Child CPR (1 of 2)

• Place child on firm surface and maintain airway with one hand.

• Place heel of other hand over lower half of the sternum.– Avoid the xiphoid process.

• Compress chest 1/3 to 1/2 the depth of the chest at a rate of 100/min.

Child CPR (2 of 2)

• Coordinate compressions with ventilations in a 30:2 ratio for one rescuer, 15:2 for two rescuers, pausing for ventilations.

• Reassess for breathing and pulse after every 2 minutes of CPR.

• If the child resumes effective breathing, place child in recovery position.

AED Use in Children (1 of 2)

• Can be safely used in children older than 1 year of age

• Use pediatric-sized pads and a dose-attenuating system for children 1-8 years old.– If not available, use adult AED.

• AED is not indicated for use in infants less than 1 year of age.

AED Use in Children (2 of 2)

• AED should be applied to children over 1 year of age after the first 2 minutes of CPR.

• After 2 minutes of CPR, AED is used to deliver shocks in the same manner as with an adult patient.

Trauma (1 of 2)

Extremity injuries in children are generally managed in the same manner as those in adults.

Trauma (2 of 2)

• Be alert for airway problems on all children with traumatic injuries.

• Give supplemental oxygen to all children with possible:– Head injuries– Chest injuries– Abdominal injuries– Shock

• If ventilation is required, provide at 20 breaths/min.

Immobilization

• Any child with a head or back injury should be immobilized.

• Young children may need padding beneath their torso.

• Children may need padding along the sides of the backboard.

Immobilization in a Child Safety Seat

• Assess child for injuries and seat for visible damage.

• If child is injured or seat is damaged, remove child to another transport device

• Apply padding around child to minimize movement.

• Move seat to ambulance and secure according to the manufacturer’s instructions.

Removing a Child froma Child Safety Seat

• Remove both the child and the seat from the vehicle.

• Place immobilization device behind the child.

• Slide child into place on device.

Signs and Symptomsof Respiratory Emergencies• Nasal flaring• Grunting respirations• Use of accessory muscles• Retractions of rib cage• Tripod position in older

children

Emergency Care

• Provide supplemental oxygen in the most comfortable manner.

• Place child in position of comfort.– This may be in caregiver’s lap.

• If patient is in respiratory failure, begin assisted ventilation immediately.– Continue to provide supplemental

oxygen.

Shock

• Circulatory system is unable to deliver sufficient blood to organs.

• Many different causes• Patients may have increased heart rate,

respirations, and pale or mottled skin.• Children do not show decreased blood

pressure until shock is severe.

Assessing Circulation

• Pulse: Above 160 beats/min suggests shock

• Skin signs: Assess temperature and moisture

• Capillary refill: Is it delayed?• Color: Is skin pink, pale, ashen, or

mottled?

Emergency Medical Carefor Shock

• Ensure airway.• Give supplemental oxygen.• Provide immediate transport.• Continue monitoring vital

signs en route.• Contact ALS for backup as

needed.

Seizures

• May present in several different ways • A postictal period of extreme fatigue or

unresponsiveness usually follows seizure.

• Be alert to presence of medications, poisons, and possible abuse.

Febrile Seizures

• Febrile seizures are most common in children from 6 months to 6 years.

• Febrile seizures are caused by fever.• Generally last less than 15 minutes• Assess ABCs and begin cooling

measures.• Provide prompt transport.

Emergency Medical Careof Seizures (1 of 2)

• Perform initial assessment, focusing on the ABCs.

• Securing and protecting the airway is the priority.

• Place patient in the recovery position.• Be ready to suction.

Emergency Medical Careof Seizures (2 of 2)

• Deliver oxygen by mask, blow-by, or nasal cannula.

• Begin BVM ventilation if no signs of improvement.

• Call ALS for backup if appropriate.

Dehydration• Determine if child is vomiting or has

diarrhea and for how long.• “How many wet diapers has the child

had during the day?” (6 to 10 is normal)• “What fluids are the child taking?”• “What was the child’s weight before the

symptoms started?”• “Has the child been normally active?”

Emergency Medical Carefor Dehydration

• Assess the ABCs.

• Obtain baseline vital signs.

• ALS backup may be needed for IV administration.

Review

1. The pediatric assessment triangle (PAT) is used to:

A. rapidly categorize a pediatric patient’s problem as being medical or trauma in nature.

B. assess an infant’s or child’s vital functions by performing a rapid hands-on physical exam.

C. rapidly form a general impression of an infant’s or child’s condition without touching him or her.

D. determine a pediatric patient’s level of consciousness and make a rapid transport decision.

Review

Answer: C

Rationale: The pediatric assessment triangle (PAT) is a structured assessment tool that allows you to rapidly form a general impression of an infant’s or child’s condition without touching him or her. The intent of the PAT is to provide a “first glance” assessment to identify the general category of the child’s physiologic problem and establish urgency for treatment and/or transport. The PAT—which consists of assessing appearance, work of breathing, and skin circulation—is a visual assessment of the child before performing a hands-on assessment.

Review (1 of 2)

1. The pediatric assessment triangle (PAT) is used to:

A. rapidly categorize a pediatric patient’s problem as being medical or trauma in nature.

Rationale: This allows the provider to rapidly form a general impression.B. assess an infant’s or child’s vital functions by performing a rapid hands-

on physical exam. Rationale: PAT is a from-the-door approach that occurs without touching

the patient.

Review (2 of 2)

1. The pediatric assessment triangle (PAT) is used to:

C. rapidly form a general impression of an infant’s or child’s condition without touching him or her.

Rationale: Correct answerD. determine a pediatric patient’s level of consciousness and make a rapid

transport decision.Rationale: This allows providers to categorize the pediatric patient’s

physiologic problem and establish the urgency for treatment and transport.

Review

2. You should position an unresponsive 2-year-old child’s airway by:

A. hyperextending the head to align the airway.B. hyperflexing the head to prevent obstruction.C. placing the head in a slightly flexed position.D. placing the head in a neutral sniffing position.

Review

Answer: D

Rationale: Position a child's airway in a neutral sniffing position. This accomplishes two goals at once. It keeps the trachea from kinking when the neck is hyperextended or flexed, and it maintains the proper alignment if you have to immobilize the spine.

Review2. You should position an unresponsive 2-year-old child’s airway by:

A. hyperextending the head to align the airway.Rationale: This will kink the airway and cause an obstruction.B. hyperflexing the head to prevent obstruction.Rationale: This will kink the airway and cause an obstruction.C. placing the head in a slightly flexed position.Rationale: This will kink the airway and cause an obstruction.D. placing the head in a neutral sniffing position.Rationale: Correct answer

Review

3. A 6-year-old boy presents with severe respiratory distress. His level of consciousness is markedly decreased and his respirations are 40 breaths/min with reduced tidal volume. You should:

A. apply oxygen with a pediatric nonrebreathing mask.B. begin assisting his ventilations with a bag-mask

device.C. assess his oxygen saturation level with a pulse

oximeter. D. put him in a position that facilitates breathing and

give blow-by oxygen.

Review

Answer: B

Rationale: As evidenced by his decreased level of consciousness, respiratory distress, and reduced tidal volume (shallow breathing), this child is not breathing adequately and needs some form of positive-pressure ventilation. Use a bag-mask device and assist ventilations with 100% oxygen. Remember that respiratory failure is the most common cause of cardiac arrest in the pediatric population.

Review3. A 6-year-old boy presents with severe respiratory distress. His level of

consciousness is markedly decreased and his respirations are 40 breaths/min with reduced tidal volume. You should:

A. apply oxygen with a pediatric nonrebreathing mask.Rationale: The patient is in respiratory failure. Ventilations need to be

assisted.B. begin assisting his ventilations with a bag-mask device.Rationale: Correct answerC. assess his oxygen saturation level with a pulse oximeter. Rationale: Assisted ventilations must be initiated. Oxygen saturation can

be determined while ventilations take place.D. put him in a position that facilitates breathing and give blow-by oxygen. Rationale: The patient needs assisted ventilations.

Review

4. Your assessment of a newborn’s heart rate reveals that it is 80 beats/min. You should:

A. transport immediately.B. begin chest compressions.C. aggressively warm the newborn.D. begin positive-pressure ventilations.

Review

Answer: D

Rationale: If a newborn's heart rate falls below 100 beats/min, you must initiate positive-pressure ventilations with a bag-mask device and high-flow oxygen. Bradycardia in the pediatric patient is an indicator of significant hypoxemia. If the newborn’s heart rate falls below 60 beats/min, you must begin chest compressions as well.

Review4. Your assessment of a newborn’s heart rate reveals that it is 80

beats/min. You should:

A. transport immediately.Rationale: Positive pressure ventilations are initiated if the heart rate

falls below 100 beats/min.B. begin chest compressions.Rationale: Chest compressions are started if the heart rate falls below

60 beats/min, despite adequate ventilations.C. aggressively warm the newborn.Rationale: Warming is done upon delivery of the newborn. Ventilations

must take place when a newborn’s heart rate is below 100 beats/min.

D. begin positive-pressure ventilations.Rationale: Correct answer

Review

5. When performing two-rescuer CPR on an infant, you should:

A. use your thumbs to compress the chest. B. compress the chest to a depth of 2 inches. C. deliver each rescue breath over 2 seconds. D. use a compression to ventilation ratio of 30:2.

Review

Answer: A

Rationale: When performing two-rescuer infant CPR, use a compression to ventilation ratio of 15:2 (30:2 for one rescuer). Compress the chest using the two thumb-encircling hands technique, at a depth equal to one-third to one-half the depth of the chest. Deliver each rescue breath over a period of 1 second—just enough to produce visible chest rise.

Review5. When performing two-rescuer CPR on an infant, you should:

A. use your thumbs to compress the chest. Rationale: Correct answerB. compress the chest to a depth of 2 inches. Rationale: The depth is ⅓ to ½ the depth of the infant’s chest.C. deliver each rescue breath over 2 seconds. Rationale: Breaths are delivered over a period of 1 second.D. use a compression to ventilation ratio of 30:2. Rationale: The compression to ventilation ratio is 15:2.

Review

6. You respond to a sick child late at night. The child appears very ill, has a high fever, and is drooling. He is sitting in a tripod position, struggling to breathe. You should suspect:

A. croup.B. pneumonia.C. epiglottitis. D. severe asthma.

Review

Answer: C

Rationale: This child has all the classic signs of epiglottitis: high fever, drooling, and severe respiratory distress. Epiglottitis is a potentially life-threatening bacterial infection that causes the epiglottis to swell rapidly and potentially obstruct the airway.

Review6. You respond to a sick child late at night. The child appears very ill, has a

high fever, and is drooling. He is sitting in a tripod position, struggling to breathe. You should suspect:

A. croup.Rationale: This is a viral disease characterized by edema of the upper

airways, a barking cough, and stridor.B. pneumonia.Rationale: This is an inflammation of the lungs caused by bacteria, viruses,

fungi, and other organisms. C. epiglottitis. Rationale: Correct answerD. severe asthma. Rationale: This is a lower airway condition resulting in intermittent

wheezing and excess mucus production.

Review

7. Treatment for an semiconscious child who swallowed an unknown quantity of pills includes:

A. administering 1 g/kg of activated charcoal and rapidly transporting.

B. monitoring the child for vomiting, administering oxygen, and transporting.

C. positioning the child on his left side, elevating his legs 6”, and transporting.

D. contacting medical control and requesting permission to induce vomiting.

Review

Answer: B

Rationale: If a semi- or unconscious child has ingested pills, poisons, or any other type of harmful substance, closely observe him or her for vomiting, give high-flow oxygen (assist ventilations if necessary), and rapidly transport to the emergency department. Do not give activated charcoal to any patient who is not conscious and alert enough to swallow. Induction of vomiting is not indicated for anyone—regardless of age.

Review (1 of 2)

7. Treatment for an semiconscious child who swallowed an unknown quantity of pills includes:

A. administering 1 g/kg of activated charcoal and rapidly transporting. Rationale: Do not give anything by mouth to an individual who is not

conscious and alert enough to swallow.B. monitoring the child for vomiting, administering oxygen, and

transporting. Rationale: Correct answer

Review (2 of 2)

7. Treatment for an semiconscious child who swallowed an unknown quantity of pills includes:

C. positioning the child on his left side, elevating his legs 6”, and transporting.

Rationale: Placing the child in the recovery position is acceptable if vomiting is possible, but the patient’s legs should remain flat.

D. contacting medical control and requesting permission to induce vomiting.

Rationale: Inducing vomiting is not indicated for anyone at any age.

Review8. A 4-year-old girl fell from a second-story balcony and landed on her

head. She is unresponsive; has slow, irregular breathing; a large hematoma to the top of her head; and is bleeding from her nose. You should:

A. immediately perform a rapid trauma assessment to detect other life-threatening injuries, administer high-flow oxygen, and transport at once.

B. apply a pediatric-sized cervical collar, administer high-flow oxygen via pediatric nonrebreathing mask, and prepare for immediate transport.

C. manually stabilize her head, open her airway with the jaw-thrust maneuver, insert an airway adjunct, and begin assisting her ventilations with a bag-mask device.

D. suction her airway for up to 10 seconds, insert a nasopharyngeal airway, apply a pediatric-sized cervical collar, and administer oxygen via pediatric nonrebreathing mask.

Review

Answer: C

Rationale: This child has a severe head injury and is not breathing adequately. You must manually stabilize her head to protect her spine, open her airway with the jaw-thrust maneuver, suction her airway if needed, insert an oropharyngeal airway, and assist her ventilations with a bag-mask device. The rapid trauma assessment is performed after you have performed an initial assessment and corrected any life threats. The nasopharyngeal airway is contraindicated for this child; she has a head injury and is bleeding from her nose.

Review (1 of 2)

8. A 4-year-old girl fell from a second-story balcony and landed on her head. She is unresponsive; has slow, irregular breathing; a large hematoma to the top of her head; and is bleeding from her nose. You should:

A. immediately perform a rapid trauma assessment to detect other life-threatening injuries, administer high-flow oxygen, and transport at once.

Rationale: A rapid trauma exam is performed after the initial assessment and life-threats are corrected.

B. apply a pediatric-sized cervical collar, administer high-flow oxygen via pediatric nonrebreathing mask, and prepare for immediate transport.

Rationale: Assisted ventilations must be started on a patient with slow, irregular respirations.

Review (2 of 2)

8. A 4-year-old girl fell from a second-story balcony and landed on her head. She is unresponsive; has slow, irregular breathing; a large hematoma to the top of her head; and is bleeding from her nose. You should:

C. manually stabilize her head, open her airway with the jaw-thrust maneuver, insert an airway adjunct, and begin assisting her ventilations with a bag-mask device.

Rationale: Correct answerD. suction her airway for up to 10 seconds, insert a nasopharyngeal

airway, apply a pediatric-sized cervical collar, and administer oxygen via pediatric nonrebreathing mask.

Rationale: A nasopharyngeal airway is contraindicated with potential facial injuries. Ventilations need to be maintained with a bag-mask device.

Review

9. A child with severe croup would MOST likely present with:

A. a high fever, difficulty breathing, and wheezing. B. a low-grade fever, respiratory distress, and stridor.C. a high fever, chest congestion, and respiratory

distress. D. an absence of fever, drooling, and difficulty

breathing.

Review

Answer: B

Rationale: Croup—also called laryngotracheobronchitis—is a viral infection of the upper airway. It is characterized by a slow onset of low-grade fever, a seal-bark cough, and varying degrees of respiratory distress. In severe cases, airway swelling may be so severe that the child has stridor—a high-pitched sound heard during inhalation. Wheezing—a whistling sound heard while auscultating the lungs—indicates a lower airway problem (ie, asthma, bronchiolitis), not croup.

Review9. A child with severe croup would MOST likely present with:

A. a high fever, difficulty breathing, and wheezing. Rationale: Wheezing indicates a lower airway condition (ie, asthma,

bronchiolitis).B. a low-grade fever, respiratory distress, and stridor.Rationale: Correct answerC. a high fever, chest congestion, and respiratory distress. Rationale: Croup is an upper airway condition not associated with

chest congestion.D. an absence of fever, drooling, and difficulty breathing. Rationale: The child will have a low-grade fever and possibly stridor in

severe cases.

Review10. A 7-year-old boy is apneic and pulseless, possibly due to an ingestion

of his father’s high blood pressure medication. You should:A. analyze his cardiac rhythm with the AED after 5 minutes of high-quality

CPR, deliver up to 3 shocks in a row, and then resume CPR. B. perform CPR, avoid the use of the AED since the child’s cardiac arrest

was likely caused by a toxic ingestion, and transport immediately. C. apply the AED and immediately deliver a shock, begin high-quality CPR,

and then contact medical control for further direction. D. begin CPR, apply the AED, analyze his cardiac rhythm after 2 minutes,

defibrillate one time if indicated, and immediately resume CPR.

Review

Answer: D

Rationale: The treatment sequence for a child in cardiac arrest is no different from that of an adult. Begin CPR, apply the AED, analyze the child’s cardiac rhythm after 2 minutes, defibrillate one time if indicated, and immediately resume CPR starting with chest compressions. If you suspect a toxic ingestion, ask the parent to retrieve any medication bottles and bring them with you to the hospital.

Review (1 of 2)

10. A 7-year-old boy is apneic and pulseless, possibly due to an ingestion of his father’s high blood pressure medication. You should:

A. analyze his cardiac rhythm with the AED after 5 minutes of high-quality CPR, deliver up to 3 shocks in a row, and then resume CPR.

Rationale: Perform quality CPR for 2 minutes, analyze the rhythm with an AED, and deliver 1 shock if indicated.

B. perform CPR, avoid the use of the AED since the child’s cardiac arrest was likely caused by a toxic ingestion, and transport immediately.

Rationale: After 2 minutes of quality CPR, deliver 1 shock with an AED if indicated.

Review (2 of 2)

10. A 7-year-old boy is apneic and pulseless, possibly due to an ingestion of his father’s high blood pressure medication. You should:

C. apply the AED and immediately deliver a shock, begin high-quality CPR, and then contact medical control for further direction.

Rationale: Provide 2 minutes of quality CPR, initiated before a shock is delivered.

D. begin CPR, apply the AED, analyze his cardiac rhythm after 2 minutes, defibrillate one time if indicated, and immediately resume CPR.

Rationale: Correct answer