PEARS Managing Respiratory Emergencies 3 — Questions and Answers
Question 1: During bag-mask ventilation of a 4-year-old, you notice the abdomen is rising but the chest is not. What is the most likely problem?
- The oxygen flow rate is too high
- Air is entering the stomach due to improper mask seal or head position (Correct answer)
- The child has a pneumothorax
- The bag volume is too small
Correct answer: Air is entering the stomach due to improper mask seal or head position
Abdominal rise during ventilation indicates gastric insufflation, caused by an inadequate mask seal, poor head positioning, or excessive ventilation pressure.
Question 2: A child in respiratory distress suddenly becomes silent and limp with absent breath sounds on the right. What should you suspect?
- Complete resolution of bronchospasm
- Tension pneumothorax (Correct answer)
- Vagal response from crying
- Successful airway clearance
Correct answer: Tension pneumothorax
Sudden silence, limpness, absent breath sounds on one side, and deterioration suggest tension pneumothorax requiring immediate needle decompression.
Question 3: Which oxygen delivery device provides the highest concentration of oxygen for a spontaneously breathing pediatric patient in severe respiratory distress?
- Nasal cannula at 4 L/min
- Simple face mask at 8 L/min
- Nonrebreather mask at 10-15 L/min (Correct answer)
- Venturi mask set to 40%
Correct answer: Nonrebreather mask at 10-15 L/min
A nonrebreather mask with flow rate of 10-15 L/min delivers approximately 95% FiO2, the highest concentration available for spontaneously breathing patients.
Question 4: A 7-year-old with croup has moderate stridor at rest. After racemic epinephrine, symptoms improve. Why must this child be observed for at least 2-4 hours?
- To ensure the child takes adequate oral fluids
- Rebound stridor may occur as epinephrine effect wears off (Correct answer)
- To monitor for hypertensive crisis from the medication
- Required observation time per PEARS protocol only
Correct answer: Rebound stridor may occur as epinephrine effect wears off
Racemic epinephrine causes transient vasoconstriction; rebound edema and worsening stridor can recur as the drug effect wanes, necessitating observation.
Question 5: Which is the most important initial action when a child with a foreign body airway obstruction becomes unconscious?
- Perform five back blows followed by five chest thrusts
- Call for help and begin CPR starting with chest compressions (Correct answer)
- Immediately perform blind finger sweeps
- Administer three rescue breaths before starting compressions
Correct answer: Call for help and begin CPR starting with chest compressions
When an FBAO victim becomes unconscious, CPR is initiated immediately, and each time the airway is opened for ventilation, look for and remove any visible object.
Question 6: In a pediatric patient with respiratory failure, which combination of findings indicates impending respiratory arrest?
- Mild tachypnea, SpO2 95%, alert
- Bradypnea, absent breath sounds, decreased consciousness (Correct answer)
- Moderate wheezing, SpO2 92%, anxious
- Tachypnea, nasal flaring, SpO2 90%
Correct answer: Bradypnea, absent breath sounds, decreased consciousness
Bradypnea (slowing respiratory rate), absent breath sounds, and decreased consciousness indicate respiratory muscle fatigue and impending arrest.
Question 7: Which medication route is preferred for epinephrine administration in pediatric anaphylaxis with severe respiratory compromise?
- Intravenous bolus
- Intramuscular into the anterolateral thigh (Correct answer)
- Subcutaneous into the abdomen
- Inhaled via nebulizer
Correct answer: Intramuscular into the anterolateral thigh
Intramuscular epinephrine in the anterolateral thigh provides faster absorption and more reliable peak plasma levels than subcutaneous injection.
PEARS Managing Respiratory Emergencies 3
During bag-mask ventilation of a 4-year-old, you notice the abdomen is rising but the chest is not.
What is the most likely problem?