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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:
- A. provide supportive care and transport.
- B. give him acetaminophen or ibuprofen.
- C. begin rapid cooling measures at once.
- D. allow the mother to take her child to the doctor.
Correct Answer: A
Rationale: After a febrile seizure, the recommended course of action is to provide supportive care and transport the child to a medical facility. Supportive care may include ensuring a safe environment, monitoring the child, and seeking medical evaluation to determine the underlying cause of the seizure and appropriate management.
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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:
- A. hypotension.
- B. combativeness.
- C. convulsions.
- D. respiratory distress.
Correct Answer: C
Rationale: In a 7-year-old child with altered mental status, high fever, and a generalized rash, the most critical concern is the potential for convulsions. These symptoms could indicate a serious underlying condition, such as a febrile seizure or another type of seizure activity. Monitoring for convulsions is crucial during transport to ensure prompt intervention if they occur, as seizures can lead to additional complications and require immediate management.
A 3-year-old child has a sudden onset of respiratory distress. The mother denies any recent illnesses or fever. You should suspect:
- A. croup.
- B. foreign body airway obstruction.
- C. lower respiratory infection.
- D. epiglottitis.
Correct Answer: B
Rationale: In a 3-year-old child with a sudden onset of respiratory distress and no recent illnesses or fever, the likely cause is a foreign body airway obstruction. Foreign body obstruction can lead to sudden respiratory distress without other preceding symptoms. It is crucial to consider this possibility and act promptly to clear the airway in such cases to prevent serious complications.
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:
- A. determining if the child has a history of croup.
- B. preparing to treat her for a febrile seizure.
- C. assessing the need for ventilation assistance.
- D. taking her temperature to see how high it is.
Correct Answer: C
Rationale: In a child with increased work of breathing, a high-pitched sound during inhalation, and a high fever, upper airway obstruction should be suspected. The child's condition may require immediate ventilation assistance to ensure adequate oxygenation and ventilation. Therefore, the most immediate concern in this scenario is to assess the need for ventilation assistance.
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:
- A. begin positive-pressure ventilations and reassess the child.
- B. lower the extremities and reassess the child.
- C. listen to the lungs with a stethoscope for abnormal breath sounds.
- D. insert a nasopharyngeal airway and increase the oxygen flow.
Correct Answer: B
Rationale: When the work of breathing increases after elevating the legs, it is important to lower the extremities. Elevating the lower extremities in a child with signs of shock can worsen the condition by reducing venous return to the heart. Lowering the extremities can help improve venous return and potentially alleviate the increased work of breathing.
What is the MOST common cause of shock in infants and children?
- A. Severe allergic reaction
- B. Dehydration
- C. Accidental poisoning
- D. Cardiac failure
Correct Answer: B
Rationale: Dehydration is the most common cause of shock in infants and children. In children, the body's fluid reserves are smaller compared to adults, making them more susceptible to dehydration, which can lead to shock if not promptly addressed. Severe allergic reactions, accidental poisoning, and cardiac failure can also cause shock, but dehydration is the most frequent cause in this age group.