Nokea
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.
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When ventilating an apneic 3-year-old child with a bag-valve mask device, what is the MOST important action to take?
- A. Avoid hyperventilation and ensure adequate chest rise.
- B. Squeeze the bag with both hands and use a pediatric mask.
- C. Immediately insert an oropharyngeal airway.
- D. Provide one breath every 3 to 5 seconds.
Correct Answer: A
Rationale: When ventilating an apneic child, the most important action is to avoid hyperventilation and ensure adequate chest rise. Hyperventilation can lead to decreased cardiac output and increased intracranial pressure. Adequate chest rise confirms effective ventilation and minimizes the risk of complications. Choice B is incorrect because using both hands to squeeze the bag may not ensure proper ventilation and can lead to complications. Choice C is incorrect as inserting an oropharyngeal airway is not the initial action in ventilating an apneic child with a bag-valve mask. Choice D is incorrect as providing ventilations every 3 to 5 seconds may not be appropriate for effective ventilation in a pediatric patient.
After attaching the AED to a 7-year-old child in cardiac arrest, you push the analyze button and receive a shock advised message. After delivering the shock, you should:
- A. assess for a carotid pulse.
- B. open the airway and ventilate.
- C. immediately perform CPR.
- D. reanalyze the cardiac rhythm.
Correct Answer: C
Rationale: After delivering a shock, it is crucial to immediately resume CPR. CPR helps circulate oxygenated blood to vital organs until the AED prompts you to stop for further rhythm analysis. This continuous cycle of CPR and defibrillation maximizes the chances of restoring a normal cardiac rhythm and improving the child's chances of survival. Assessing for a carotid pulse is not necessary after a shock as pulse checks are often unreliable during resuscitation. Opening the airway and ventilating is not the immediate step after delivering a shock as CPR takes precedence. Reanalyzing the cardiac rhythm should be done only when prompted by the AED after a set period of CPR.
Which of the following clinical signs would MOST suggest acute respiratory distress in a 2-month-old infant?
- A. Heart rate of 130 beats/min
- B. Respiratory rate of 30 breaths/min
- C. Abdominal breathing
- D. Grunting respirations
Correct Answer: D
Rationale: Grunting respirations are a key clinical sign of acute respiratory distress in infants. Grunting is a protective mechanism where the infant exhales against a partially closed glottis to increase functional residual capacity and oxygenation. This is often seen in conditions such as respiratory distress syndrome, pneumonia, or other causes of respiratory compromise in infants. Monitoring respiratory patterns like grunting is crucial for early recognition and intervention in infants with respiratory distress. Choices A, B, and C are less specific to acute respiratory distress in infants. While an elevated heart rate and respiratory rate can be present in respiratory distress, grunting respirations are a more direct indicator of significant respiratory compromise in infants.
Which of the following is an abnormal finding when assessing the abdomen of a newborn?
- A. The umbilical cord has two arteries and one vein.
- B. The presence of green vomit.
- C. The liver is palpable 1 to 2 cm below the costal margin.
- D. The abdomen is soft and nondistended.
Correct Answer: B
Rationale: The correct answer is B. The presence of green vomit in a newborn is an abnormal finding and indicates a possible intestinal obstruction. This finding requires immediate attention and further investigation. Choices A, C, and D are normal findings in a newborn's abdomen assessment. A newborn typically has an umbilical cord with two arteries and one vein, a liver that may be palpable 1 to 2 cm below the costal margin due to its normal size in a neonate, and a soft, nondistended abdomen as expected in healthy newborns.
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.