Deck 31: Pediatric Trauma

Question 1

Intracranial pressure (ICP)monitoring has been initiated for a patient with brain injury.The child's ICP is 10 mm Hg,and mean blood pressure is 80 mm Hg.What is this child's CPP?

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

Answer 1

B
Compression of the brain tissue inhibits blood flow by reducing cerebral perfusion pressure (CPP)and causes cerebral tissue hypoxia,ischemia,and coma.CPP = mean BP - ICP and averages 85 ± 15 mm Hg.

Question 2

What is the mechanism of action of the osmotic diuretic mannitol in the setting of increased ICP?

A)Mannitol crosses the blood-brain barrier and removes water from the cerebral vascular spaces.
B)Mannitol increases the permeability of the loop of Henle,causing water to leave the nephrons.
C)Mannitol enters the ventricles of the brain,causing fluid to leave the choroid plexus and enter the circulation for delivery to the kidneys.
D)Mannitol remains in the plasma,creating an osmotic gradient that draws water from the brain into the cerebral capillaries.

Answer 2

D
Mannitol is given intravenously as a 20% solution.It does not cross the blood-brain barrier and remains in the plasma,creating an osmotic gradient that draws water from the brain into the capillaries,reducing cerebral fluid volume and therefore ICP.The effect is short term,and infusions must be given 3 to 6 times each day.

Question 3

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

Answer 3

D
Children are not just small adults.It is important to understand the fundamental differences between adults and children.Notable are the size and shape differences.There is a greater distribution of force per unit body area because of smaller body mass resulting in greater acceleration.The child's body has less fat,elastic connective tissue,and close proximity of multiple organs.This can place the child with a penetrating injury at risk of multiple organ involvement.Children also have a large surface area relative to volume,predisposing them to thermal evaporative loss resulting in hypothermia.A child's skeleton is more pliable due to incomplete calcification.Trauma can result in serious organ injury without overlying skeletal fracture.

Question 4

Which of the following respiratory procedures must be avoided in a patient suspected of having direct cranial trauma?
I)Oral airway insertion
II)Nasotracheal suctioning
III)Nasotracheal intubation
IV)Nasogastric tube insertion

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

Question 5

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.

Question 6

The therapist is instituting hyperventilation to a child with intracranial hypertension.What should be the lowest PaCO₂ before brain ischemia can occur?

A)50 mm Hg
B)40 mm Hg
C)35 mm Hg
D)25 mm Hg

Question 7

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 8

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 9

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 8.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

Question 10

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 11

A child is admitted to the emergency department displaying an abnormal breathing pattern consisting of random,ineffective,haphazard breaths and pauses.What is the name of this breathing pattern?

A)Apneustic
B)Ataxic
C)Cheyne Stokes
D)Primary alveolar hypoventilation

Question 12

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 13

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 14

A 3-month-old baby suspected of having a life-threatening encephalopathy is being transported from a rural area.Which of the following signs may assist in the confirmation of intracranial hypertension?

A)Diplopia
B)Bulging fontanels
C)Seizures
D)Miosis

Question 15

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 16

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 17

The respiratory therapist has intubated a patient with a traumatic brain injury whose respiration has deteriorated.Which of the following ventilatory strategies should the therapist try to minimize the effects on intracranial pressures?

A)Minimize peak inspiratory pressure
B)Increase mean airway pressure
C)Prolong inspiratory time
D)Decrease respiratory rate

Question 18

A patient with status epilepticus has been treated with benzodiazepines and phenobarbital without success.Now a pentobarbital coma is indicated.What should the therapist do at this time?

A)Place the patient on an oxygen cannula prior to the administration of pentobarbital
B)Place an oropharyngeal airway to avoid patient's biting the tongue
C)Prepare to intubate and start mechanical ventilation
D)Place the patient on noninvasive mechanical ventilation

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

What is the normal value for intracranial pressure?

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

Question 21

A penetrating chest wall trauma that produces a ball-valve type injury of the visceral pleura frequently produces which type of condition?

A)Empyema
B)Hydrothorax
C)Flail chest
D)Tension pneumothorax

Question 22

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

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

Question 23

Which of the following signs indicate injury of a major thoracic vessel?

A)Evacuation of 200 mL of blood from the pleural space after placing the chest tube
B)Continuous bleeding through the chest tube
C)Presence of pneumothorax
D)Presence of respiratory distress

Question 24

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

A)Chest radiograph demonstrating focal infiltrates
B)Singed nasal vibrissae
C)Inspiratory and expiratory stridor
D)Mucoid sputum

Question 25

Injury to which of the following structures should be suspected in a young child who has a penetrating chest wound located at the 5th intercostal space?

A)Diaphragm
B)Esophagus
C)Trachea
D)Vertebrae

Question 26

What are 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 27

Which of the following procedures can cause an iatrogenic pneumothorax?

A)Oropharyngeal suctioning
B)Central venous catheter placement
C)Orogastric tube placement
D)Nasogastric tube placement

Question 28

What range of systolic pressure should be sufficient to maintain adequate tissue perfusion during fluid resuscitation of a victim of a penetrating chest injury before controlling the source of bleeding?

A)40 to 60 mm Hg
B)60 to 80 mm Hg
C)80 to 100 mm Hg
D)100 to 120 mm Hg

Question 29

Which of the following conditions is the most commonly associated with penetrating chest trauma?

A)Pulmonary contusion
B)Hemothorax
C)Empyema
D)Pleural effusion

Question 30

A smoke inhalation victim is having his oxygenation status evaluated in the emergency room by a therapist using a pulse oximeter,which indicates an SpO₂ (oxygen saturation as determined by pulse oximetry)of 87%.How should the therapist interpret this value?

A)As accurate
B)Falsely high
C)Falsely low
D)Inconsistent

Question 31

What management practice has accounted for the drop in mortality from burn injuries over the decades?

A)Systemically administered antibiotics
B)Aggressive wound excision
C)Aggressive application of topical corticosteroids
D)Aggressive administration of topical antibiotics

Question 32

When a suction catheter is inserted beyond the distal tip of an endotracheal tube,which of the following segmental bronchi is prone to injury?

A)The posterior basilar segment of the right lower lobe
B)The inferior segment of the right middle lobe
C)The medial basilar segment of the right lower lobe
D)Either lingular segment of the left upper lobe

Question 33

Which of the following medications is/are used to treat patients who have inhalation injury?
I)Beta-2 agonists
II)Inhaled corticosteroids
III)Racemic epinephrine
IV)N-Acetylcysteine

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

Question 34

What type of ventilation strategy is often employed when a patient with a penetrating chest wall injury has a massive air leak while receiving mechanical ventilation?

A)Sedation and paralysis along with patient-triggered,volume-controlled ventilation
B)Sedation and paralysis along with inverse ratio ventilation
C)Noninvasive positive pressure ventilation
D)Ventilation to achieve reduced mean airway pressures

Question 35

For victims of penetrating chest wall trauma demonstrating respiratory distress,which of the following therapeutic interventions generally need to be administered before radiologic studies are obtained to ascertain the status of intrathoracic organ injuries?

A)Arterial puncture procedure
B)Noninvasive ventilation
C)Neurological assessment
D)Ipsilateral tube thoracotomy

Question 36

Patients experiencing penetrating thoracic trauma presenting with a significant pneumothorax with a continuous air leak through the chest tube should be suspected of having what type of problem?

A)Decreased pulmonary compliance
B)Aspiration of stomach contents
C)Gastric inflation
D)Major airway injuries

Question 37

Which ventilation strategy should the therapist suggest for patients with very large leaks?

A)Volume-controlled ventilation
B)Inverse ratio ventilation
C)High-frequency ventilation
D)Airway pressure release ventilation

Question 38

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 39

When should endotracheal intubation be performed on a smoke inhalation victim?

A)As soon as possible
B)Only if the patient demonstrates inspiratory and expiratory stridor
C)When the airway appears to be narrowing as determined by bronchoscopy
D)When the signs and symptoms of respiratory failure are present

Question 40

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)Intra-abdominal injury

Question 41

What appears to be the advantage of using high-frequency percussive ventilation instead of conventional mechanical ventilation?
I)Less barotrauma
II)Lower oxygen concentrations
III)Lower tidal volumes (VTs)
IV)Lower inspiratory pressures

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

Question 42

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

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

Question 43

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 44

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 45

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)Neurologic injury

Question 46

Which of the following conditions is considered a late mechanical complication of inhalation injuries?

A)Tracheomalacia
B)Atelectasis
C)Stridor
D)Infection

Question 47

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

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 48

Which of the following types of victims should be admitted to the hospital despite being stable in the emergency room after a submersion injury?
I)Patients with any degree of respiratory compromise
II)Victims who needed rescue breathing
III)Patients who experienced a loss of consciousness
IV)Victims who were combatant at the scene

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

Question 49

Which of the following conditions should be anticipated in a near-drowning victim brought to the emergency department?
I)Cardiac dysrhythmia
II)Hypoxia
III)Acidosis
IV)Hypothermia

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

Question 50

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 membrane oxygenation (ECMO)
D)Mechanical ventilation with heated humidity

Question 51

During resuscitation after cold water submersion,which of the following cardiovascular responses tends to occur when the patient is rewarmed?

A)Cardiac dysrhythmia
B)Pulmonary hypertension
C)Hypotension
D)Myocardial infarction

Question 52

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)3 hours
D)4 hours

Question 53

When should a rescuer begin applying airway management and rescue breathing at the scene of a drowning event?

A)As soon as the victim is removed from the water
B)Once water is removed from the victim's lungs after the victim is removed from the water
C)By the emergency medical crew after the victim is removed from the water
D)If possible,before the victim is out of the water