ENPC Home Exam Questions with complete solutions

ENPC Home Exam Questions with complete solutions Tachycardia = an _______ sign of shock Early What is a late sign of circulatory compromise in children? Hypotension Children can remain normotensive until about _____ percent of blood volume is lost 25% What are two intervention you should always be doing? Applying oxygen Checking bedside blood glucose How long should the car seat be rear facing? Until at least one year of age _____ model parents behavior with toys Toddlers Age 3 to 5: Preschoolers Magical and it logical thinkers Take things literally What are common fears of the preschooler? Pain Darkness Body mutilation Being alone Ages 5 to 11: School age kids Beers include separation from parents, loss of control, and physical disability 11 to 18 years old: Body a parent is the most important thing What is one of the critical public health issues in today society? Childhood obesity At how many years old can a child start using the faces pain scale? Three years old What is there an emphasis on during the prioritization of the patient? Safety I focused assessment is what type of information? Objective I focused history is what type of information? Subjective The pediatric assessment triangle a.k.a. the across the room assessment of a patient looks at what three things? General appearance Work of breathing Circulation to the skin How long should the pediatric assessment triangle take? About 3 to 5 seconds What does the general appearance section include: Interaction Muscle tone Consolabilty Look or gaze Speech or cry Work of breathing— a good indicator of oxygenation and ventilation. What should you look for in this assessment? Abnormal airway sounds Coughing Abnormal positioning Retractions/nasal flaring Rate and depth of respirations Circulation to the skin: Skin reflects perfusion status Inspect the color of central areas such as lips and mucous membranes Assessed for pallor, molting, or cyanosis Is the patient flushed or diaphoretic What are the three patient categories for the pediatric assessment triangle? Sick Sicker Sickest If all three components of the PAT are stable know what will the patient be ranked as? Sick If there is disruption in one of the areas of the PAT what will the patient be ranked? Sicker If there is Disruption in two or more components of the PAT what ranking will the patient receive? Sickest If a patient is identified as sickest what is indicated? Rapid resuscitation And a child what event typically leads to a code? Typically a respiratory event leads to a cardiac event What is the priority with any trauma or suspected drama? Stabilize the C-spine and stop any bleeding What maneuver is used to open the jaw in a trauma patient? Jaw thrust maneuver When is the nasal pharyngeal airway indicated? In a semi conscious or conscious patient Where is the nasopharyngeal airway contra indicated? In trauma patients What type of airway should be used for a trauma patient? Oral pharyngeal airways and be prepared for intubation with RSI if oral pharyngeal airway is unsuccessful After you have bagged the patient, the patients oxygen saturations and respiratory effort including respiratory rate have not improved, what is your next step? Prepare to Intubate Less than eight intubate When will you start CPR? When the heart rate is less than 60 bpm and the patient is symptomatic you should start CPR How do you calculate the normal systolic blood pressure for a child? 90 + 2x the age in years How to calculate minimum acceptable SBP: 70 + 2x age in years What are you going to use for your history during the assessment? CIAMPEDS What should the urinary output be for an infant? 2 ml/ kg / hour What should the normal urinary output be for an adolescent 1-1.5 ml/kg / hour What is the most common cause of arrest in pediatric patients? Respiratory arrest What is the second most common cause of arrest in a pediatric patient? Shock _____ is the inadequate delivery of oxygen and nutrients necessary for normal tissue and cellular function. It is the in balance between supply and demand at the cellular level. Shock Anytime a patient presents with Shock what is the first intervention that we should do? Place them on oxygen What happens in the body during shock? Plasma leakage/fluid shifts. This results in puffy kids. DIC, inflammatory responses, intracellular acidosis, ards, and MODS are also seen in shock What type of fluid should you give a patient with hypovolemic shock due to Burns? Lactated ringer fluid replacement using the Parkland formula. What is seen in early Shock? In early Shock or warm Shock there is flash cab refill. Look for bounding pulses fever and flushed skin What medication is used to correct SVT? Adenosine What are some different types of obstructive shock? Pneumothorax - you will want to do needle aspiration that the second intercostal space in the midclavicular line and you want to always place a chest tube after PDA - start this patient on prostaglandins. Do not give this patient any Motrin as it can help the PDA to close. Tampa nod - you need to pull the fluid off surrounding the heart PE Congenital heart disease What is the urine output that we I would like to maintain when a patient is in shock? 1 mL per kilo Monitoring should be done for a patient in shock? Cardiac monitoring Pulse ox Capnography 12 lead EKG Chest x-ray CT for any trauma Echo Coags, CBC, electrolytes, type and cross, lactate, arterial blood gas, urinalysis, blood and urine culture, and always check glucose What is the goal with septic shock? The goal is to restore adequate perfusion What is the rate and depth of CPR that should be administered? The rate of CPR should be 100 to 120 compressions per minute The death should be 1.5 to 2 inches and then 2 to 2.5 depth allow for recoil What will you give to correct hypoglycemia and in a neonate? Give D 10- 2cc per kilo can be given over one minute What will you give to the patient that is two years or older with hypoglycemia? You can give D 25. Either 2 to 4 mL per kilo can be given What is the drug of choice for children with bradycardia? EPI When do you choose atropine for bradycardia and children? When you suspect that the bradycardia is vagal in nature What is the number one site choice for an IO? The proximal tibia How can you tell that an I/O is infiltrated? I feeling underneath of the leg when flushing How long can an I/O same place for? For 24 hours or until you get another form of access What are the things that you want to consider pre-intubation? Preoxygenation Atropine, this drug maybe used for patients less than eight years old Prepare for any alternative things that may have to happen such as cric Consider lido What are the complications of intubation? Pneumothorax Gastric dissension How will you confirm placement of the ET tube? Auscultation CO2 detector Chest x-ray Capnography If an ET tube fails what are alternative airway solutions? LMA mask Needle cricothyrotomy _____ A barky seal like cough, worse at night. Low-grade fever. Steeple sign is seen via x-ray. You will want to inform parents to do coolness, take the child outside or open the freezer. Steam from the shower can also help. Administer steroids for inflammation. Give her Seemic Kathy for relief up to two hours, observation is key. Croup We should observe a patient that received racemic epi-for at least ____ hours? 6 ______ is a true emergency! High fever. Muffled voice. Sore throat. Drooling. Stridor . This is caused by a marvelous influenza B. Often times you will see the thumb sign. For these patients you want to give blow by oxygen as tolerated. Make sure to avoid any invasive procedures until the patient is stabilized, this means no IV or throat exam until the patient's airway is stable. Epiglottis pneumonia: Maybe viral, bacterial, fungal, or parasitic Give antibiotics Most kids are viral Abdominal pain may be present in lower lobe pneumonia