PEARS Managing Respiratory Emergencies 2 — Questions and Answers
Question 1: A 3-year-old presents with sudden onset of stridor, drooling, and refusal to swallow. Which intervention is most appropriate initially?
- Perform direct laryngoscopy to inspect the airway
- Allow the child to maintain a position of comfort and prepare for airway management (Correct answer)
- Insert a nasopharyngeal airway immediately
- Begin bag-mask ventilation with 100% oxygen
Correct 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.
Question 2: During management of a pediatric patient in respiratory distress, which finding best indicates that bag-mask ventilation is effective?
- Heart rate increases to above 160 bpm
- Visible chest rise with each breath (Correct answer)
- Oxygen saturation immediately reaches 100%
- The child begins crying vigorously
Correct answer: Visible chest rise with each breath
Visible and bilateral chest rise confirms adequate tidal volume delivery during bag-mask ventilation.
Question 3: 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?
- Discharge home with oral albuterol prescription
- Administer systemic corticosteroids and reassess (Correct answer)
- Perform immediate endotracheal intubation
- Apply a nonrebreather mask only and observe
Correct 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.
Question 4: When selecting a bag-mask for a pediatric patient, which sizing criterion is most important?
- The mask covers the mouth, nose, and eyes for a complete seal
- The mask covers the nose and mouth without overlapping the eyes or chin (Correct answer)
- The bag volume must be at least 1500 mL regardless of patient size
- The mask color matches the patient's age group per AHA protocol
Correct 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.
Question 5: 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?
- Tension pneumothorax
- Airway obstruction from the tongue (Correct answer)
- Severe pulmonary edema
- Diaphragmatic hernia
Correct 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.
Question 6: Which clinical sign best differentiates upper airway obstruction from lower airway obstruction in a pediatric patient?
- Presence of nasal flaring
- Inspiratory stridor versus expiratory wheezing (Correct answer)
- Oxygen saturation below 94%
- Use of sternocleidomastoid muscles
Correct answer: Inspiratory stridor versus expiratory wheezing
Inspiratory stridor indicates upper airway (extrathoracic) obstruction, while expiratory wheezing indicates lower airway (intrathoracic) obstruction.
Question 7: A 2-year-old with bronchiolitis has increased work of breathing and SpO2 of 90% on room air. Which intervention is the priority?
- Administer nebulized albuterol every 20 minutes
- Apply supplemental oxygen to achieve SpO2 ≥94% (Correct answer)
- Initiate IV corticosteroids immediately
- Perform nasotracheal suctioning every 15 minutes
Correct 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.
PEARS Managing Respiratory Emergencies 2
A 3-year-old presents with sudden onset of stridor, drooling, and refusal to swallow.
Which intervention is most appropriate initially?