Pediatric and Neonatal Care Flashcards

A 2-year-old is being transported for severe croup. The child has significant inspiratory stridor at rest, marked subcostal retractions, and is becoming agitated. Which of the following interventions is the most appropriate initial treatment?

Answer: Administer nebulized epinephrine and corticosteroids.

For a child with moderate to severe croup, characterized by stridor at rest and significant work of breathing, the primary treatment is nebulized epinephrine and corticosteroids. Nebulized epinephrine provides rapid vasoconstriction of the upper airway mucosa, reducing edema and relieving the obstruction, while corticosteroids (like dexamethasone) reduce inflammation over a longer period.

A term neonate is delivered through thick, particulate meconium-stained amniotic fluid. The infant is limp, has a heart rate of 80 bpm, and is making no respiratory effort. According to the most recent Neonatal Resuscitation Program (NRP) guidelines, what is the appropriate first step AFTER initial warming, drying, and stimulation?

Answer: Initiate positive-pressure ventilation (PPV) with a bag-mask device.

Current NRP guidelines no longer recommend routine intubation and tracheal suctioning for non-vigorous infants born through meconium-stained fluid. The priority is to establish effective ventilation. After the initial steps (warming, drying, positioning, clearing the mouth/nose if needed, and stimulation), if the infant is apneic or has a heart rate below 100 bpm, positive-pressure ventilation should be initiated immediately.

When performing endotracheal intubation on a 1-year-old child, the flight paramedic should be aware that the narrowest portion of the pediatric airway is at the level of the:

Answer: Cricoid cartilage

A key anatomical difference between pediatric and adult airways is the location of the narrowest point. In adults, the narrowest part is the glottic opening (vocal cords). In infants and young children, the airway is funnel-shaped, and the narrowest point is the cricoid cartilage, which is a complete, non-expandable ring.

You are treating a 15 kg pediatric patient in hypovolemic shock secondary to gastroenteritis. According to Pediatric Advanced Life Support (PALS) guidelines, what is the appropriate initial isotonic crystalloid fluid bolus?

Answer: 300 mL (20 mL/kg)

PALS guidelines recommend an initial fluid bolus of 20 mL/kg of an isotonic crystalloid (such as Normal Saline or Lactated Ringer's) for pediatric patients in hypovolemic or septic shock, administered over 5-20 minutes. For a 15 kg child, this calculates to 300 mL (15 kg x 20 mL/kg).

A flight crew is transporting a neonate with a diagnosis of Persistent Pulmonary Hypertension of the Newborn (PPHN). A primary goal of management during transport is to avoid which of the following triggers that can worsen pulmonary vasoconstriction?

Answer: Hypothermia

In PPHN, the pulmonary vasculature is highly reactive. Stimuli such as hypoxia, acidosis, and hypothermia can trigger intense pulmonary vasoconstriction, worsening the right-to-left shunting and hypoxemia. Maintaining normothermia is a critical component of care to prevent this adverse reaction. While severe hyperoxia and alkalosis are also avoided, hypothermia is a potent and preventable vasoconstrictive trigger.

Which component of the Pediatric Assessment Triangle (PAT) is the most reliable single indicator of the adequacy of ventilation and oxygenation?

Answer: Work of Breathing

The PAT consists of Appearance, Work of Breathing, and Circulation to Skin. While all three are crucial, 'Work of Breathing' is the most direct indicator of respiratory status. It reflects the effort the child is expending to maintain adequate ventilation and oxygenation. Abnormal findings include retractions, nasal flaring, and abnormal airway sounds, which point directly to a respiratory problem.