CPEN Respiratory Emergencies 3 — Questions and Answers
Question 1: Which of the following is the FIRST priority when managing a child in respiratory failure?
- Obtain IV access
- Administer supplemental oxygen (Correct answer)
- Obtain arterial blood gas
- Perform chest X-ray
Correct answer: Administer supplemental oxygen
Airway and oxygenation are always the first priority; supplemental oxygen should be applied immediately in any child showing signs of respiratory failure.
Question 2: A 5-month-old with RSV bronchiolitis has an SpO2 of 88% on room air, moderate retractions, and a respiratory rate of 72. The most appropriate initial intervention is:
- Nebulized albuterol
- Nebulized racemic epinephrine
- Supplemental oxygen via nasal cannula (Correct answer)
- Immediate intubation
Correct answer: Supplemental oxygen via nasal cannula
Supplemental oxygen is the mainstay of bronchiolitis treatment; bronchodilators are not routinely recommended as they show no consistent benefit.
Question 3: A tension pneumothorax in a pediatric patient is BEST initially treated with:
- Chest X-ray confirmation before intervention
- Needle decompression at the 2nd intercostal space, midclavicular line (Correct answer)
- Immediate chest tube insertion
- High-flow oxygen and observation
Correct answer: Needle decompression at the 2nd intercostal space, midclavicular line
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression — do not delay for imaging.
Question 4: Heliox therapy in pediatric respiratory emergencies is MOST beneficial for which condition?
- RSV bronchiolitis
- Bacterial pneumonia
- Upper airway obstruction (croup/foreign body) (Correct answer)
- Pulmonary edema
Correct answer: Upper airway obstruction (croup/foreign body)
Heliox (helium-oxygen mixture) reduces turbulent airflow and work of breathing, making it most useful for upper airway obstruction conditions like croup.
Question 5: Which medication is CONTRAINDICATED in pediatric anaphylaxis with severe bronchospasm?
- Epinephrine IM
- Diphenhydramine IV
- Albuterol nebulization
- Morphine IV (Correct answer)
Correct answer: Morphine IV
Morphine (and other opioids) can cause histamine release and worsen bronchospasm and hypotension in anaphylaxis.
Question 6: A child intubated for status asthmaticus develops sudden hypotension and absent breath sounds on the left. The priority action is:
- Increase ventilator PEEP
- Administer IV fluid bolus
- Check for right mainstem intubation or pneumothorax (Correct answer)
- Increase FiO2 to 100%
Correct answer: Check for right mainstem intubation or pneumothorax
Sudden hemodynamic deterioration with unilateral absent breath sounds post-intubation suggests right mainstem intubation or tension pneumothorax — check tube position first.
Question 7: The 'steeple sign' on anteroposterior neck X-ray in a child with stridor is characteristic of:
- Epiglottitis
- Foreign body aspiration
- Croup (laryngotracheobronchitis) (Correct answer)
- Retropharyngeal abscess
Correct answer: Croup (laryngotracheobronchitis)
The steeple sign represents subglottic narrowing on AP X-ray, which is the classic radiographic finding in viral croup.
CPEN Respiratory Emergencies 3
Which of the following is the FIRST priority when managing a child in respiratory failure?