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Final Test Flashcards

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1
Q

What are the five components of the APGAR score?

A

Appearance, Pulse, Grimace, Activity, Respiration

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2
Q

What does Appearance assess in the APGAR score?

A

Skin color: 0 = Blue/pale, 1 = Pink body, blue extremities, 2 = Completely pink

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3
Q

What does Pulse assess in the APGAR score?

A

Heart rate: 0 = Absent, 1 = <100 bpm, 2 = ≥100 bpm

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4
Q

What does Grimace assess in the APGAR score?

A

Reflex irritability: 0 = No response, 1 = Grimace/weak cry, 2 = Cries/pulls away

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5
Q

What does Activity assess in the APGAR score?

A

Muscle tone: 0 = Limp, 1 = Some flexion, 2 = Active motion

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6
Q

What does Respiration assess in the APGAR score?

A

0 = Absent, 1 = Slow, irregular, 2 = Good, crying

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7
Q

What does the Pediatric Assessment Triangle (PAT) assess?

A

Appearance, Work of Breathing, Circulation to Skin

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8
Q

What does Appearance assess in the Pediatric Assessment Triangle?

A

Tone, interactiveness, consolability, look/gaze, speech/cry

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9
Q

What does Work of Breathing assess in the Pediatric Assessment Triangle?

A

Retractions, nasal flaring, abnormal sounds (stridor, grunting), tripod positioning

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10
Q

What does Circulation to Skin assess in the Pediatric Assessment Triangle?

A

Color (pallor, cyanosis, mottling), cap refill

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11
Q

What do abnormalities in the PAT indicate?

A

An unstable child, requiring immediate intervention.

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12
Q

What are the 4 most common pediatric emergencies?

A

Fever, Respiratory difficulties, Injuries/trauma, Vomiting/diarrhea

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13
Q

What indicates a fever in pediatric patients?

A

Temp ≥ 38.0°C

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14
Q

What are key signs of upper airway issues in pediatric respiratory distress?

A

Stridor, drooling (e.g., croup, epiglottitis)

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15
Q

What are key signs of lower airway issues in pediatric respiratory distress?

A

Wheezing, tachypnea (e.g., asthma, bronchiolitis)

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16
Q

What is the common age range for febrile seizures?

A

6 months to 5 years

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17
Q

What is the treatment for febrile seizures?

A

Manage fever, protect airway

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18
Q

What are signs of dehydration in children?

A

Lethargy, Sunken fontanelle, Dry mucosa, ↓ Urine output

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19
Q

When should hypoglycemia be treated in pediatric patients?

A

Treat if BGL < 2.6 mmol/L

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20
Q

What are the three main categories in neonatal resuscitation?

A

Basic steps, Ventilation, Chest compressions

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21
Q

What is the typical cause of neonatal cardiac arrest?

A

Respiratory failure (asphyxia)

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22
Q

What is the pathway of asphyxia in neonates?

A

Hypoxia → pulmonary vasoconstriction → Bradycardia → ↓ Cardiac output → ↓ Cerebral & organ perfusion → Secondary apnea

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23
Q

What is the difference between Primary and Secondary Apnea?

A

Primary Apnea: Mild hypoxia, Slight ↓ HR, Yes response to stimuli. Secondary Apnea: Prolonged severe hypoxia, ↓↓↓ HR, No response to stimuli.

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24
Q

What is MR SOPA and when is it used?

A

Used when PPV is ineffective: Mask seal, Reposition airway, Suction mouth/nose, Open mouth, Pressure increase, Alternate airway

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25
What are key guidelines for neonatal ventilations?
BVM with room air, Vent rate: 40–60/min, Reassess HR every 30 sec
26
Describe correct chest compression technique for neonates.
Location: Lower third of sternum, Method: 2 thumbs encircling hands preferred, Ratio: 3:1
27
How is shoulder dystocia managed?
McRoberts maneuver, Suprapubic pressure, Gaskin maneuver
28
What’s the management for a prolapsed cord?
Elevate presenting part, Place in knee-chest or Sims position, Cover cord with moist sterile dressing, Urgent transport
29
How do you calculate normal SBP in children?
Normotensive SBP: 90 + (2 × age in years)
30
How do you estimate a child’s weight in kg?
Weight (kg) = (Age × 2) + 10
31
What are the first steps immediately after delivery?
Warm the infant (drying, removing wet linens, skin-to-skin). Position airway in the 'sniffing' position (towel under shoulders). Suction mouth first, then nose if needed. Stimulate (rubbing back, flicking soles) to encourage breathing.
32
What are the risks of neonatal hypothermia?
↑ O₂ demand. ↑ risk of hypoglycemia. Worsening bradycardia, acidosis, hypoxia. Can impair resuscitation success.
33
What is the 'sniffing' position and why is it used?
Aligns airway for ventilation. Chin in line with glabella. External auditory meatus aligned horizontally with suprasternal notch. Open anterior neck space to improve airflow.
34
When should suctioning be done in newborns?
If ineffective respiratory effort (obstruction suspected). Visible secretions in mouth/nose. Meconium with poor tone or respiratory effort. Always suction mouth before nose to prevent aspiration. Avoid aggressive suctioning to prevent vagal bradycardia.
35
When and how is free-flow oxygen delivered to neonates?
Indicated if: Central cyanosis or respiratory distress (grunting, flaring). Flow: 5–6 L/min. Hold tubing or mask 1–2 cm from face. Slowly withdraw as color improves.
36
What are the three main indications for positive-pressure ventilation (PPV) in neonates?
Apnea or gasping. HR < 100 bpm. Persistent central cyanosis despite 100% oxygen.
37
When should chest compressions be started?
HR remains <60 bpm after 30 seconds of effective PPV with 100% O₂.
38
What are the ventilation rates in neonatal resuscitation?
With PPV only: 40–60 breaths/min. With compressions: 3:1 ratio (90 compressions, 30 ventilations per min).
39
How often should HR be reassessed during resuscitation?
Every 30 seconds. Use cardiac monitor or auscultation of umbilical pulse.
40
How should maternal arrest be modified for pregnancy?
If >20 weeks gestation, displace uterus to the left. Helps relieve aortocaval compression and improves cardiac output during CPR. Requires 3-person team: Airway, compressions, uterine displacement.
41
How do you manage a breech presentation in the field?
Do not pull on the baby. Allow gravity to assist with delivery. Deliver head last using Mauriceau-Smellie-Veit maneuver if needed.
42
What should be done for a limb presentation during delivery?
Do not attempt delivery. Wrap exposed limb. Elevate hips. Urgent transport to obstetric facility.
43
What are signs of stillbirth and what should you do?
Signs: Macerated skin, foul odor, soft skull. Resuscitate if unsure about viability. Provide support to family. Avoid false reassurance or speculation.
44
What are key signs of postpartum hemorrhage?
Vaginal: Blood loss >500 mL. C-section: Blood loss >1000 mL. 5 soaked pads postpartum. Boggy or soft uterus. May present with tachycardia or hypotension.
45
How do you manage suspected postpartum hemorrhage in the field?
Fundal massage to stimulate uterine contraction. Encourage breastfeeding (stimulates oxytocin). Rapid transport. Monitor vitals, assess blood loss.
46
What are the minimum target BGLs for pediatric patients?
<2 years old: ≥ 3.0 mmol/L. >2 years old: ≥ 4.0 mmol/L.
47
What is considered abnormal cap refill time in pediatric patients?
>2 seconds = poor perfusion. Suggests hypovolemia or shock.
48
How does the neonate clear lung fluid after birth, and what complications can arise?
During vaginal delivery, chest compression through the birth canal expels ~1/3 of lung fluid. Remaining fluid is absorbed by alveoli and lymphatics. C-section or rapid deliveries = less compression = more retained fluid. ## Footnote Can cause: Poor gas exchange, Respiratory distress: grunting, nasal flaring, retractions.
49
What are expected SpO₂ values in neonates immediately after birth (pre-ductal)?
Time After Birth Target SpO₂ (%) 1 min 60–65% 2 min 65–70% 3 min 70–75% 4 min 75–80% 5 min 80–85% 10 min 85–95% ## Footnote Use right hand for accurate pre-ductal SpO₂ reading.
50
When should you consider stopping PPV in neonates?
If HR ≥100 bpm, Spontaneous respirations begin, Good color and tone. ## Footnote Gradually reduce and discontinue PPV.
51
Where are chest compressions delivered on a neonate?
Lower third of the sternum, preferably using 2-thumb encircling hands technique.
52
What are hallmark signs that differentiate croup from epiglottitis in children?
Croup: Barky cough, Stridor, Often viral, gradual onset. Epiglottitis: Sudden onset, Drooling, High fever, Sitting forward/tripod, No cough.
53
How does neonatal airway anatomy differ from adults?
Larger tongue, tonsils, epiglottis, occiput; Smaller airway diameter; More prone to obstruction.
54
What are the three peaks of death in pediatric trauma (trimodal)?
Seconds–Minutes: Brainstem/life-threatening injuries → prevention only helps. Minutes–Hours: Internal bleeding, airway → rapid transport and treatment can help. Days–Weeks: Infection, organ failure → definitive care needed.
55
What makes pediatric patients more vulnerable to trauma?
Smaller size → more organ involvement; Higher metabolic rate and BSA → increased heat loss; Smaller blood volume → small blood loss = large % lost; Larger head → more head injuries. ## Footnote Airway management and shock prevention are critical.
56
What are early and late signs of pediatric shock?
Early: Tachycardia, cool extremities, delayed cap refill. Late: Hypotension (very late!), AMS, mottling.
57
What does a sunken or bulging fontanelle indicate?
Sunken: Dehydration. Bulging: Increased ICP (e.g., meningitis, trauma).
58
What are signs of increased work of breathing in the PAT assessment?
Nasal flaring, Retractions, Grunting, Head bobbing, Abnormal posture (tripod), Audible sounds: stridor, wheezing.
59
What signs suggest normal vs abnormal appearance in PAT?
Normal: Alert, moving, strong cry/speech, responds to parent. Abnormal: Limp or rigid tone, Inconsolable or unresponsive, No cry, weak or high-pitched cry.
60
What abnormal skin signs suggest poor circulation in a pediatric patient?
Pallor, Cyanosis (central or peripheral), Mottling, Significant visible bleeding.
61
What are early warning signs of sepsis in children?
Tachycardia, Temperature instability (fever or hypothermia), Poor perfusion, Irritability.
62
What are late signs of sepsis in children?
Altered mental status, Mottled skin, Hypotension (VERY late in kids).
63
Why do we avoid using supplemental oxygen for initial BVM in neonates?
Neonates are at risk of hyperoxemia and oxygen toxicity. Use room air initially. ## Footnote Only use 100% O₂ if HR <60 bpm after 30 sec of room air PPV.
64
What should you do if the umbilical cord is wrapped around the neck at birth?
Attempt to slip it over the head gently. If not possible, clamp and cut the cord before completing delivery. Avoid traction on the cord. Monitor for bradycardia or delayed transition.
65
In what order should the shoulders be delivered after the head?
Restitution (head aligns with body). Anterior shoulder delivered downward. Posterior shoulder delivered upward.
66
When should cord clamping be delayed, and for how long?
Wait 2–3 minutes or until cord stops pulsing. Benefits: better iron stores, reduced anemia. If resuscitation needed → clamp immediately.
67
What is the Mauriceau-Smellie-Veit maneuver used for?
Assists delivery of the after-coming head in a breech birth. One hand supports fetal body on forearm, fingers on malar bones. Other hand provides pressure on occiput.
68
What do APGAR score ranges indicate about newborn status?
0–3: Severely depressed, requires full resuscitation. 4–6: Moderately depressed, needs some intervention. 7–10: Good condition.
69
What’s the best method to assess HR during neonatal resuscitation?
Use umbilical pulse or cardiac monitor. Avoid long auscultation interruptions. Goal HR: consistently >100 bpm.
70
What is the purpose of tactile stimulation in a newborn?
Helps initiate spontaneous breathing. Often effective in primary apnea. Avoid rough methods (e.g. slapping).
71
When is stimulation alone not effective and BVM is required?
If no response after 30 seconds of stimulation. If HR is dropping. If signs of secondary apnea.
72
How is blow-by oxygen administered to a neonate?
Use O₂ tubing or mask near nose/mouth. Flow: 5–6 L/min. Hold ~1–2 cm from face. Taper away as skin color improves.
73
What are safe and effective forms of stimulation in neonates?
Rubbing back. Flicking soles of feet. Drying vigorously. Avoid slapping, shaking, or cold immersion.
74
How often should you reassess HR during neonatal compressions?
Every 30 seconds. Stop compressions if HR ≥60 bpm and rising.
75
How do you distinguish a stillbirth, and when do you resuscitate anyway?
Signs: maceration, foul odor, soft skull. If in doubt, begin resuscitation. Emotional support and privacy essential.
76
What are normal HR ranges by pediatric age group?
0–1 year: 100–160 bpm. 1–10 years: 80–120 bpm. >10 years: 60–100 bpm.
77
How can you estimate a child’s weight using their age?
Weight (kg) = (age in years × 2) + 10.
78
How do you estimate the hypotensive threshold for a child’s SBP?
<70 mmHg + (2 × age in years) = hypotensive. ≥90 mmHg + (2 × age) = normal SBP.
79
Why is hypotension considered a late sign of shock in children?
Children compensate with vasoconstriction and tachycardia. By the time BP drops, decompensation is already occurring. Early recognition = vitals, LOC, cap refill.
80
What are common signs of hypoglycemia in pediatric patients?
Altered LOC. Seizures. Pallor. Irritability. Sweating. Poor feeding (infants).
81
What’s the treatment threshold for pediatric hypoglycemia?
If <2.6 mmol/L, treat immediately. Goal: ≥3.0 mmol/L. Can cause seizures and permanent damage.
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