You are caring for patients in the emergency department. Which 2-year-old child requires immediate intervention?

A 3-year-old child is having difficulty breathing. Which finding would most likely lead you to suspect an upper airway obstruction in this child?

An 8-year-old child is brought to the emergency department by his mother for difficulty breathing. He has a history of asthma and nut allergies. His mother tells you that he recently ate a cookie at a family picnic. Which condition is most likely to be present in this child?

An 8-year-old child is brought to the emergency department by ambulance after being involved in a motor vehicle collision. Which finding would suggest that immediate intervention is needed?

A 6-year-old child is found unresponsive, not breathing, and without a pulse. One healthcare worker leaves to activate the emergency response system and get the resuscitation equipment. You and another healthcare provider immediately begin performing CPR. Which compression-to-ventilation ratio do you use?

A 3-year-old child is in cardiac arrest, and high-quality CPR is in progress. You are the team leader. The first rhythm check reveals the rhythm shown here.

You are caring for a 5-year-old boy with a 4-day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His oxygen saturation is 72% on room air and 89% when on a nonrebreathing oxygen mask. He has shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles.

Which assessment finding is consistent with respiratory failure in this child?

You are caring for a 5-year-old boy with a 4-day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His oxygen saturation is 72% on room air and 89% when on a nonrebreathing oxygen mask. He has shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles.

Which medication would be most appropriate?

During a resuscitation attempt, the team leader asks you to administer an initial dose of epinephrine at 0.1 mg/kg to be given IO. How should you respond?

A 6-month-old infant is unresponsive. You begin checking for breathing at the same time you check for the infant’s pulse. Which is the maximum time you should spend when trying to simultaneously check for breathing and palpate the infant’s pulse before starting CPR?

A 6-year-old boy is being evaluated for difficulty breathing. Which finding would suggest this child has respiratory distress?

What ratio for compressions to breaths should be used for 1-rescuer infant CPR?

A 3-year-old boy is brought to the emergency department by his mother. He is lethargic, with retractions and nasal flaring. He has a respiratory rate of 70/min, with warm extremities and brisk capillary refill. To which immediate life-threatening condition could this child’s condition most likely progress if left untreated?

You are evaluating a 10-year-old child who is febrile and tachycardic. The child’s capillary refill time is 5 seconds. Which parameter will determine if the child is in compensated shock?

An 18-month old has had vomiting and diarrhea for the past 2 days; the mother brings him to the emergency department because he is becoming more lethargic. What diagnostic test should you order first?

You are caring for a 9-month-old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infant’s SpO2 is 94%. On auscultation, the lungs are clear bilaterally.

Which is the most likely cause of this infant’s respiratory distress?

You are caring for a 9-month-old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infant’s SpO2 is 94%. On auscultation, the lungs are clear bilaterally.

Which medication should you administer first?

Which condition is characterized by a prolonged expiratory phase and wheezing?

A 4-year-old child is brought to the emergency department for seizures. The seizures stopped a few minutes ago, but the child continues to have slow and irregular respirations. Which condition is most consistent with your assessment?

You are evaluating a 1-year-old child for respiratory distress. His heart rate is 168/min, and his respiratory rate has decreased from 65/min to 30/min. He now appears more lethargic and continues to have severe subcostal retractions. On the basis of your assessment, which is the most likely reason for this change in the child’s condition?

A 7-year-old child in cardiac arrest is brought to the emergency department by ambulance. No palpable pulses are detected. The child’s ECG is shown here.

How would you characterize this child’s rhythm?

After rectal administration of diazepam, an 8-year-old boy with a history of seizures is now unresponsive to painful stimulation. His respirations are shallow, at a rate of 10/min. His oxygen saturation is 94% on 2 L of nasal cannula oxygen. On examination, the child is snoring with poor chest rise and poor air entry bilaterally.

Which action should you take next?

After rectal administration of diazepam, an 8-year-old boy with a history of seizures is now unresponsive to painful stimulation. His respirations are shallow, at a rate of 10/min. His oxygen saturation is 94% on 2 L of nasal cannula oxygen. On examination, the child is snoring with poor chest rise and poor air entry bilaterally.

If the patient continues to deteriorate after your initial intervention, which next step is most appropriate?

You are performing the airway component of the primary assessment. Which finding would lead you to conclude that the child has an upper airway obstruction?

In management of post-cardiac arrest patients, extra care should be taken to avoid reperfusion injury. What should the ideal oxygen saturation range most likely be?

You are caring for a 12-year-old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 39°C (102.2°F), heart rate is 118/min, respiratory rate is 36/min, blood pressure is 100/40 mm Hg, and oxygen saturation is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% oxygen by nonrebreathing mask.

Laboratory studies document a lactic acidosis. On the basis of the patient’s clinical assessment and history, which type of shock does this patient most likely have?

You are caring for a 12-year-old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 39°C (102.2°F), heart rate is 118/min, respiratory rate is 36/min, blood pressure is 100/40 mm Hg, and oxygen saturation is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% oxygen by nonrebreathing mask.

Which assessment finding is most important in your determination of the severity of the patient’s condition?

You are caring for a 12-year-old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 39°C (102.2°F), heart rate is 118/min, respiratory rate is 36/min, blood pressure is 100/40 mm Hg, and oxygen saturation is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% oxygen by nonrebreathing mask.

What is the most appropriate amount to administer for the first normal saline fluid bolus?

You are caring for a 12-year-old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 39°C (102.2°F), heart rate is 118/min, respiratory rate is 36/min, blood pressure is 100/40 mm Hg, and oxygen saturation is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% oxygen by nonrebreathing mask.

In addition to oxygen administration and appropriate fluid resuscitation, what additional early intervention should you provide to this patient?

A 10-year-old child is brought to the emergency department for fever and cough. You obtain an oxygen saturation on the child. Which oxygen saturation would indicate that immediate intervention is needed?

An unresponsive 14-year-old girl is pale and cool to the touch. His blood pressure is 70/45 mm Hg, heart rate is 190/min, and respiratory rate is 12/min. The SpO2 is not detectable. Capillary refill time is 5 seconds. An IV is in place. The cardiac monitor displays the rhythm shown here.

If pharmacological interventions are unavailable or delayed, which intervention is indicated?

The parents of a 7-year-old child who is undergoing chemotherapy report that the child has been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals that the child is difficult to arouse and her skin color is pale. The child’s heart rate is 160/min, respiratory rate is 38/min, blood pressure is 76/45 mm Hg, capillary refill time is 5 to 6 seconds, and temperature is 39.4°C (103°F). IV access has been established, and blood cultures have been obtained. Which action should you perform next?

An unresponsive 9-year-old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His blood pressure is 80/40 mm Hg, heart rate is 45/min, respiratory rate is 6/min, and SpO2 is 60% on room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here.

Which rhythm is most consistent with this patient’s presentation and ECG findings?

An unresponsive 9-year-old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His blood pressure is 80/40 mm Hg, heart rate is 45/min, respiratory rate is 6/min, and SpO2 is 60% on room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here.

Which action do you take next?

A 3-year-old child is brought to the emergency department by his mother. Which is a normal finding for a 3-year-old child?