CFRN Pediatric and Neonatal Patients 3 — Questions and Answers
Question 1: A 5-year-old with suspected meningitis develops a petechial/purpuric rash en route. The MOST critical immediate intervention is:
- Obtain blood cultures before any antibiotics
- Administer IV ceftriaxone immediately (Correct answer)
- Give IV dexamethasone 0.6 mg/kg before antibiotics
- Perform lumbar puncture to confirm diagnosis
Correct 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.
Question 2: A neonate born at 34 weeks has a pre-ductal SpO2 of 92% and post-ductal SpO2 of 78%. This gradient most likely indicates:
- Pulmonary hypertension with right-to-left ductal shunting (Correct answer)
- Patent ductus arteriosus with left-to-right shunting
- Coarctation of the aorta with reversed differential cyanosis
- Normal transitional circulation in a preterm infant
Correct 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.
Question 3: What is the correct initial defibrillation dose for a 20 kg child in ventricular fibrillation per current PALS guidelines?
- 1 J/kg
- 2 J/kg (Correct answer)
- 4 J/kg
- 10 J/kg
Correct 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.
Question 4: A 4-month-old presents with inspiratory stridor, a 'seal-bark' cough, and a Westley croup score of 8. The flight nurse should prioritize:
- Racemic epinephrine nebulization and dexamethasone (Correct answer)
- Immediate RSI and intubation with a tube one size smaller
- High-flow oxygen via non-rebreather mask only
- Heliox 70/30 nebulization as first-line therapy
Correct 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.
Question 5: 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:
- Flat supine to maximize cerebral perfusion pressure
- 30-degree head elevation with the head in midline (Correct answer)
- Left lateral decubitus to prevent aspiration
- Trendelenburg to increase venous return to the brain
Correct 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.
Question 6: A 3-kg neonate with ductal-dependent congenital heart disease becomes cyanotic after birth. The most critical pharmacologic intervention to maintain ductal patency is:
- Indomethacin 0.2 mg/kg IV
- Prostaglandin E1 (alprostadil) 0.05–0.1 mcg/kg/min IV infusion (Correct answer)
- Sildenafil 1 mg/kg PO
- Nitroglycerin 1 mcg/kg/min IV
Correct 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.
Question 7: 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:
- Clamp the chest tube to prevent air entry
- Keep the device unclamped and below chest level (Correct answer)
- Convert to a one-way Heimlich valve before ascent
- Increase suction to -30 cmH2O during flight
Correct 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.
CFRN Pediatric and Neonatal Patients 3
A 5-year-old with suspected meningitis develops a petechial/purpuric rash en route.
The MOST critical immediate intervention is: