Question

1. All of the following may be associated with respiratory distress in the pediatric patient except:
   1. Bradycardia
   2. Agitation
   3. Retractions
   4. Nasal flaring
2. Which of these interventions would be the most appropriate during endotracheal intubation of an infant or child with respiratory failure?
   1. Any single attempt at intubation should be continued without interruption until tube placement is achieved.
   2. Interrupt the attempt and provide bag-mask ventilation with 100% if the heart rate decreases or clinical condition worsens.
   3. Always use cuffed tubes.
   4. Evaluate tube position by auscultation over the trachea.
3. A 10-month old infant has a history of an upper respiratory infection for 3 days. She is agitated, has a respiratory rate of 74 with moderate sternal retractions, and a heart rate of 172 bpm with strong pulses and and cap refill < 2 seconds. Initial treatment should include:
   1. Opening the airway, oxygen delivery with a non-rebreather mask and reservoir of 100% free flow as tolerated & monitoring oxygen saturation.
   2. Vascular access and a fluid bolus of 20 ml/kg of normal saline.
   3. Opening the airway and providing positive pressure ventilation with bag/mask with 100% oxygen.
   4. Immediate intubation and monitoring saturation with pulse oximetry.
4. A 6-week-old infant is pale, has severe substernal retractions with expiratory grunting and decreased muscle tone. You should first:
   1. Apply a pulse oximeter.
   2. Administer 100% oxygen.
   3. Obtain IV access.
   4. Prepare for chest x-ray.
5. While attempting to intubate the 6-week-old infant his heart rate drops to 40 bpm. What should be initiated?
   1. Apply cricoid pressure and establish IV access.
   2. Administer blow-by oxygen and begin chest compressions.
   3. Ask the physician to stop intubation attempt and attempt bag/mask ventilation.
   4. Inform the physician of the change and request faster intubation.

Answer 1

1)Pediatric patient with respiratory distress will exhibit nasal flaring, retraction, agitation. But instead of bradycardia they shows tachycardia, later on in worsening condition which leads to respiratory arrest bradycardia will be a late sign. So the answer is bradycardia.

2) interrupt the attempt and provide bag-mask ventillation with 100percent if the heart rate decreases or the clinical condition worsens. Since decreasing heart rate is indicative of respiratory arrest.

3) opening the airway, oxygen delivery with a partial rebreather mask and reservior of 100 percentage free flow as tolerated and monotoring oxygen saturation.

5) Ask the physician to stop intubation attempt and attempt bag and mask ventillation.