Pediatric Emergencies
What body proportion is notably different in a child compared with an adult?
$100 — A child has a proportionally larger head.
Define primigravida.
$100 — A woman who is pregnant for the first time.
What is the key intervention when a neonate acutely deteriorates?
100 — Constant observation and reassessment while supporting immediate needs.
What is the initial positioning principle for a patient with asthma/COPD distress?
$100 — Allow a position of comfort, often sitting upright; supine positioning may worsen symptoms.
What classic cough and airway sound suggest croup?
$100 — Barking cough with hoarseness and inspiratory stridor.
When is oral glucose appropriate for a hypoglycemic patient?
$100 — Only if alert enough to swallow and protect the airway.
What is the first-line external hemorrhage control method?
$100 — Direct pressure.
Name four signs of hypovolemic shock
$100 — Tachycardia, tachypnea, hypotension, diaphoresis, cool skin, pallor, or flat neck veins.
What does BE-FAST help identify
$100 — Possible stroke: Balance, Eyes, Face, Arm, Speech, Time.
What aspirin dose is listed for suspected ACS, and by what route?
$100 — 324 mg chewable PO, unless contraindicated by allergy/anaphylaxis or active internal bleeding.
What is the purpose of a 4-lead ECG in field assessment
$100 — Continuous rhythm monitoring and rhythm identification; it does not replace a diagnostic 12-lead when indicated.
A caregiver is calm and provides the pediatric patient's history. Why is rapport important?
$100 — Caregivers provide key history and assistance; children often mirror caregiver responses, so calm communication can help the child cope.
What is the primary purpose of a BVM?
To provide PPV when a patient cannot adequately ventilate on their own
A condition or circumstance in which a medication should not be administered because it may cause harm.
What is the difference between heat exhaustion and heat stroke?
Answer: Heat stroke involves severe heat illness with central nervous system dysfunction, such as confusion, seizures, or coma. Heat exhaustion typically does not involve this degree of CNS dysfunction.
Why can a child with shock look compensated before suddenly deteriorating?
$200 — Children can maintain perfusion through increased heart rate and vascular resistance; hypotension is a late sign.
How is fundal height measured
$200 — In centimeters, from the top of the pubic bone to the top of the uterine fundus.
What risk increases when membranes have been ruptured for a prolonged period?
$200 — Infection risk; the blueprint highlights increased concern as time approaches/exceeds 18 hours.
According to the supplied guideline excerpt, what SpO₂ targets are listed for general respiratory distress and COPD?
$200 — At least 94% generally; 90% in COPD, per the supplied excerpt and local protocol.
What dexamethasone dose is listed for croup?
$200 — 0.6 mg/kg PO/IV/IM, maximum 16 mg, per the supplied excerpt.
What glucose threshold in the supplied excerpt triggers treatment/reassessment pathways for symptomatic hypoglycemia?
$200 — Blood glucose below 60 mg/dL in the listed protocols.
How far proximal to an extremity wound does the excerpt say to place a tourniquet?
$200 — At least 2–3 inches proximal to the wound.
What three major causes of obstructive shock
$200 — Tension pneumothorax, pulmonary embolism, and cardiac tamponade.
What RACE score threshold is highlighted for considering direct transport to a comprehensive stroke center?
$200 — RACE score greater than 5, according to local/regional protocol.
When should oxygen be given for ACS?
$200 — For dyspnea, hypoxia (SpO₂ <94%), or signs of heart failure; titrate to maintain SpO₂ at least 94%.
Regular narrow-complex tachycardia: name two initial assessment priorities before selecting treatment.
$200 — Assess stability/perfusion and obtain vitals; evaluate symptoms, monitor rhythm, and obtain a 12-lead when feasible.
A patient with sudden focal weakness has an unknown onset time. What critical timeline question should you ask?
$200 — Determine last known well; seek a witness/family member and clarify whether the patient was at baseline after waking.
During ventilation with a BVM the patient's chest does not rise, name two immediate corrective actions
A medication is ordered at 0.2 mg/kg IV. The patient weighs 70 kg. What is the calculated dose before considering any maximum-dose limit?
Answer: 14 mg. Then verify the drug-specific maximum dose, concentration, and protocol before administration.
Question: What are two immediate field priorities for a patient with suspected heat stroke?
Answer: Begin rapid active cooling and support ABCs, while arranging urgent transport. Do not delay cooling while waiting for transport.
Name four signs of pediatric respiratory distress.
$300 — Examples: tachypnea for age, retractions, nasal flaring, abdominal breathing, stridor, grunting, pallor/mottling, restlessness, mild tachycardia.
What is gestational diabetes, and what symptoms may appear?
$300 — Difficulty processing carbohydrates during pregnancy; may be asymptomatic or show polyuria, polydipsia, and polyphagia.
What is a neologism in a psychiatric assessment?
$300 — A made-up word with meaning known only to the patient; can indicate a thought disorder.
What albuterol nebulizer dose is listed, and how often may it be repeated in the excerpt
$300 — Albuterol 2.5 mg nebulized; repeat every 5 minutes for persistent symptoms, up to three doses in the listed protocol.
What is the listed CPAP PEEP for suspected asthma/COPD versus acute pulmonary edema?
$300 — Asthma/COPD: 5 cm H₂O; suspected acute pulmonary edema: 10 cm H₂O (the document sometimes writes mmHg; verify units and local protocol).
Adult protocol excerpt: what is the preferred IV dextrose formulation and standard dose?
$300 — D10; up to 25 g IV, with reassessment and stopping as mental status returns to baseline and glucose is at least 60 mg/dL.
What two details must be communicated/documented after tourniquet placement?
$300 — Application time and the fact that a tourniquet is in place; do not release a properly applied tourniquet before definitive care.
What combination strongly suggests tension pneumothorax in a deteriorating trauma patie
$300 — Worsening distress/hypoxia plus shock signs and unilateral diminished/absent breath sounds; JVD, hyperresonance, or late tracheal deviation may occur.
A seizure continues for more than two minutes. Name a preferred initial benzodiazepine route/dose for an adult
$300 — Midazolam 5 mg IM or IN; if IV access already exists, the excerpt also lists midazolam 5 mg IV. Follow current local protocol.
What are two key nitroglycerin safety screens before administratio
$300 — Check systolic BP per protocol and recent PDE-5 inhibitor use: sildenafil/vardenafil within 24 hours or tadalafil within 48 hours; use extreme caution with inferior MI/RV involvement.
A regular wide-complex tachycardia with hypotension and altered mental status should be treated as what until proven otherwise?
$300 — A potentially life-threatening unstable tachydysrhythmia (often presumed VT); follow the applicable rhythm/cardioversion protocol.
A wheezing patient has crackles/rales and a history consistent with pulmonary edema. What diagnostic trap should you avoid?
$300 — Do not assume all wheezing is asthma/COPD; CHF can cause 'cardiac wheeze.'
A pt has a respiratory rate of 6BPM, shallow chest rise and an SPO2 of 82% why is simply applying a NRB insufficient
The patient has inadequate ventilation, not just inadequate oxygen delivery. Assisted ventilation with a BVM and appropriate airway support is needed while monitoring the patient's response.
You must administer 150 mg of a medication supplied as 50 mg/mL. How many milliliters will you draw up?
Answer: 3 mL. Calculation: 150 mg ÷ 50 mg/mL = 3 mL.
A hypothermic patient is confused, has a slow pulse, and is shivering. What handling and treatment considerations are important?
Answer: Handle gently, prevent further heat loss, remove wet clothing when feasible, insulate, and provide appropriate rewarming and cardiac monitoring. Avoid rough movement and follow local guidance for moderate or severe hypothermia.
A child becomes lethargic, cyanotic, and the heart rate begins to slow after prolonged respiratory distress. What does this suggest?
$400 — Impending or established respiratory failure; support airway/ventilation and rapidly manage/transport per protocol.
During labor, a patient with a prior uterine scar develops weakness, dizziness, diaphoresis, tachycardia, and falling BP. What complication is concerning?
$400 — Uterine rupture; treat for shock and provide rapid transport. Vaginal bleeding may not be obvious.
Differentiate delirium from dementia by onset and course.
$400 — Delirium is acute/fluctuating with attention or consciousness changes and may be reversible; dementia is chronic/progressive with prominent memory impairment.
What combination and dose are listed for DuoNeb, and what is the listed maximum repeat count?
$400 — Ipratropium 0.5 mg plus albuterol 2.5 mg nebulized; may repeat every 5 minutes, maximum three doses in the excerpt.
A CHF patient is sitting upright, RR 30, SpO₂ 88%, accessory muscle use, SBP 168. What support and medication pathway does the excerpt describe?
$400 — Consider CPAP (SBP threshold in excerpt ≥100), IV access and 12-lead ECG; nitroglycerin is listed for respiratory distress with BP-dependent dosing and contraindication screening.
A pediatric patient weighs 18 kg. Using the supplied pediatric dose of dextrose 0.5 g/kg, how many grams are calculated?
$400 — 18 kg × 0.5 g/kg = 9 g. Confirm concentration/volume and protocol before administration.
A deep junctional wound cannot be controlled by pressure and cannot accept a tourniquet. What method is listed?
$400 — Pack with an approved gauze-format topical hemostatic agent and apply sustained direct pressure.
What two needle thoracostomy sites
$400 — 4th/5th intercostal space mid-axillary line, or 2nd intercostal space midclavicular line, per the supplied protocol.
For suspected opioid overdose with severe respiratory depression, what comes before or alongside naloxone?
$400 — Airway positioning and assisted ventilation with BVM and oxygen; naloxone does not replace ventilation.
A chest-pain patient has taken tadalafil within the past 24 hours. Should nitroglycerin be given
$400 — No—tadalafil requires avoiding nitrates for 48 hours in the supplied excerpt.
What does ST elevation in contiguous leads raise concern for, and what field action is highlighted?
$400 — STEMI; transmit/communicate the ECG and activate/notify the receiving facility with a STEMI alert when criteria are met.
A patient with altered mental status has pinpoint pupils and slow respirations. What toxidrome is concerning, and what is the immediate priority?
$400 — Opioid toxicity; support ventilation/oxygenation and administer naloxone according to protocol.
After advanced airway placement, waveform capnography shows a persistent, sustained waveform and an ETCO₂ of 38 mmHg. What does this support, and what does it not prove by itself?
It supports tracheal placement and effective exhaled CO₂ detection, but it does not independently guarantee correct tube depth or exclude later displacement. Continue clinical reassessment and secure the airway.
A child weighs 18 kg. The protocol specifies 0.1 mg/kg, with a maximum single dose of 2 mg. The medication concentration is 1 mg/mL. What dose and volume should be administered?
Answer: 1.8 mg, or 1.8 mL. The calculated dose is below the 2 mg maximum. This is a math exercise; the actual drug, route, and protocol must be verified.
After a prolonged entrapment, a patient is freed and develops profound hypotension and dysrhythmias. Explain why release can precipitate deterioration and name two important management priorities.
Answer: Crush injury can cause major fluid shifts, shock, acidosis, and release of potassium from damaged muscle, potentially causing lethal dysrhythmias. Priorities include ABC support, ECG monitoring, rapid transport, and early medical-control consultation for crush syndrome and hyperkalemia management.
Contrast toddler toxic ingestion with adolescent toxic ingestion.
$500 — Toddlers/preschoolers more often have accidental, small-quantity, single-substance exposures; adolescents more often have recreational or intentional exposures involving multiple agents.
Define cephalopelvic disproportion and the likely definitive delivery route
$500 — Fetal head is too large relative to the maternal pelvis; cesarean delivery is commonly required.
A patient has excessive, difficult-to-control worry more days than not for at least six months. Which disorder is consistent with this description?
Generalized anxiety disorder (GAD)
A severe asthma patient is failing initial treatment. Name two escalation options listed in the supplied excerpt and one important caution.
$500 — CPAP/BiPAP up to 10 cm H₂O; magnesium sulfate 2 g IV/IO over 10 minutes; steroid therapy is also listed. The excerpt says not to give magnesium to COPD patients and distinguishes epinephrine for asthma from terbutaline for COPD.
Name three CPAP cautions/contraindications from the supplied excerpt.
$500 — Examples: suspected pneumothorax, obvious chest trauma, respiratory arrest/depression, severe facial/laryngeal injury, tracheostomy, recent gastric surgery, basilar skull fracture, GI bleed, esophageal anastomosis; relative cautions include vomiting or SBP <100.
A 16 kg child needs glucagon under the weight bands in the supplied excerpt. What dose/route is listed when IV/IO access is unavailable?
$500 — For under 20 kg: glucagon 0.5 mg IM or IN; recheck glucose in 15 minutes.
Name four priorities/pearls for suspected hemorrhagic shock from the supplied excerpt.
$500 — Control bleeding, prevent heat loss, rapid transport/notification, frequent reassessment, consider blood products only under agency credentialing/protocol, and use fluids according to protocol/physiologic response.
A 70 kg adult meets the excerpt's blood-product criteria. What adult product quantity is listed, and what adjunct medication class is listed?
$500 — The excerpt lists 2 units low-titer O+ whole blood OR 2 units packed RBCs, plus calcium chloride 1–2 g or calcium gluconate 3–6 g; only credentialed agencies/providers may use this protocol.
A suspected TCA overdose patient has tachycardia, hypotension, seizure, and QRS >110 ms. What treatment is listed for ALS communication failure
$500 — Sodium bicarbonate 1–2 mEq/kg IV/IO in the adult excerpt; pediatric excerpt lists 1 mEq/kg. Use only under applicable protocol/medical direction.
A patient with suspected ACS has diaphoresis, nausea, weakness, and dyspnea but no chest pain. Can ACS still be present? What ECG steps are listed
$500 — Yes; atypical presentations occur, especially in women, people with diabetes, and older adults. Monitor rhythm, obtain a 12-lead, consider serial ECGs, and notify the receiving facility if STEMI is confirmed.
Scenario: patient becomes pulseless and unresponsive; monitor shows a shockable rhythm. State the broad priorities.
$500 — High-quality CPR, rapid defibrillation for VF/pulseless VT, airway/oxygenation and team coordination, medication/timing per current cardiac-arrest algorithm, and frequent rhythm/pulse reassessment.
A patient deteriorates after an intervention. What should drive your next action?
$500 — Immediate reassessment of ABCs, mental status, vitals, rhythm, response/complications, and adjustment of care under protocol; do not continue a failing plan without reassessment.
A patient with severe asthma becomes exhausted and less responsive. Wheezing becomes nearly absent, chest rise decreases, and ETCO₂ rises. Why is this more concerning than loud wheezing?
These findings suggest critically reduced airflow and worsening ventilatory failure. A “silent chest” can indicate minimal air movement, not improvement. Support oxygenation and ventilation as indicated, prepare for advanced airway management, and expedite transport.
A patient weighs 24 kg. The order is 0.15 mg/kg, maximum 3 mg. The vial contains 2 mg/mL. What dose and volume are appropriate under the stated order?
Answer: The calculated dose is 3.6 mg, but the maximum limits the dose to 3 mg. Volume = 3 mg ÷ 2 mg/mL = 1.5 mL.
A 7-year-old child weighing 22 kg is pulled from a frozen lake after an estimated 15-minute submersion. The child is unresponsive, apneic, and pulseless. The skin is extremely cold. After moving the child to a protected environment, your crew obtains a reliable core temperature of 26°C (78.8°F). The monitor shows ventricular fibrillation (VF).
You are the lead paramedic. Your crew has an AED/monitor, BVM, suction, IV/IO equipment, warmed crystalloid, and active external rewarming equipment.
For $500, explain your complete management plan from initial assessment through transport. Include the resuscitation priorities, rewarming method, initial and subsequent shock decisions, the core-temperature thresholds governing vasoactive medications, how medications and fluids should be administered, and when resuscitation may be considered for termination.
1. Immediate resuscitation priorities
Ensure scene safety and safe removal from the ice; do not expose rescuers to additional danger.
Confirm pulselessness and absent breathing carefully. Hypothermia can make pulses extremely difficult to detect, so assess for signs of life for at least 60 seconds.
Begin high-quality pediatric CPR immediately, with effective ventilation because this is a submersion-related arrest. Use a BVM with 100% oxygen, suction as needed, and avoid excessive ventilation.
Apply the monitor/AED promptly and establish IV or IO access without unnecessary interruption of compressions.
Do not delay resuscitation while waiting for a temperature measurement.
2. Rewarming and temperature thresholds
Your 2025 NJ protocol, Section 2.10, provides these specific thresholds.
Core temperature
Protocol action
26°C, below 30°C: For VF or an AED shock advisory, give one shock at maximum power per the hypothermia protocol. Continue CPR and rewarming. Do not administer vasoactive drugs yet.
30°C to below 35°C: The protocol permits vasoactive medication, with the dosing interval extended to twice the normal interval. Its hypothermia section specifies epinephrine up to three doses.
Above 30°C: Further shocks may be considered after the required rewarming increment; the protocol specifies warming 1–2°C or until above 30°C before additional shocks.
32°C: For a hypothermic patient without contraindications, do not consider termination of resuscitation until the core temperature has reached 32°C (90°F) without ROSC; follow the resuscitation policy and Medical Command.
Important pediatric medication distinction: The hypothermia section lists epinephrine 1 mg IV/IO, but that is not a stand-alone pediatric dose instruction. For this 22 kg child, use the pediatric cardiac-arrest protocol (3.2P) and Medical Command for the weight-based dose and how the hypothermia-specific delay and extended interval apply. Do not simply administer an adult dose to the child.
3. How to rewarm and administer treatment
External rewarming: Move the child to a warm environment, gently cut away wet clothing, dry the child, and use insulation plus a vapor barrier. Handle gently and keep the child horizontal.
Warmed crystalloid: Your NJ hypothermia protocol specifies crystalloid warmed to 40–42°C (104–107.6°F). For a pediatric patient, the listed bolus is 20 mL/kg IV. At 22 kg, the calculated volume is 440 mL. Reassess the child's response and follow the protocol for further fluid decisions.
Vascular access: Administer medications via IV/IO according to the relevant pediatric arrest protocol. Follow medication-specific preparation, concentration, dose, and flush requirements; do not interrupt compressions unnecessarily.
Airway: Continue effective BVM ventilation and manage the airway as indicated. The hypothermia protocol advises ventilating at half the standard rate when an advanced airway is in place.
Defibrillation: Follow the hypothermia protocol's temperature-dependent shock sequence, with minimal interruption of CPR.
Transport: Contact the receiving facility early. Consider direct transport to a center capable of cardiopulmonary bypass (CPB) or extracorporeal membrane oxygenation (ECMO), if feasible, particularly for severe hypothermia or cardiac arrest.
Source: NJ EMS Clinical Practice Protocols, Section 2.10, pp. 55–56; hypothermic cardiac-arrest provisions in the cardiac-arrest and resuscitation policies.
Critical clinical reasoning: The child may have suffered hypoxic cardiac arrest from drowning before becoming profoundly cold. Do not assume hypothermia alone explains the arrest or that cold exposure guarantees neurologic protection. The 2025 AHA guidance also emphasizes full resuscitation alongside rewarming in children with life-threatening environmental hypothermia, and notes that evidence for exact medication timing in severely hypothermic children remains limited.
A strong exam answer explicitly identifies the three separate decisions:
Resuscitate now: CPR, ventilation, rhythm assessment, and the first indicated shock.
Use temperature-dependent treatment: defer vasoactive drugs below 30°C; extend the dosing interval between 30°C and 35°C, following pediatric-specific dosing and medical direction.
Continue rewarming and transport: do not use ordinary termination criteria as though this were a normothermic arrest; apply the hypothermia policy and consult Medical Command.