Managing Respiratory Emergencies Flashcards

A 3-year-old presents with sudden onset of stridor, drooling, and refusal to swallow. Which intervention is most appropriate initially?

Answer: Allow the child to maintain a position of comfort and prepare for airway management

In suspected epiglottitis, allowing the child to assume a position of comfort (usually tripod position) minimizes agitation and reduces risk of complete airway obstruction.

During management of a pediatric patient in respiratory distress, which finding best indicates that bag-mask ventilation is effective?

Answer: Visible chest rise with each breath

Visible and bilateral chest rise confirms adequate tidal volume delivery during bag-mask ventilation.

A 6-year-old with known asthma presents with severe wheezing, accessory muscle use, and SpO2 of 88%. After albuterol, SpO2 rises to 91%. What is the next best step?

Answer: Administer systemic corticosteroids and reassess

Systemic corticosteroids reduce airway inflammation and are indicated when initial bronchodilator therapy does not fully resolve a moderate-to-severe asthma exacerbation.

When selecting a bag-mask for a pediatric patient, which sizing criterion is most important?

Answer: The mask covers the nose and mouth without overlapping the eyes or chin

A properly sized mask creates a seal from the bridge of the nose to the chin cleft without covering the eyes, preventing injury and ensuring an airtight seal.

A 10-month-old is found unresponsive with labored, gasping respirations. After opening the airway, you note poor air entry. What is the most likely cause?

Answer: Airway obstruction from the tongue

In an unresponsive infant, the most common cause of airway obstruction is the tongue falling back against the posterior pharynx, which can be relieved by head-tilt chin-lift or jaw thrust.

Which clinical sign best differentiates upper airway obstruction from lower airway obstruction in a pediatric patient?

Answer: Inspiratory stridor versus expiratory wheezing

Inspiratory stridor indicates upper airway (extrathoracic) obstruction, while expiratory wheezing indicates lower airway (intrathoracic) obstruction.

A 2-year-old with bronchiolitis has increased work of breathing and SpO2 of 90% on room air. Which intervention is the priority?

Answer: Apply supplemental oxygen to achieve SpO2 ≥94%

Supplemental oxygen to maintain SpO2 ≥94% is the primary supportive intervention for bronchiolitis, as bronchodilators and steroids have not shown consistent benefit.

A 5-year-old post-drowning patient is breathing spontaneously but has SpO2 of 85% on 10L nonrebreather mask. What is the next step?

Answer: Provide positive pressure ventilation with bag-mask

Failure to maintain adequate SpO2 on high-flow oxygen with spontaneous breathing indicates the need for assisted ventilation with positive pressure.

When performing the jaw thrust maneuver in a pediatric trauma patient, why is it preferred over head-tilt chin-lift?

Answer: It opens the airway without extending the cervical spine

The jaw thrust opens the airway by displacing the mandible anteriorly without requiring cervical spine extension, making it the preferred maneuver when spinal injury is suspected.

A 14-month-old in respiratory distress has nasal flaring, subcostal retractions, and grunting. What does grunting indicate?

Answer: The child is generating PEEP to maintain alveolar patency

Grunting is produced by partial closure of the glottis during exhalation, creating autoPEEP to prevent alveolar collapse and maintain functional residual capacity.

Which assessment finding in a child with respiratory distress requires the MOST immediate intervention?

Answer: Central cyanosis unresponsive to supplemental oxygen

Central cyanosis unresponsive to supplemental oxygen indicates severe hypoxemia from cardiac or pulmonary shunting, requiring immediate advanced intervention.

A 9-year-old with severe asthma who is not improving with bronchodilators develops a paradoxical pulse (pulsus paradoxus >20 mmHg). What does this indicate?

Answer: Severe air trapping causing significant intrathoracic pressure swings

Significant pulsus paradoxus in asthma reflects severe air trapping and increased intrathoracic pressure swings that impede venous return during inspiration.

When providing supplemental oxygen to a newborn in respiratory distress, which target SpO2 range is appropriate in the first minutes of life?

Answer: 85-95% in the first 10 minutes, titrating upward

SpO2 rises gradually after birth; targeting 85-95% in the first 10 minutes with titration prevents both hypoxia and oxygen toxicity in neonates.

A child requiring ventilatory support has gastric distension from bag-mask ventilation. What is the most appropriate intervention?

Answer: Insert an orogastric or nasogastric tube to decompress the stomach

An orogastric or nasogastric tube decompresses the stomach, reducing aspiration risk and improving diaphragm excursion during bag-mask ventilation.

A 3-year-old is found with a button battery lodged in the esophagus causing stridor and drooling. What is the priority management?

Answer: Urgent endoscopic removal due to risk of tissue necrosis

Esophageal button batteries cause rapid tissue necrosis via electrical current and alkali generation, requiring emergency endoscopic removal within hours.

During resuscitation of a 2-year-old, which ventilation rate is recommended when an advanced airway is in place?

Answer: 1 breath every 6 seconds (10 breaths/min) asynchronously

With an advanced airway secured, deliver 1 breath every 6 seconds (approximately 10 breaths/min) asynchronously with continuous chest compressions to avoid hyperventilation.

A 6-year-old has fever, muffled voice, and drools despite sitting upright. Neck radiograph shows a 'thumb sign.' Which diagnosis is most likely?

Answer: Epiglottitis

The thumb sign on lateral neck X-ray represents a swollen epiglottis and, combined with fever, drooling, and muffled voice, is pathognomonic of epiglottitis.

A 4-year-old with respiratory failure has been intubated. After intubation, SpO2 drops and breath sounds are heard only on the right. What is the most likely cause?

Answer: Right mainstem intubation

Unilateral breath sounds after intubation most commonly result from advancing the endotracheal tube too far into the right mainstem bronchus; the tube must be pulled back.

A 10-year-old with sickle cell disease presents with acute chest syndrome: fever, chest pain, and SpO2 of 89%. Which is the MOST important initial management?

Answer: Administer supplemental oxygen and ensure adequate hydration

Supplemental oxygen to correct hypoxia and IV hydration to prevent further sickling are the cornerstone initial treatments for acute chest syndrome.

Which physical finding best indicates successful relief of a foreign body airway obstruction in a conscious child?

Answer: Effective cough returns with improved air entry

Return of an effective cough and improved air entry confirm that the foreign body has been dislodged and the airway is now patent.