Deck 31: Pediatric Trauma

Question 1

A respiratory therapist working in the emergency department has received report of a patient who suffered a traumatic brain injury and whose Glasgow Coma Scale score is 6. What should the therapist anticipate doing when the patient arrives?

A) Place a cervical collar.
B) Place an intravenous catheter.
C) Obtain a head CT scan.
D) Intubate.

Answer 1

D
If the GCS is less than or equal to 8, the patient likely does not have the ability to protect his or her airway, and a more definitive airway should be established. Intubation is the most common option for a definitive airway, with cricothyroidotomy being a secondary option.

Question 2

What is the meaning of the word plasticity when used to describe brain damage in infants?

A) The infant's brain has the ability to absorb more energy per square centimeter than the adult brain.
B) The infant's brain is more rigid than the adult brain up to 2 years of age.
C) The infant's brain is capable of transferring functions from damaged to undamaged regions.
D) The brain of an infant has the ability to completely replace damaged neurons with new neurons.

Answer 2

C
The brains of infants and children apparently have a large degree of plasticity (i.e., adaptability) in redistributing function from a damaged area to an undamaged area. In adults, the ability of brain segments to adapt to new functions seems to be rarely, if ever, present.

Question 3

Which of the following is used to guide resuscitation efforts in the pediatric but patient?

A) The Parkland formula
B) Berlin criteria
C) Glascow coma scale
D) A FAST exam

Answer 3

The Parkland formula

Question 4

What is the most effective means of rewarming a near-drowning victim whose core temperature in the emergency room is 27°C?

A) Radiant warmers
B) Heated aerosol therapy
C) Extracorporeal bypass
D) Mechanical ventilation with heated humidity

Question 5

A respiratory therapist is asked to rapidly assess adequacy of peripheral circulation while an intravenous line is placed. Which of the following methods should the therapist use?

A) Measure blood pressure.
B) Measure pulse pressure.
C) Assess pulse intensity.
D) Assess capillary refill.

Question 6

Patients experiencing penetrating thoracic trauma presenting with subcutaneous emphysems in the neck and upper chest should be suspected of having what type of problem?

A) Decreased pulmonary compliance
B) Aspiration of stomach contents
C) Gastric inflation
D) An injury to the bronchial tree

Question 7

Which of the following factors provide infants and young children protection against head trauma by allowing a degree of expansion of the cranial volume?
I) Reduced cranial weight
II) Less cranial ossification
III) Presence of fontanels
IV) Presence of flat bones

A) I and III only
B) II and III only
C) I, II, and IV only
D) II, III, and IV only

Question 8

What should be always assumed in the case of traumatic injury regardless of the mechanism?

A) Head injury
B) Pulmonary contusion
C) Cervical spine injury
D) Leg fracture

Question 9

Which of the following areas is evaluated on the Glasgow Coma Scale, used for the neurologic assessment of adults, older children, and adolescents?

A) Respiratory
B) Verbal
C) Circulatory
D) Olfactory

Question 10

Intracranial pressure (ICP) monitoring has been initiated for a patient with brain injury. What level of pressure should the CPP be maintained at for an infant?

A) 90 mm Hg
B) 70 mm Hg
C) 50 mm Hg
D) 40 mm Hg

Question 11

Which of the following conditions results from the fracture of adjacent ribs in at least two places along the same ribs?

A) Pneumothorax
B) Respiratory alternans
C) Flail chest
D) Condochondritis

Question 12

The definition of abdominal compartment syndrome is a pressure greater than _________.

A) 10 mm Hg
B) 20 mm Hg
C) 30 mm Hg
D) 40 mm Hg

Question 13

Which of the following respiratory procedures must be used in a patient suspected of having direct cranial trauma?

A) Nasogastric tube insertion
B) Hypocapnia
C) Nasotracheal intubation
D) Oral airway insertion

Question 14

The presence of entrance wounds below the level of the nipples suggests which of the following types of injury?

A) Spinal cord injury
B) Thoracic cage damage
C) Esophageal injury
D) Concomitant abdominal injury

Question 15

A respiratory therapist arrives at the scene of an accident to assist a victim of a motor vehicle accident. What would the best method to open the airway until a full assessment is completed?

A) Jaw thrust
B) Head tilt
C) Sniff position
D) Chin lift

Question 16

Which of the following anatomic considerations in children are important to better understand trauma in this age group?
I) Children have less body fat.
II) Children have a small surface area relative to volume.
III) Children's skeletons are more pliable.
IV) Children have a greater distribution of force per unit body area of smaller body mass.

A) I and III only
B) II and IV only
C) I, II, and III only
D) I, III, and IV only

Question 17

The indications for resuscitative thoracotomy for pediatric trauma patients are a penetrating thoracic injury with no signs of life for what amount of time?

A) Less than 5 minutes
B) Less than 15 minutes
C) Less than 30 minutes
D) Less than 45 minutes

Question 18

Why are infants and children highly vulnerable to head injury?
I) Their head is large and heavy compared with the rest of the body.
II) They lack mature judgment.
III) They are uncoordinated.
IV) They tend to move too fast.

A) I and III only
B) II and IV only
C) I, II, and III only
D) II, III, and IV only

Question 19

A child with a head injury displays bruising discolorations around the orbits, or "raccoon eyes." What does this indicate?

A) Direct trauma to the eyes
B) Frontal trauma
C) Basilar skull fracture
D) Brain herniation

Question 20

Why are children more susceptible to lung injury without fib fractures?

A) Children have a slower metabolite rate and lower oxygen demand.
B) Children have a higher functional residual capacity.
C) Children are more likely to fall.
D) Children have increased cartilage content with incomplete ossification of their ribs.

Question 21

What is the purpose of the "rule of nines"?

A) To categorize the degree of burn injury
B) To triage the body to determine which area demands immediate attention
C) To estimate the percent body surface area burned
D) To ascertain the percent of skin grafting needed

Question 22

When a victim's airway moves below the surface of a liquid, what is that person's first physiologic response?

A) Voluntary breath holding
B) Laryngospasm
C) Hypercarbia and hypoxemia
D) Aspiration

Question 23

When mechanically ventilating a victim of inhalation injury, what tidal volume should the therapist initially recommend?

A) 4 to 6 mL/kg
B) 6 to 8 mL/kg
C) 8 to 10 mL/kg
D) 10 to 12 mL/kg

Question 24

What are the characteristics of direct thermal burns to the upper airway?
I) Edema
II) Hemorrhage
III) Ulceration
IV) Pseudomembranous casts

A) IV only
B) I and II only
C) I, II, and III only
D) II, III, and IV only

Question 25

Which of the following medications are used to treat patients who have inhalation injury?
I) Antibiotics
II) Inhaled heparin
III) Racemic epinephrine
IV) N-Acetylcysteine

A) II and IV only
B) I, II, and III only
C) I, III, and IV only
D) II, III, and IV only

Question 26

In the emergency room, a patient with smoke inhalation injury will tend to display which of the following?

A) Chest radiograph demonstrating focal infiltrates
B) Soot around the mouth
C) Wheezing
D) Mucoid sputum

Question 27

Which of the following medications should be considered during the hypermetabolic state of a patient who has a burn injury?

A) Catabolic agents
B) Anabolic agents
C) Diuretics
D) Inotropes

Question 28

What form of injury is the major determinant of subsequent survival and long-term morbidity in cases of near drowning?

A) Pulmonary injury
B) Cardiovascular injury
C) Renal injury
D) CNS injury

Question 29

Which of the following conditions often results as a complication among survivors of submersion injury?

A) Pneumonia
B) Acute respiratory distress syndrome
C) Empyema
D) Hypersensitivity pneumonitis

Question 30

What occurs to the victim during drowning after the victim has been immersed in water to the point of becoming hypercarbic, acidemic and worsening hypoxia?

A) Laryngospasm stops, and the victim actively inspires water.
B) The victim begins to vomit.
C) Laryngospasm continues and the hypercarbia, hypoxemia, and acidemia worsen.
D) The victim stops breathing, and water flows into the lungs, causing asphyxia.

Question 31

What is the leading cause of smoke-related deaths?

A) The patient's inability to protect airway
B) Carbon monoxide poisoning
C) Extensive burns
D) Decreasing pulmonary compliance

Question 32

What should be the least amount of time required to rewarm a hypothermic near-drowning victim who has a core temperature of 29°C in the emergency department?

A) 1 hour
B) 2 hours
C) 4 hours
D) 6 hours

Question 33

What is the cause for a ball valve-type obstruction in a patient with an inhalation injury?

A) Edema
B) Inactivation of surfactant
C) Particles inhaled during the fire
D) Sloughing of the tracheobronchial mucosa