boy with major trauma, a blood pressure of 70/40 mm Hg and a pulse rate of 140 beats/min, and weak, indicate decompensated shock. This presentation signifies inadequate perfusion, leading to compensatory mechanisms being overwhelmed, resulting in decompensated shock. Choice B is incorrect as the vital signs suggest the body is unable to adequately compensate for the trauma. Choice C is incorrect as the vital signs are more indicative of shock rather than increased intracranial pressure. Choice D is incorrect as such low blood pressure is not appropriate for a child of this age and indicates a critical condition.