1. 32: Pediatric Assessment and Management

2. 6-1.4Indicate various causes of respiratory emergencies. 6-1.5Differentiate between respiratory distress and respiratory failure. 6-1.6List steps in the management of foreign body airway obstruction. Cognitive Objectives (1 of 3)

3. 6-1.7Summarize EMS care strategies for respiratory distress and respiratory failure. 6-1.8Identify the signs and symptoms of shock (hypoperfusion) in the infant and child patient. 6-1.9Describe the methods of determining end organ perfusion in the infant and child patient. 6-1.10State the usual cause of cardiac arrest in infants and children versus adults. Cognitive Objectives (2 of 3)

4. Cognitive Objectives (3 of 3) 6-1.12Describe the management of seizures in the infant and child patient. 6-1.14Discuss the field management of the infant and child trauma patient. There are no affective objectives for this chapter.

5. Psychomotor Objectives (1 of 2) 6-1.21Demonstrate the techniques of foreign body airway obstruction removal in the infant. 6-1.22 Demonstrate the techniques of foreign body airway obstruction removal in the child. 6-1.23Demonstrate the assessment of the infant and child.

6. Psychomotor Objectives (2 of 2) 6-1.24Demonstrate bag-valve-mask artificial ventilations for the infant. 6-1.25Demonstrate bag-valve-mask artificial ventilations for the child. 6-1.26Demonstrate oxygen delivery for the infant and child.

7. Additional Objectives* Cognitive 1. Describe the steps in positioning an infant and/or child to maintain an open airway. 2. Summarize neonatal resuscitation procedures. Affective None Psychomotor 3. Demonstrate the techniques necessary in neonatal resuscitation. *These are noncurriculum objectives.

8. Pediatric Assessment and Management Caring for sick and injured children presents special challenges. EMT-Bs may find themselves anxious when dealing with critically ill or injured children. Treatment is the same as that for adults in most emergency situations.

9. Scene Size-up Take note of your surroundings. Scene assessment will supplement additional findings. Observe: –Position of the patient –Condition of the home –Clues to child abuse

10. Initial Assessment Begins before you touch the patient Form a general impression. Determine a chief complaint. The Pediatric Assessment Triangle can help.

11. Pediatric Assessment Triangle Appearance –Awake –Aware –Upright Work of breathing –Retractions –Noises Skin circulation

12. Assessing the ABCs Ensure airway is open and position patient. Breathing assessment –Effort –Obstructions –Rate Circulation assessment –Rate –Skin color, temperature, and capillary refill

13. Transport Decision Children under 40 lb should be transported in a child safety seat, if the situation allows. Seat should be secured to the cot or captain’s chair. Cannot be secured to bench seat Child may have to be transported without a seat, depending on condition.

14. Focused History and Physical Exam Should be completed on scene unless severity requires rapid transport Young children should be examined toe to head. Focused exam on noncritical patients Rapid exam on potentially critical patients

15. Vital Signs by Age AgeRespirations (breaths/min) Pulse (beats/min) Systolic Blood Pressure (mm Hg) Newborn: 0 to 1 mo30 to 6090 to 18050 to 70 Infant: 1 mo to 1 yr25 to 50100 to 16070 to 95 Toddler: 1 to 3 yr20 to 3090 to 15080 to 100 Preschool age: 3 to 6 yr20 to 2580 to 14080 to 100 School age: 6 to 12 yr15 to 2070 to 12080 to 110 Adolescent: 12 to 18 yr12 to 1660 to 10090 to 110 Older than 18 yr12 to 2060 to 10090 to 140

16. Respirations Abnormal respirations are a common sign of illness or injury. Count respirations for 30 seconds. In children less than 3 years, count the rise and fall of the abdomen. Note effort of breathing. Listen for noises.

17. Pulse In infants, feel over the brachial or femoral area. In older children, use the carotid artery. Count for at least 1 minute. Note strength of the pulse.

18. Blood Pressure Use a cuff that covers two thirds of the upper arm. If scene conditions make it difficult to measure blood pressure accurately, do not waste time trying.

19. Skin Signs Feel for temperature and moisture. Estimate capillary refill.

20. Detailed Physical Exam and Ongoing Assessment Status changes frequently in children. The PAT can help with reassessment. Repeat vital signs frequently. If child deteriorates, repeat the initial assessment.

21. Care of the Pediatric Airway (1 of 2) Position the airway. Position the airway in a neutral sniffing position. If spinal injury is suspected, use jaw-thrust maneuver to open the airway.

22. Care of the Pediatric Airway (2 of 2) Positioning the airway: –Place the patient on a firm surface. –Fold a small towel under the patient’s shoulders and back. –Place tape across patient’s forehead to limit head rolling.

23. Oropharyngeal Airways Determine the appropriately sized airway. Place the airway next to the face to confirm correct size. Position the airway. Open the mouth. Insert the airway until flange rests against lips. Reassess airway.

24. Nasopharyngeal Airways (1 of 2) Determine the appropriately sized airway. Place the airway next to the face to make certain length is correct. Position the airway. Lubricate the airway.

25. Nasopharyngeal Airways (2 of 2) Insert the tip into the right naris. Carefully move the tip forward until the flange rests against the outside of the nostril. Reassess the airway.

26. Assessing Ventilation Observe chest rise in older children. Observe abdominal rise and fall in younger children or infants. Skin color indicates amount of oxygen getting to organs.

27. Oxygen Delivery Devices Nonrebreathing mask at 10 to 15 L/min provides 90% oxygen concentration. Blow-by technique at 6 L/min provides more than 21% oxygen concentration. Nasal cannula at 1 to 6 L/min provides 24% to 44% oxygen concentration.

28. BVM Devices Equipment must be the right size. BVM device at 10 to 15 L/min provides 90% oxygen concentration. Ventilate at the proper rate and volume. May be used by one or two rescuers

29. One-rescuer BVM Ventilation AB CD

30. Airway Obstruction Croup –A viral infection of the airway below the level of the vocal cords Epiglottitis –Infection of the soft tissue in the area above the vocal cords Foreign body airway obstructions

31. Signs and Symptoms Decreased or absent breath sounds Stridor Retractions Difficulty speaking

32. Signs of Severe Airway Obstruction Signs and symptoms –Ineffective cough (no sound) –Inability to cry –Increasing respiratory difficulty, with stridor –Cyanosis –Loss of consciousness

33. Removing a Foreign Body Airway Obstruction (1 of 5) In an unconscious child: –Place the child on a firm, flat surface. Open airway using head tilt-chin lift maneuver. –Inspect the upper airway and remove any visible object. –Attempt rescue breathing. If unsuccessful, reposition head and try again. –If ventilation is still unsuccessful begin CPR.

34. Removing a Foreign Body Airway Obstruction (2 of 5) Place heel of one hand on lower half of sternum between the nipples. Administer 30 chest compressions at a depth of 1/3 to 1/2 the depth of the chest.

35. Removing a Foreign Body Airway Obstruction (3 of 5) Open airway using head tilt-chin lift maneuver. If you see the object, remove it. Repeat process.

36. Removing a Foreign Body Airway Obstruction (4 of 5) In a conscious child: –Kneel behind the child. –Give the child five abdominal thrusts. –Repeat the technique until object comes out.

37. Removing a Foreign Body Airway Obstruction (5 of 5) If the child becomes unconscious, inspect the airway. Attempt rescue breathing. If airway remains obstructed, begin CPR.

38. Management of Airway Obstruction in Infants Hold the infant facedown. Deliver five back slaps. Bring infant upright on the thigh. Give five quick chest thrusts. Check airway. Repeat cycle as often as necessary.

39. Neonatal Resuscitation Resuscitation measures include: –Positioning airway –Drying –Warming –Suctioning –Tactile stimulation

40. Neonatal Equipment

41. Additional Efforts Deliver chest compressions at 120 per minute. Coordinate chest compressions with ventilations at a ratio of 3:1. If meconium is present, suction infant vigorously.

42. BLS Review Cardiac arrest in children is commonly due to respiratory arrest. Many causes of respiratory arrest For purposes of pediatric BLS: –Infancy ends at 1 year of age. –Childhood extends from 1 year of age to onset of puberty (12 to 14 years of age).

43. Determine Responsiveness Gently tap on shoulder and speak loudly. If responsive, place in position of comfort. If you find an unresponsive child when you are not on duty: –Provide BLS for about 2 minutes. –Then call EMS system.

44. Airway Airway may be obstructed by tongue. Use head tilt-chin lift technique or jaw-thrust maneuver to open the airway. Jaw-thrust maneuver is safer if possibility of neck injury exists.

45. Breathing Look, listen, and feel. Provide rescue breathing if needed. Perform Sellick maneuver to prevent gastric distention.

46. Circulation Assess circulation after airway is open and two rescue breaths have been given. Check for pulses. Evaluate for other signs of circulation. Take at least 5 seconds but not more than 10 seconds trying to find a pulse. If infant or child is not breathing, the pulse is often too slow or absent. CPR will be required.

47. Infant CPR (1 of 2) Place infant on firm surface and maintain airway. Place two fingers in the middle of the sternum. Use two fingers to compress the chest 1/3 to 1/2 the depth of the chest at a rate of 100/min.

48. Infant CPR (2 of 2) Allow sternum to return briefly to its normal position between compressions. Coordinate rapid compressions and ventilations in a 30:2 ratio. Reassess the infant for return of breathing and pulse after every 2 minutes of CPR.

49. 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.

50. 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.

51. 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.

52. 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.

53. Trauma (1 of 2) Extremity injuries in children are generally managed in the same manner as those in adults.

54. 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.

55. 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.

56. 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.

57. Removing a Child from a 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.

58. Signs and Symptoms of Respiratory Emergencies Nasal flaring Grunting respirations Use of accessory muscles Retractions of rib cage Tripod position in older children

59. 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.

60. 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.

61. 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?

62. Emergency Medical Care for Shock Ensure airway. Give supplemental oxygen. Provide immediate transport. Continue monitoring vital signs en route. Contact ALS for backup as needed.

63. 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.

64. 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.

65. Emergency Medical Care of 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.

66. Emergency Medical Care of 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.

67. 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?”

68. Emergency Medical Care for Dehydration Assess the ABCs. Obtain baseline vital signs. ALS backup may be needed for IV administration.

69. 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.

70. 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.

71. 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.

72. 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 answer D. 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.

73. 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.

74. 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.

75. Review 2. 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

76. 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.

77. 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.

78. 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. Rationale: The patient is in respiratory failure. Ventilations need to be assisted. B. begin assisting his ventilations with a bag-mask device. Rationale: Correct answer C. 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.

79. 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.

80. 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.

81. Review 4. 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

82. 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.

83. 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.

84. Review 5. When performing two-rescuer CPR on an infant, you should: A.use your thumbs to compress the chest. Rationale: Correct answer B. 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.

85. 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.

86. 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.

87. 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. 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 answer D. severe asthma. Rationale: This is a lower airway condition resulting in intermittent wheezing and excess mucus production.

88. 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.

89. 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.

90. 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

91. 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.

92. Review 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. 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.

93. 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.

94. 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.

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

96. 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.

97. 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.

98. Review 9. 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 answer C. 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.

99. Review 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. 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.

100. 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.

101. 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.

102. 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