Pediatric Medical Emergencies - NREMT AEMT Level

1. Which condition is suggested by a barking cough and inspiratory stridor in a young child?

   Croup (laryngotracheobronchitis). Viral inflammation of the upper airway produces characteristic subglottic edema, leading to the seal-like cough and high-pitched stridor during inspiration.

2. What is the most common cause of cardiac arrest in pediatric patients?

   Respiratory failure or shock resulting in hypoxia. Unlike adults, children's cardiac arrests typically result from systemic hypoxia secondary to respiratory or circulatory compromise rather than primary cardiac events.

3. Which condition is suggested by wheezing, prolonged expiration, and a history of asthma?

   Acute asthma exacerbation. Bronchospasm from triggers causes airway narrowing, manifesting as expiratory wheezing and extended expiratory phase in patients with known reactive airway disease.

4. Identify the correct epinephrine volume for a $20\ \text{kg}$ child using $1\ \text{mg/mL}$ IM.

   $0.2\ \text{mL IM}$. For a 20 kg child, the 0.01 mg/kg dose calculates to 0.2 mg, which equates to 0.2 mL of the 1 mg/mL concentration for intramuscular administration.

5. What is the preferred positioning to open an infant airway without hyperextension?

   Neutral sniffing position (pad under shoulders if needed). Infants' larger occiputs cause natural neck flexion, so shoulder padding helps achieve optimal airway alignment without risking spinal injury.

6. What is the primary concern with a febrile child who has a stiff neck and altered mental status?

   Meningitis (possible sepsis). These symptoms indicate meningeal irritation and potential central nervous system infection, often progressing to sepsis if untreated.

7. What is the preferred initial medication for anaphylaxis with respiratory distress or shock?

   Intramuscular epinephrine. It rapidly reverses life-threatening histamine-mediated effects like bronchospasm and hypotension by stimulating alpha and beta receptors.

8. Which ingestion toxidrome is suggested by miosis, bradycardia, bronchorrhea, and wheezing?

   Cholinergic poisoning (organophosphates/carbamates). Excessive acetylcholine from acetylcholinesterase inhibition produces muscarinic effects like pupil constriction, slowed heart rate, secretions, and bronchoconstriction.

9. Which triad most strongly suggests diabetic ketoacidosis in a child?

   Hyperglycemia, dehydration, and Kussmaul respirations. Insulin deficiency leads to elevated blood sugar, osmotic diuresis causing dehydration, and metabolic acidosis prompting deep, rapid breathing for compensation.

10. What is the most common cause of respiratory arrest in infants and children?

    Progressive respiratory failure (hypoxia) leading to arrest. In pediatric patients, untreated hypoxia from respiratory distress commonly progresses to complete respiratory arrest due to immature compensatory mechanisms.

11. What is the most appropriate prehospital treatment priority for suspected pediatric DKA?

    Airway/ventilation support and isotonic fluid per protocol. Addressing hypoxia and hypovolemia stabilizes the patient, as aggressive fluid resuscitation corrects dehydration while avoiding cerebral edema risks.

12. What is the first-line treatment for a febrile seizure that is actively convulsing?

    Support airway and ventilation; administer a benzodiazepine per protocol. Prioritizing oxygenation prevents hypoxia-induced complications, while benzodiazepines terminate prolonged seizures to reduce metabolic demand and injury risk.

13. Which breath sound finding is most consistent with bronchiolitis in an infant?

    Diffuse wheezing and/or crackles with increased work of breathing. Viral infection causes small airway inflammation and mucus production, leading to adventitious sounds and compensatory increased respiratory effort in young infants.

14. What is the correct first action for a conscious child with severe airway obstruction?

    Abdominal thrusts (Heimlich maneuver). For children over one year, subdiaphragmatic thrusts generate intra-abdominal pressure to expel obstructions from the airway effectively and safely.

15. Which finding best distinguishes compensated shock from decompensated shock in children?

    Hypotension indicates decompensated shock. Children maintain blood pressure through compensatory mechanisms like tachycardia until late stages, where hypotension signifies failure of these mechanisms.

16. Which pediatric assessment finding is a late sign of hypoxia and impending failure?

    Bradycardia. In children, initial tachycardia compensates for hypoxia, but bradycardia signals myocardial depression and imminent cardiorespiratory collapse.

17. What is the correct first action for a conscious infant with severe airway obstruction?

    Alternate 5 back slaps and 5 chest thrusts. This sequence applies manual force to dislodge foreign bodies in infants under one year, alternating methods to maximize efficacy without abdominal injury risk.

18. Which anatomic feature makes infants more prone to airway obstruction than adults?

    Relatively larger tongue in a smaller oral cavity. This anatomical disproportion increases the likelihood of the tongue falling back and blocking the airway, particularly in unconscious or supine positions.

19. Which condition is suggested by sudden onset stridor or cough during eating or play?

    Foreign body airway obstruction. Sudden aspiration during activities involving small objects or food can partially or completely obstruct the airway, triggering immediate protective reflexes.

20. What is the pediatric intramuscular epinephrine dose for anaphylaxis using $1:1{,}000$?

    $0.01\ \text{mg/kg IM}$ (maximum $0.3\ \text{mg}$ per dose). This weight-based dosing ensures effective alpha and beta adrenergic stimulation to counteract severe allergic reactions without exceeding safe limits in children.

21. Which glucose value defines hypoglycemia in a symptomatic pediatric patient for EMS care?

    Blood glucose $<60\ \text{mg/dL}$. This threshold identifies clinically significant hypoglycemia requiring intervention to prevent neurological sequelae in children exhibiting symptoms.

22. What is the key prehospital airway priority when epiglottitis is suspected?

    Avoid agitation; provide oxygen and prepare for airway failure. Minimizing stress prevents further airway swelling, while oxygen supports hypoxemia and readiness anticipates rapid deterioration requiring intervention.

23. Which condition is suggested by drooling, dysphagia, and tripod positioning with fever?

    Epiglottitis. Bacterial infection causes supraglottic swelling, resulting in painful swallowing, drooling to avoid irritation, and positional relief to maintain airway patency.

24. Calculate the crystalloid bolus volume for a $15\ \text{kg}$ child at $20\ \text{mL/kg}$.

    $300\ \text{mL}$. Multiplying the child's weight by the per-kilogram rate yields the appropriate bolus to improve perfusion without exceeding standard protocol limits.

25. What is the recommended pediatric crystalloid bolus for hypovolemic shock (typical EMS protocol)?

    $20\ \text{mL/kg}$ isotonic crystalloid, reassess after each bolus. This volume restores intravascular fluid deficits in hypovolemia, with reassessment preventing overload and guiding further boluses based on response.

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