Pediatric CCRN Respiratory Flashcards

A 2-year-old with bronchiolitis on high-flow nasal cannula has worsening work of breathing. What parameter BEST indicates the need to escalate to non-invasive ventilation?

Answer: Respiratory rate of 60 with subcostal retractions and poor feeding

Increasing work of breathing with retractions, tachypnea, and poor feeding despite high-flow oxygen signals impending respiratory failure requiring escalation to CPAP or BiPAP.

Which ventilator strategy is recommended for pediatric ARDS to minimize ventilator-induced lung injury?

Answer: Low tidal volumes (4–6 mL/kg) with permissive hypercapnia

Lung-protective ventilation using low tidal volumes (4–6 mL/kg IBW) with permissive hypercapnia minimizes volutrauma and barotrauma in pediatric ARDS.

A 7-year-old post-op with a right-sided chest tube has sudden respiratory distress, absent breath sounds on the left, and tracheal deviation to the right. The MOST likely diagnosis is:

Answer: Left-sided tension pneumothorax

Absent left breath sounds, tracheal deviation away from the left, and sudden respiratory distress indicate a left-sided tension pneumothorax compressing mediastinal structures.

What is the MOST common trigger for status asthmaticus requiring PICU admission in children?

Answer: Viral upper respiratory infection

Viral URIs (most commonly rhinovirus) are the predominant trigger for acute severe asthma exacerbations requiring pediatric intensive care unit admission.

A 4-year-old with croup (laryngotracheobronchitis) has a Westley croup score of 8. Which intervention is MOST appropriate?

Answer: Nebulized racemic epinephrine and parenteral dexamethasone with observation

A Westley score of 8 indicates moderate-to-severe croup; nebulized racemic epinephrine provides rapid relief while systemic dexamethasone reduces airway inflammation and edema.

Which blood gas result is MOST consistent with early respiratory failure in a child with acute severe asthma?

Answer: pH 7.35, PaCO2 42, PaO2 65

A normalizing PaCO2 (42 mmHg) with a normal or slightly low pH and mild hypoxia in a severely dyspneic child indicates CO2 retention despite hyperventilation — a sign of impending respiratory failure.