Pediatric Medical and Trauma Emergencies - NREMT Paramedic Level

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

   Respiratory failure leading to hypoxia. In pediatrics, cardiac arrest typically arises from progressive respiratory compromise causing oxygen deprivation to vital organs.

2. What is the preferred airway adjunct for an unconscious child with no gag reflex?

   Oropharyngeal airway (OPA). OPA maintains airway patency in unconscious patients by preventing posterior tongue displacement without triggering reflexes.

3. Which finding most strongly suggests impending respiratory failure in a child with asthma?

   Decreasing mental status with a silent chest. These signs indicate severe airflow obstruction, exhaustion, and hypoxia, signaling imminent respiratory collapse in asthma exacerbations.

4. What is the most common cause of death in pediatric trauma overall?

   Head injury. Head injuries predominate in pediatric trauma mortality due to the vulnerability of the developing brain and skull.

5. What is the preferred fluid for initial pediatric resuscitation in hypovolemic shock?

   Isotonic crystalloid (normal saline or lactated Ringer's). Isotonic crystalloids effectively expand plasma volume and are compatible with pediatric physiology for shock resuscitation.

6. What is the first-line prehospital medication for active pediatric status epilepticus?

   Benzodiazepine (e.g., midazolam or diazepam). Benzodiazepines enhance GABA-mediated inhibition to rapidly terminate prolonged seizure activity in prehospital settings.

7. What is the preferred airway adjunct for a child with an intact gag reflex needing airway support?

   Nasopharyngeal airway (NPA), if not contraindicated. NPA is tolerated in patients with preserved gag reflex as it bypasses the oropharynx and does not stimulate gagging.

8. What is the appropriate prehospital action when child abuse is suspected?

   Treat injuries, document objectively, and report per protocol. EMS protocols mandate patient stabilization, accurate documentation, and mandatory reporting to protect suspected abuse victims.

9. What is the most common cause of pediatric traumatic brain injury death?

   Secondary injury from hypoxia and hypotension. Hypoxia and hypotension exacerbate neuronal damage through ischemia and inflammation following the primary brain trauma.

10. What is the definition of a febrile seizure in a child?

    Seizure with fever, no CNS infection, typically age $6\text{ mo}$ to $5\text{ y}$. Febrile seizures occur due to rapid temperature elevation in neurologically normal children within this age range without infection.

11. What is the most common life-threatening arrhythmia in pediatric cardiac arrest?

    Asystole or pulseless electrical activity (PEA). Pediatric arrests often stem from asphyxia, progressing to non-shockable rhythms rather than ventricular arrhythmias seen in adults.

12. What is the most common type of shock in pediatric trauma patients?

    Hypovolemic (hemorrhagic) shock. Trauma frequently leads to blood loss, resulting in inadequate circulating volume and tissue perfusion in children.

13. What is the immediate treatment for pediatric anaphylaxis with respiratory compromise or hypotension?

    Intramuscular epinephrine. Epinephrine rapidly counters anaphylactic effects through vasoconstriction, bronchodilation, and cardiac stimulation in compromised patients.

14. What is the correct initial airway maneuver for suspected pediatric trauma with possible C-spine injury?

    Jaw-thrust maneuver with manual in-line stabilization. This technique opens the airway without hyperextending the neck, thereby preserving spinal alignment in trauma cases.

15. Which injury pattern should raise strong concern for nonaccidental trauma in an infant?

    Posterior rib fractures. Posterior rib fractures in infants are highly specific for inflicted trauma, often from compressive or shaking forces.

16. What bedside test should be obtained early in any child with unexplained altered mental status?

    Point-of-care blood glucose. Rapid glucose testing identifies reversible hypoglycemia, a frequent cause of altered consciousness in pediatric emergencies.

17. What is the most common cause of altered mental status in infants and young children?

    Hypoglycemia. Low blood sugar impairs cerebral glucose metabolism, commonly causing neurological symptoms in young children.

18. What is the classic presentation of epiglottitis in a child?

    Drooling, dysphagia, tripod posture, and stridor. These symptoms result from acute supraglottic inflammation causing pain, obstruction, and compensatory positioning in epiglottitis.

19. What is the preferred site for intramuscular epinephrine in pediatric anaphylaxis?

    Anterolateral thigh (vastus lateralis). The vastus lateralis provides optimal absorption and accessibility for rapid epinephrine delivery in pediatric emergencies.

20. What is the most appropriate prehospital airway approach for suspected epiglottitis?

    Do not agitate; provide oxygen and prepare for advanced airway. Minimizing agitation prevents exacerbation of swelling, while oxygen support and airway readiness ensure safe management.

21. Which pediatric finding is an early sign of shock before hypotension develops?

    Tachycardia with delayed capillary refill. Children compensate for early shock through increased heart rate and vasoconstriction before blood pressure drops.

22. Calculate the initial crystalloid bolus for a $15\ \text{kg}$ child in shock.

    $300\ \text{mL}$. The bolus is calculated using the standard 20 mL/kg guideline for initial resuscitation in pediatric hypovolemic shock.

23. What is the preferred treatment for pediatric croup with moderate to severe respiratory distress?

    Nebulized epinephrine plus corticosteroid (e.g., dexamethasone). Nebulized epinephrine reduces laryngeal edema, while corticosteroids address underlying inflammation for sustained relief in severe croup.

24. What is the first-line inhaled medication for acute pediatric bronchospasm?

    Inhaled beta-2 agonist (albuterol). Beta-2 agonists like albuterol relax bronchial smooth muscle, rapidly alleviating acute bronchoconstriction in pediatric patients.

25. What is the standard initial crystalloid bolus for pediatric hypovolemic shock?

    $20\ \text{mL/kg}$ isotonic crystalloid. This volume restores intravascular fluid deficits in hypovolemic shock without risking overload in pediatric patients.

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