Chapter 1 Assessment of the Critically Ill Child
(2026/2027) Questions and Verified Answers,
100% Guarantee Pass
A 3-month-old infant girl with a history of prematurity is brought to the emergency department
by her father and mother following a 1-week history of nasal congestion, cough, wheezing, post-
tussive emesis, poor fluid intake, tachypnea, and fever. On arrival, the infant's vital signs are:
heart rate, 182 beats/min; respiratory rate, 72 breaths/min; pulse oximetry, 87% in room air;
and temperature, 101.7 F (38.7C). She is irritable, grunting, and tachypneic with subcostal and
intercostal retractions. Capillary refill is delayed at 3 seconds. She is given an albuterol
(salbutamol) nebulizer treatment followed by 45% oxygen via an air-entrainment Venturi mask
by the emergency department staff. You have been asked to assist in her management. -
CORRECT ANSWER -Case Study 1
What is this child's physiologic status based on the Pediatric Early Warning Score (PEWS)? What
are the most likely and worst possible diagnoses? - CORRECT ANSWER -Case study 1 Detection
What are the most immediate treatment strategies? - CORRECT ANSWER -Case study 1
Intervention
Is the current treatment strategy effective? Does she need more albuterol (salbutamol)
nebulization and/or other therapeutic interventions? - CORRECT ANSWER -Case Study 1
Reassessment
When the patient's clinical status changes, who needs to know and how will the information be
disseminated? Where is the best place to manage care of this patient? - CORRECT ANSWER -
Case Study 1 Effective Communication
How are you going to implement the treatment strategy? Who is to do what and when? -
CORRECT ANSWER -Case Study 1 Teamwork
, Behavior, Cardiovascular, Respiratory. Minimum score of 0 (Healthy) , maximum score of 9
(Sick). - CORRECT ANSWER -Pediatric Early Warning Score (PEWS) Categories
Playing/appropriate, Pink or capillary refill 1-2 s, Within normal parameters and no retractions -
CORRECT ANSWER -Pediatric Early Warning Score (PEWS) Column 0
Sleeping, Pale or dusky or capillary refill 3 s, >10 above normal parameters or using accessory
muscles or >30% FIO2 or >3L/min - CORRECT ANSWER -Pediatric Early Warning Score (PEWS)
Column 1
Irritable, Gray or cyanotic or capillary refill 4 s or tachycardia of 20 beats/min above normal rate,
>20 above normal parameters or retractions or >40% FIO2 or >6 L/Min - CORRECT ANSWER -
Pediatric Early Warning Score (PEWS) Column 2
Lethargic/confused or reduced response to pain, Gray or cyanotic and mottled or capillary refill
>5 s or or tachycardia of 30 beats/min above normal rate or bradycardia, >or= 5 below normal
parameters with retractions or grunting or >50% FIO2 or >8 L/min - CORRECT ANSWER -
Pediatric Early Warning Score (PEWS) Column 3
Score by starting with the most severe parameters. Score 2 extra for every 15-minute
nebulization (including continuous) or persistent postoperative vomiting. Use L/min to score
regular nasal cannula. Use FIO2 to score high-flow nasal cannula. - CORRECT ANSWER -Pediatric
Early Warning Score (PEWS) score details
Age, Heart rate at rest (beat/min), Respiratory rate at rest(breaths/min) - CORRECT ANSWER -
Pediatric vital signs categories
Birth - 1 mo, 100-180 BPM, 40-60 RR - CORRECT ANSWER -Newborn vital signs
(2026/2027) Questions and Verified Answers,
100% Guarantee Pass
A 3-month-old infant girl with a history of prematurity is brought to the emergency department
by her father and mother following a 1-week history of nasal congestion, cough, wheezing, post-
tussive emesis, poor fluid intake, tachypnea, and fever. On arrival, the infant's vital signs are:
heart rate, 182 beats/min; respiratory rate, 72 breaths/min; pulse oximetry, 87% in room air;
and temperature, 101.7 F (38.7C). She is irritable, grunting, and tachypneic with subcostal and
intercostal retractions. Capillary refill is delayed at 3 seconds. She is given an albuterol
(salbutamol) nebulizer treatment followed by 45% oxygen via an air-entrainment Venturi mask
by the emergency department staff. You have been asked to assist in her management. -
CORRECT ANSWER -Case Study 1
What is this child's physiologic status based on the Pediatric Early Warning Score (PEWS)? What
are the most likely and worst possible diagnoses? - CORRECT ANSWER -Case study 1 Detection
What are the most immediate treatment strategies? - CORRECT ANSWER -Case study 1
Intervention
Is the current treatment strategy effective? Does she need more albuterol (salbutamol)
nebulization and/or other therapeutic interventions? - CORRECT ANSWER -Case Study 1
Reassessment
When the patient's clinical status changes, who needs to know and how will the information be
disseminated? Where is the best place to manage care of this patient? - CORRECT ANSWER -
Case Study 1 Effective Communication
How are you going to implement the treatment strategy? Who is to do what and when? -
CORRECT ANSWER -Case Study 1 Teamwork
, Behavior, Cardiovascular, Respiratory. Minimum score of 0 (Healthy) , maximum score of 9
(Sick). - CORRECT ANSWER -Pediatric Early Warning Score (PEWS) Categories
Playing/appropriate, Pink or capillary refill 1-2 s, Within normal parameters and no retractions -
CORRECT ANSWER -Pediatric Early Warning Score (PEWS) Column 0
Sleeping, Pale or dusky or capillary refill 3 s, >10 above normal parameters or using accessory
muscles or >30% FIO2 or >3L/min - CORRECT ANSWER -Pediatric Early Warning Score (PEWS)
Column 1
Irritable, Gray or cyanotic or capillary refill 4 s or tachycardia of 20 beats/min above normal rate,
>20 above normal parameters or retractions or >40% FIO2 or >6 L/Min - CORRECT ANSWER -
Pediatric Early Warning Score (PEWS) Column 2
Lethargic/confused or reduced response to pain, Gray or cyanotic and mottled or capillary refill
>5 s or or tachycardia of 30 beats/min above normal rate or bradycardia, >or= 5 below normal
parameters with retractions or grunting or >50% FIO2 or >8 L/min - CORRECT ANSWER -
Pediatric Early Warning Score (PEWS) Column 3
Score by starting with the most severe parameters. Score 2 extra for every 15-minute
nebulization (including continuous) or persistent postoperative vomiting. Use L/min to score
regular nasal cannula. Use FIO2 to score high-flow nasal cannula. - CORRECT ANSWER -Pediatric
Early Warning Score (PEWS) score details
Age, Heart rate at rest (beat/min), Respiratory rate at rest(breaths/min) - CORRECT ANSWER -
Pediatric vital signs categories
Birth - 1 mo, 100-180 BPM, 40-60 RR - CORRECT ANSWER -Newborn vital signs
