Pediatric, Geriatric, and Obstetric Patients
Help Questions
NREMT: EMT Level › Pediatric, Geriatric, and Obstetric Patients
A 6-month-old infant is unresponsive and not breathing. The parents state the baby was fine when put down for a nap 2 hours ago. What is the appropriate compression-to-ventilation ratio for CPR?
15 compressions to 2 ventilations using two-thumb encircling hands technique
30 compressions to 1 ventilation using heel of one hand technique
30 compressions to 2 ventilations using two-finger compression technique
15 compressions to 1 ventilation using two-finger compression technique
Explanation
For single-rescuer infant CPR, the ratio is 30:2 using the two-finger technique on the lower half of the breastbone. Choice B uses the wrong ratio (15:2 is for two-rescuer infant CPR). Choice C uses wrong ventilation ratio and compression technique. Choice D combines wrong ratio with potentially correct technique but in wrong context.
An 82-year-old patient complains of chest pain but vital signs are stable. The patient takes multiple medications and has a complex medical history. What is the most important consideration for medication assistance?
Document all current medications first to prevent adverse reactions with assisted medication
Administer half the normal dose due to the patient's advanced age and slower metabolism
Verify the medication belongs to the patient, check expiration date, and confirm proper dosing
Contact medical control immediately to discuss potential drug interactions before assisting
Explanation
The EMT must follow the standard five rights of medication administration: right patient, right medication, right dose, right route, and right time. This includes verifying ownership, checking expiration, and confirming proper dosing. Choice B may cause unnecessary delays in emergency care. Choice C involves dose modification outside EMT scope. Choice D prioritizes documentation over immediate patient care needs.
A 3-year-old child is having a febrile seizure. The parents are very upset and want you to do something immediately. The seizure has been ongoing for 2 minutes. What is your priority action?
Immediately begin cooling measures with ice packs to reduce the fever quickly
Restrain the child's movements to prevent injury while the seizure continues
Insert an oral airway to prevent the tongue from blocking the airway
Position the child to protect from injury and ensure the airway remains clear
Explanation
During an active seizure, the priority is positioning to protect from injury and maintaining airway patency without insertion of objects. The child should be placed on their side if possible. Choice A could cause injury through restraint. Choice B is dangerous during active seizure and could cause trauma. Choice D uses inappropriate cooling methods that could cause shivering and worsen the condition.
A 75-year-old patient fell and is complaining of hip pain. The patient lives alone and has been on the floor for 6 hours. Besides the obvious injury, what complication should the EMT be most concerned about?
Pressure sores from lying on hard surfaces
Dehydration from prolonged inability to access fluids
Hypothermia from prolonged exposure to cool temperatures
Rhabdomyolysis from prolonged pressure and immobility
Explanation
Rhabdomyolysis can occur when muscles are compressed for prolonged periods, releasing toxins that can cause kidney failure. This is a serious complication of prolonged immobilization, especially in elderly patients. Choice A is concerning but less immediately life-threatening. Choice B is possible but less likely indoors. Choice D takes much longer to develop than 6 hours.
A newborn baby is delivered and appears blue and limp with slow respirations. After drying and warming, what is the next appropriate step?
Begin chest compressions immediately at a rate of 120 compressions per minute
Stimulate the baby by flicking the soles of the feet and rubbing the back
Suction the mouth and nose aggressively to clear any remaining amniotic fluid
Provide positive pressure ventilation with bag-mask device at 40-60 breaths per minute
Explanation
After initial steps of drying and warming, tactile stimulation (flicking feet, rubbing back) is the next step to stimulate breathing and improve tone in a depressed newborn. This may be all that's needed before more invasive interventions. Choice A is premature without assessing heart rate first. Choice B should only be done if stimulation fails. Choice D uses aggressive suctioning which is no longer recommended.
A 72-year-old patient is found unconscious by family members. The patient is diabetic and takes insulin. Blood glucose reading is 45 mg/dL. What is the appropriate treatment?
Place the patient in recovery position and provide supportive care during transport
Attempt to wake the patient first, then administer oral glucose if successful
Administer intravenous dextrose immediately to correct the hypoglycemia
Administer oral glucose gel even though the patient is unconscious
Explanation
Oral glucose should never be given to unconscious patients due to aspiration risk. EMTs cannot administer IV medications. The appropriate action is supportive care with proper positioning and rapid transport for advanced treatment. Choice A risks aspiration. Choice B is outside EMT scope. Choice D delays appropriate care and oral glucose still shouldn't be given to barely conscious patients.
A 14-year-old patient has been vomiting and appears dehydrated. The patient is alert but weak. Vital signs show tachycardia and normal blood pressure. What is the most appropriate fluid management?
Establish IV access and administer normal saline bolus to correct dehydration
Encourage small, frequent sips of clear fluids if the patient can tolerate them
Provide nothing by mouth and transport for intravenous fluid replacement therapy
Administer oral rehydration solution through nasogastric tube placement
Explanation
EMTs cannot establish IV access or place nasogastric tubes. For a patient with active vomiting and dehydration, oral fluids may worsen vomiting. The appropriate action is to withhold oral intake and transport for advanced care including IV fluid replacement. Choice A and C are outside EMT scope. Choice B could worsen vomiting and delay recovery.
An 89-year-old nursing home patient is experiencing difficulty breathing. The patient has a living will that specifies no intubation but allows other life-sustaining measures. What is appropriate care?
Respect the living will completely and provide only comfort care measures
Contact medical control to override the living will in this emergency situation
Provide oxygen, positioning, and other supportive care while honoring the no-intubation directive
Ignore the living will since EMTs cannot perform intubation anyway
Explanation
A living will that specifies no intubation but allows other life-sustaining measures means the EMT can provide oxygen, proper positioning, medication assistance, and other supportive care while respecting the intubation limitation. Choice A provides inadequate care when other measures are permitted. Choice C is inappropriate as living wills should be respected. Choice D misunderstands the importance of advance directives.
A 7-year-old child fell from playground equipment and is complaining of arm pain. The child is crying and calling for their parents who are not present. How should you approach this patient?
Have bystanders restrain the child while you quickly complete your assessment
Immediately begin assessment while explaining each step to gain the child's trust
Get down to the child's eye level and introduce yourself before beginning assessment
Wait for the parents to arrive before beginning any assessment or treatment
Explanation
When treating pediatric patients, it's important to establish rapport first by getting to their eye level, introducing yourself calmly, and explaining what you're doing in age-appropriate terms. This helps reduce anxiety and improves cooperation. Choice A may frighten the child further. Choice B delays necessary care inappropriately. Choice D is traumatic and inappropriate for a conscious, cooperative child.
A pregnant woman at 28 weeks gestation is experiencing severe abdominal pain and has not felt fetal movement for several hours. She appears pale and has a weak, rapid pulse. What is the priority treatment?
Apply external fetal monitor to assess fetal heart rate and uterine contractions
Place the patient in Trendelenburg position to improve blood flow to the fetus
Perform immediate assessment for crowning and prepare for emergency delivery
Position the patient on her left side and provide high-flow oxygen during transport
Explanation
This presentation suggests possible placental abruption or other obstetric emergency with maternal shock. Left lateral positioning prevents supine hypotensive syndrome and improves venous return, while high-flow oxygen supports both mother and fetus. Choice B worsens supine hypotensive syndrome. Choice C is inappropriate without signs of imminent delivery. Choice D is outside EMT scope and delays necessary care.