AEMCA Pediatric Emergencies 5 — Questions and Answers
Question 1: A 2-year-old has ingested an unknown quantity of acetaminophen 4 hours ago. The child appears well with no vomiting. What is the primary concern and prehospital action?
- Immediate seizure risk; administer benzodiazepines prophylactically
- Delayed hepatotoxicity risk; contact poison control and transport for N-acetylcysteine evaluation (Correct answer)
- Anaphylaxis risk; administer epinephrine IM
- Acute renal failure; initiate aggressive IV fluid resuscitation
Correct answer: Delayed hepatotoxicity risk; contact poison control and transport for N-acetylcysteine evaluation
Acetaminophen overdose causes delayed hepatotoxicity 24–72 hours after ingestion; prehospital care includes contacting poison control and transporting for antidote evaluation.
Question 2: Which of the following findings in a pediatric trauma patient most strongly suggests non-accidental trauma (child abuse)?
- A single mid-shaft femur fracture in a 4-year-old who fell from a bicycle
- Multiple bruises in various stages of healing on the trunk and posterior of a non-ambulatory infant (Correct answer)
- A spiral tibia fracture in a 3-year-old who fell while running
- A green-stick forearm fracture in a 6-year-old who fell from playground equipment
Correct answer: Multiple bruises in various stages of healing on the trunk and posterior of a non-ambulatory infant
Multiple bruises in various stages of healing on the trunk or posterior of a non-ambulatory infant are highly suspicious for non-accidental trauma, as healthy infants cannot inflict these injuries on themselves.
Question 3: A full-term neonate is delivered in the field. After drying, warming, and stimulation, the infant remains apneic with a heart rate of 55 bpm at 60 seconds of life. What is the next intervention?
- Begin chest compressions immediately at 3:1 ratio with ventilations
- Administer epinephrine via umbilical vein
- Initiate positive pressure ventilation (PPV) with 100% oxygen (Correct answer)
- Start IV fluid bolus at 10 mL/kg
Correct answer: Initiate positive pressure ventilation (PPV) with 100% oxygen
PPV with supplemental oxygen is the priority intervention for an apneic or bradycardic neonate; chest compressions begin only if HR remains below 60 bpm after 30 seconds of effective PPV.
Question 4: A 3-year-old presents with sudden onset of stridor and cyanosis while eating. The child is conscious but cannot cough effectively. What is the most appropriate intervention?
- Perform blind finger sweeps of the oropharynx
- Administer five back blows followed by five abdominal thrusts (Heimlich maneuver) (Correct answer)
- Perform five back blows followed by five chest thrusts
- Initiate immediate positive pressure ventilation via BVM
Correct answer: Administer five back blows followed by five abdominal thrusts (Heimlich maneuver)
For a conscious child over 1 year with an ineffective cough and severe foreign body airway obstruction, alternating back blows and abdominal thrusts (Heimlich maneuver) are indicated.
Question 5: What is the most common shockable cardiac rhythm encountered in pediatric cardiac arrest?
- Ventricular fibrillation (VF)
- Pulseless ventricular tachycardia (VT)
- Pulseless electrical activity (PEA)
- Asystole (Correct answer)
Correct answer: Asystole
Unlike adults, pediatric cardiac arrest is most commonly caused by respiratory failure or shock, resulting in asystole or PEA as the predominant initial rhythms rather than shockable rhythms.
Question 6: A 7-year-old with sickle cell disease presents with severe bone pain in the extremities, fever of 38.8°C, and pallor. What is this presentation most consistent with?
- Acute splenic sequestration crisis
- Vaso-occlusive (pain) crisis (Correct answer)
- Aplastic crisis
- Stroke
Correct answer: Vaso-occlusive (pain) crisis
Vaso-occlusive crisis is the most common acute complication of sickle cell disease, presenting with severe extremity and back pain due to microvascular occlusion by sickled erythrocytes.
Question 7: When assessing a pediatric burn patient, which rule is used to more accurately estimate total body surface area (TBSA) burned in children compared to the Rule of Nines?
- Lund and Browder chart (Correct answer)
- Wallace Rule of Sevens
- Parkland formula
- Modified Glasgow scale
Correct answer: Lund and Browder chart
The Lund and Browder chart accounts for age-related differences in body proportions (larger head, smaller legs in children) and is more accurate than the Rule of Nines for estimating pediatric burns.
AEMCA Pediatric Emergencies 5
A 2-year-old has ingested an unknown quantity of acetaminophen 4 hours ago.
The child appears well with no vomiting.
What is the primary concern and prehospital action?