Pediatric and Neonatal Patients Flashcards

A 5-year-old with suspected meningitis develops a petechial/purpuric rash en route. The MOST critical immediate intervention is:

Answer: Administer IV ceftriaxone immediately

Purpuric rash with meningitis signs suggests meningococcal septicemia; immediate ceftriaxone administration takes priority over cultures or LP in the flight environment.

A neonate born at 34 weeks has a pre-ductal SpO2 of 92% and post-ductal SpO2 of 78%. This gradient most likely indicates:

Answer: Pulmonary hypertension with right-to-left ductal shunting

A pre-ductal SpO2 higher than post-ductal SpO2 indicates right-to-left shunting across the ductus arteriosus, consistent with persistent pulmonary hypertension of the newborn.

What is the correct initial defibrillation dose for a 20 kg child in ventricular fibrillation per current PALS guidelines?

Answer: 2 J/kg

PALS recommends an initial defibrillation dose of 2 J/kg for pediatric VF/pulseless VT, with subsequent shocks at 4 J/kg.

A 4-month-old presents with inspiratory stridor, a 'seal-bark' cough, and a Westley croup score of 8. The flight nurse should prioritize:

Answer: Racemic epinephrine nebulization and dexamethasone

Severe croup (Westley ≥6) is managed with racemic epinephrine for rapid airway dilation and dexamethasone for sustained anti-inflammatory effect before considering intubation.

A 7-year-old with a closed head injury has a GCS of 8 and ICP suspected to be elevated. During transport, head positioning should be:

Answer: 30-degree head elevation with the head in midline

Elevating the head of bed 30 degrees with the head in a neutral midline position promotes venous drainage and reduces ICP without compromising CPP.

A 3-kg neonate with ductal-dependent congenital heart disease becomes cyanotic after birth. The most critical pharmacologic intervention to maintain ductal patency is:

Answer: Prostaglandin E1 (alprostadil) 0.05–0.1 mcg/kg/min IV infusion

Prostaglandin E1 infusion keeps the ductus arteriosus open in ductal-dependent congenital heart lesions, providing critical pulmonary or systemic blood flow.

During pediatric transport at altitude, a child with a pneumothorax has a chest tube in place draining to a water-seal device. The flight nurse should:

Answer: Keep the device unclamped and below chest level

The chest tube should remain unclamped and the drainage device kept below chest level to allow continuous drainage as gas expands at altitude.