A 6 month old infant, being held in her mothers arms, is ejected on impact from a vehicle
that is struck head on by an oncoming car traveling at 64kph. The infant arrives in the ED
with multiple facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory sup-
port is not effective using a bag mask device, and her oxygen saturation is falling. Repeated
attempts at orotracheal intubation are unsuccessful. the most appropriate procedure to per-
form next is:
A.Administer heliox and racemic epinephrine
B. Perform nasotracheal intubation
C.Perform surgical cricothyroidotomy
D.Repeat orotracheal intubation
E. Perform needle cricothyroidotomy with jet insufflation
ANSWER
E. Perform needle cricothyroidotomy with jet insufflation
A 22 year old male present following a motorcycle crash. He complains of the inability to
move his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21 na-
sal prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His man-
agement should be:
A: 1L of iv . crystalloid and two units of pRBCs
B. 1L of iv. crystalloid, mannitol and iv steroids
C. 1 unit of albumin and compression stockings
D. Vasopressors and laparotomy
E. 1 L of cystalloid and vasopressors if blood pressure does not respond
ANSWER
E. 1 L of cystalloid and vasopressors if blood pressure does not respond
1
,A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he
was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing
and has a thready pulse. However, he is unconsious and has no detectable blood pressure.
Optimale immediate management is to:
A. Perform a FAST
B. Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive
ANSWER
D. Transfer the patient to the operating room, while initiating fluid therapy
Which of the following is MOST RELIABLE to confirm endotracheal intubation?
a. presence of breath sounds bilaterally
b. absence of borborygmi in the epigatrium on ascultation
c. presence of CO2 in exhaled air via capnography
d. appearance of fog in the endotracheal tube
e. chest xray with endotracheal tube tip appearing above the carina
ANSWER
e. chest xray with endotracheal tube tip appearing above the carina
A 28 year olf male is brought to the ED. He was involved in a fight, during which he was
beaten with a wooden stick. His chest shows multiple severe bruises. His arway is clear, resp
rate is 22, hear rate 126, and systolic blood pressure is 90 mmHG. Which of the following
should be performed during the primary survey
2
, a. glasgow coma
b. tetanus status
c. cervical spine xray
d. blood alcohol level
e. rectal exam
ANSWER
a. glasgow coma
an 18yo male is brought to the emergency department after being dumped by a large wave
while surfing. He landed head first on the firm beach sand. His vital signs are blood pressure
85/60 mmHg, heart rate 60, and respiratory rate 18; he is unable to move his lower extremi-
ties. He appears calm and asks if he will ever walk again. The most appropriate next step is
to:
a. reassure patient that he will walk again
b. proceed to a more detailed neuro exam
c. obtain c spin xrays
d. begin infusion of vasopressors
e. begin bolus of warm IV crystalloid
ANSWER
e. begin bolus of warm IV crystalloid
Whic one of the following statements is true regarding access in pediatric resuscitation?
a. intraosseous access should be considered only after 5 percutaneous attempts
b. cutdown at teh ankle is the preferred initial access technique
c. internal jugular cannulation is the next preferred option when percutaneous venous ac-
cess fails
d. intraosseous cannulation should be the first choice
3
that is struck head on by an oncoming car traveling at 64kph. The infant arrives in the ED
with multiple facial injuries, is lethargic, and is in severe respiratoy distress. Respiratory sup-
port is not effective using a bag mask device, and her oxygen saturation is falling. Repeated
attempts at orotracheal intubation are unsuccessful. the most appropriate procedure to per-
form next is:
A.Administer heliox and racemic epinephrine
B. Perform nasotracheal intubation
C.Perform surgical cricothyroidotomy
D.Repeat orotracheal intubation
E. Perform needle cricothyroidotomy with jet insufflation
ANSWER
E. Perform needle cricothyroidotomy with jet insufflation
A 22 year old male present following a motorcycle crash. He complains of the inability to
move his legs. His BP is 80/50, HR 70, RR 18 and GCS 15. Oxygen saturation is 99% on 21 na-
sal prongs. Chest x-ray, pelvic x-ray and FAST are normal. Extremities are normal. His man-
agement should be:
A: 1L of iv . crystalloid and two units of pRBCs
B. 1L of iv. crystalloid, mannitol and iv steroids
C. 1 unit of albumin and compression stockings
D. Vasopressors and laparotomy
E. 1 L of cystalloid and vasopressors if blood pressure does not respond
ANSWER
E. 1 L of cystalloid and vasopressors if blood pressure does not respond
1
,A 23-year-old man is brought immediately to the ED from the hospitals parking lot where he
was shot in the lower abdomen. Examination reveals a single bullet wound. He is breathing
and has a thready pulse. However, he is unconsious and has no detectable blood pressure.
Optimale immediate management is to:
A. Perform a FAST
B. Initiate infusion of packed red blood cells
C. Insert a nasogastric tube and urinary catheter
D. Transfer the patient to the operating room, while initiating fluid therapy
E. Initiate fluid therapy to return his blood pressure to normotensive
ANSWER
D. Transfer the patient to the operating room, while initiating fluid therapy
Which of the following is MOST RELIABLE to confirm endotracheal intubation?
a. presence of breath sounds bilaterally
b. absence of borborygmi in the epigatrium on ascultation
c. presence of CO2 in exhaled air via capnography
d. appearance of fog in the endotracheal tube
e. chest xray with endotracheal tube tip appearing above the carina
ANSWER
e. chest xray with endotracheal tube tip appearing above the carina
A 28 year olf male is brought to the ED. He was involved in a fight, during which he was
beaten with a wooden stick. His chest shows multiple severe bruises. His arway is clear, resp
rate is 22, hear rate 126, and systolic blood pressure is 90 mmHG. Which of the following
should be performed during the primary survey
2
, a. glasgow coma
b. tetanus status
c. cervical spine xray
d. blood alcohol level
e. rectal exam
ANSWER
a. glasgow coma
an 18yo male is brought to the emergency department after being dumped by a large wave
while surfing. He landed head first on the firm beach sand. His vital signs are blood pressure
85/60 mmHg, heart rate 60, and respiratory rate 18; he is unable to move his lower extremi-
ties. He appears calm and asks if he will ever walk again. The most appropriate next step is
to:
a. reassure patient that he will walk again
b. proceed to a more detailed neuro exam
c. obtain c spin xrays
d. begin infusion of vasopressors
e. begin bolus of warm IV crystalloid
ANSWER
e. begin bolus of warm IV crystalloid
Whic one of the following statements is true regarding access in pediatric resuscitation?
a. intraosseous access should be considered only after 5 percutaneous attempts
b. cutdown at teh ankle is the preferred initial access technique
c. internal jugular cannulation is the next preferred option when percutaneous venous ac-
cess fails
d. intraosseous cannulation should be the first choice
3
