Questions and Answers 1 You are en route to the local children’s emergency department having picked up a 3-year-old male who fell off the monkey bars at a playground. The patient has a left elbow deformity ( Fig. 44.1 ). What are key characteristic features of pediatric bones compared to adult bones that can affect presentation and management? The presence of a growth plate or physis. The…
Questions and Answers Case: You are called to the scene of a moderate-speed (45 miles per hour) motor vehicle crash and find a 10-year-old female in the back seat, restrained with a seat belt. Her mother’s vehicle was “T-boned” on the driver’s side, causing the vehicle to rollover several times. She is awake and alert. Her vital signs are blood pressure 110/76, heart rate of 110…
Questions and Answers Case: You respond to the scene of a motor vehicle collision to find a 5-year-old child complaining of neck pain. She does not report any other complaints. 1 What challenges do children present in evaluation of neck injuries? Young children are not always able to reliably communicate the extent or even location of their injuries. You must rely on observation of their behaviors…
Questions and Answers 1 A 12-year-old male steps too close to another golfer’s backswing and is hit in the right eye by the club. How can you prevent further eye damage on the way to the emergency department (ED)? You should physically protect the eye as well as avoid an increase in intraocular pressure (IOP), which can cause secondary injury. Anchor the protective shield on bones…
Questions and Answers Case: Your healthcare unit is sent to a farm to see a child who has fallen through a hay hole. You find a 7-year-old boy lying on the grass near a barn. His mother tells you that she saw him fall from the second floor of the barn through the hay hole down about 12 feet. Initial assessment shows that the boy is…
Questions and Answers 1 What is the definition of a “technologically-dependent child?” Technology-dependent children are those who are reliant on a medical device to augment (or completely replace) a vital bodily function to sustain life. 2 What are the most common classes of technologies used by technology-dependent children? Respiratory support, nutritional support, indwelling venous catheters, cerebrospinal fluid shunts. Case: You respond to a call at a…
Questions and Answers 1 What is the definition of a seizure? Sudden occurrence of signs and/or symptoms causing change in motor, sensory, behavioral activity, or consciousness due to abnormal neuronal electrical activity in the brain. Seizures account for about 1% of all emergency department (ED) visits for children <18 years old. 2 What is an unprovoked seizure? Seizures that occur due to unknown etiology or no immediate…
Questions And Answers Pneumonia 1 You are called to the house of a 7-year-old male. His mother tells you that he has been coughing for about a week. Yesterday, he developed a fever up to 103°F and today he began coughing more and seemed to be struggling to breathe. What are the first steps in assessing this child? You should always use the Pediatric Assessment Triangle…
Questions and Answers Chest Pain Case: You are called to evaluate a 12-year-old boy with no medical history who has been complaining of chest pain over the last few hours. He reports the pain as central, sharp, and worse with deep inspiration. He denies any additional symptoms. He reports that he helped his father over the weekend move some firewood but denies any other increased physical…
Questions and Answers 1 What does altered mental status (AMS) mean? AMS is synonymous with an altered level of consciousness. It encompasses the spectrum of responsiveness between a patient’s baseline level of consciousness and a comatose state. It alerts the provider that an underlying condition is causing the patient to act in an abnormal or altered way. 2 What terms should be used to describe altered…
Questions and Answers 1 What is shock? Shock is inadequate blood flow (and therefore oxygen delivery) to meet tissue demands. 2 Why is early recognition and treatment of shock important? Early recognition and treatment of shock are associated with improved outcomes, with decreased morbidity and mortality. As shock progresses, it often becomes more refractory to treatment. 3 What is the difference between compensated and uncompensated shock?…
Questions and Answers 1 What is the most common cause of cardiac arrest in children? Respiratory failure. In sharp contrast to adults, cardiopulmonary arrest in infants and children is most often associated with hypoxia, respiratory failure, and respiratory arrest. While arrest in adults is often triggered by myocardial ischemia and dysrhythmias, children typically have no primary cardiac dysfunction. A child in cardiac arrest must be supported…
Questions and Answers 1 Why is it important to have a systematic approach to the evaluation of a seriously ill or injured child? It is important because it will help the provider quickly recognize clear signs of respiratory distress, respiratory failure, and shock, as well as immediately provide lifesaving procedures once these signs are identified. 2 According to the American Heart Association (AHA) Pediatric Advanced Life…
Questions and Answers 1 Why is scene safety so important? There are a variety of scenarios to which EMS providers will be called. When discussing patient extrications, the majority will be from severe motor vehicle accidents. There are also many possible industrial and agricultural accidents, as well as the rare but catastrophic natural disasters and acts of terrorism. Extreme caution must be used to avoid secondary…
Questions and Answers 1 What characteristics describe the various degrees of burns? The historical classification of burns was first established almost 200 years ago and was based on the depth of the burn and is still utilized today. First-degree burns are superficial. Second-degree burns are partial-thickness. Third-degree burns are full-thickness. Although less frequently utilized, higher-grade burn descriptions also exist. Fourth-degree burns extend into the underlying soft tissue.…
Questions and Answers 1 You are called to the scene of a 78-year-old male who was involved in a motor vehicle collision after he ran a red light. He is reporting pain in his right wrist and left leg. Describe the initial evaluation of the patient’s extremities after completion of the initial Basic Life Support (BLS) assessment. Once basic life support has been completed, a secondary…
Questions and Answers 1 How should chest trauma be evaluated? Patients suffering from significant chest trauma may complain of chest pain, shortness of breath, back or flank discomfort, or abdominal pain. Significant injuries may be accompanied by tachycardia, tachypnea, hypotension, and hypoxia. The first step is visual inspection of the patient. How is the work of breathing—is there any splinting or flail chest? Further inspection should…
Questions and Answers 1 How common are traumatic spine injuries (TSIs)? There are an estimated 12,000 injuries per year in the United States, with the majority occurring as a result of motor vehicle crashes and falls. 2 Why is this subject important? The morbidity associated with severe TSI results in significant change in quality of life and financial costs. Patients with severe TSI have significant reductions…
Questions and Answers 1 What is the anatomy of the brain and pathophysiology of injury? Familiarity with the anatomy leads to an understanding of the pathophysiology of traumatic brain injury. The skull is a hard area with a fixed volume. Contact of the brain against the bone of the skull can cause primary injury. The fixed volume of the skull allows for little room for any…
Questions and Answers 1 What is a traumatic injury? A traumatic injury is a term that refers to physical injuries of sudden and onset severity. These injuries require immediate medical attention as they can sometimes be life-threatening. Trauma makes up a significant percentage of the calls to which prehospital personnel respond and is the leading cause of death for those between the ages of 1 and…