Pediatric and Neonatal Patients Flashcards

A 2-week-old term neonate presents with poor feeding, hypotonia, and a serum sodium of 118 mEq/L. The SAFEST rate of sodium correction is:

Answer: Increase serum sodium no faster than 0.5 mEq/L/hr (max 10–12 mEq/L/24 hr)

Overcorrection of hyponatremia risks osmotic demyelination; the safe rate is no faster than 0.5 mEq/L/hr or 10–12 mEq/L per 24 hours.

A 5-month-old in respiratory distress has nasal flaring, subcostal retractions, and diffuse wheezing. RSV bronchiolitis is suspected. Which intervention has the BEST evidence for flight transport?

Answer: High-flow nasal cannula oxygen therapy

High-flow nasal cannula therapy is the best-supported intervention for moderate-to-severe bronchiolitis, reducing work of breathing without the inconsistent response seen with bronchodilators.

A premature neonate on a ventilator develops sudden oxygen desaturation, absent breath sounds on the left, and a trachea deviated to the right. The flight nurse should first:

Answer: Needle decompress the left chest at the 2nd ICS MCL

Absent unilateral breath sounds with tracheal deviation in a ventilated neonate is a tension pneumothorax requiring immediate needle decompression.

A 9-year-old with status epilepticus has failed two doses of lorazepam. Per current pediatric guidelines, what is the next appropriate medication?

Answer: Fosphenytoin 20 PE/kg IV

Fosphenytoin 20 PE/kg IV is the recommended second-line agent for pediatric benzodiazepine-refractory status epilepticus per current guidelines.

A 12-hour-old neonate has a blood glucose of 32 mg/dL and is symptomatic with jitteriness. The appropriate initial IV treatment is:

Answer: D10W 2 mL/kg IV bolus followed by D10W infusion at GIR 6 mg/kg/min

Symptomatic neonatal hypoglycemia is treated with D10W 2 mL/kg IV bolus (200 mg/kg), then a continuous D10W infusion to maintain glucose; D50W is too concentrated for neonates.

During rotor-wing transport of an 8-year-old burn patient with 40% TBSA burns, fluid resuscitation in the first 24 hours using the Parkland formula should be calculated as:

Answer: 4 mL × weight (kg) × % TBSA plus maintenance, half given in first 8 hours from burn time

Pediatric burn resuscitation uses the modified Parkland formula: 4 mL × kg × % TBSA plus maintenance fluids, with half delivered in the first 8 hours from time of burn.

A 4-year-old presents with sudden onset drooling, a muffled 'hot potato' voice, trismus, and unilateral tonsillar bulging with uvular deviation. The most likely diagnosis requiring surgical consultation is:

Answer: Peritonsillar abscess

Unilateral peritonsillar bulging with uvular deviation away from the affected side and trismus are classic signs of peritonsillar abscess requiring drainage.