C-NPT: Special Situations

A 12-year-old patient has sustained head, chest, and thoracic spine trauma.  Upon viewing the chest x-ray, you note a widened mediastinum, obliteration of the aortic knob, and the presence of a pleural cap.  You suspect what injury?

A 13-year-old obese child complains of right knee pain with no precipitating injury or event, and the pain has been ongoing for three months. What is the likely cause?

A 15-year-old patient has sustained a gunshot wound to the left chest. The left chest has been decompressed with a needle, but a continued increase in subcutaneous air is noted. The patient is intubated and continues to desaturate.  How would you manage this patient?

A 15-year-old trauma patient undergoes fluid resuscitation with three liters of normal saline solution and four units of unwarmed packed red blood cells (PRBCs). They remain unconscious, intubated, and ventilated with 100% oxygen. They have received sedation and remain immobilized on a backboard. You should remain concerned about: 

A 16-year-old sustained an aortic arch tear during a motor vehicle collision, which is commonly associated with which of the following?

A 16-year-old with significant head, chest and abdominal trauma from an MVC is being transferred. They have received five units of PRBCs before transfer.  They continue to bleed profusely from all wounds despite direct pressure to control bleeding secondary to suspected DIC.  What treatment do you expect to administer?

A 17-year-old arrives at the emergency department. They have been outside participating in sports activities when they began complaining of nausea and had a couple of episodes of vomiting. Upon arrival, they have a core temperature of 101.3°F orally and tachycardia at 126 bpm. They are complaining of weakness and dizziness. This presentation is an example of what?

A 6-year-old has been camping over the past three days. The transferring facility states the patient presented with headache and lethargy, with the following abnormal labs: Na⁺121, K⁺2, Ca⁺⁺8.9. What would be the first treatment?

A patient presents with complaints of throat pain, difficulty swallowing, and a change in their voice over the past three days. You notice a rancid smell on their breath and they have asymmetric tonsillar hypertrophy. What diagnosis do is most likely suspected? 

A patient sustained commotio cordis after being hit in the chest with a baseball. This condition occurs as a result of which of the following?

A patient was exposed to a substance that is inhibiting ATP production by blocking the electron transport chain in their mitochondria. What antidote management would best suit this patient?

A pediatric patient has incurred a black widow envenomation and is currently exhibiting signs of symptoms associated with this. After the primary and secondary assessments are completed, management would include all of the following EXCEPT what?

A pediatric patient has sustained a pelvic fracture. What is the most likely secondary complication associated with this?

A pediatric patient is being transferred to a pediatric intensive care unit after sustaining a venomous snake bite approximately six hours ago. They have bleeding from their IV site as well as the initial wound. The referring facility has marked the area of edema and written the time. Which of the following lab values would be suggestive of disseminated intravascular coagulation (DIC)?

A pediatric patient presents to the emergency room from church camp after being “bitten on the hand by a spider.”  History and physical examination reveal diaphoresis, abdominal cramping with a board-like rigidity, tachycardia, hypertension, global weakness, nausea, and vomiting. Based on the presentation, you suspect:

A pediatric patient was found down in the snow with a core temperature of 27°C. The following rhythm is identified, with no pulse present. What is the best treatment option?

A pediatric patient was left in a hot car. Resuscitation efforts have produced the return of spontaneous circulation (ROSC). Which indicator would alert you to an associated diagnosis of rhabdomyolysis?

A 3-year-old patient has sustained traumatic injuries after being involved in a motor vehicle collision (MVC). They have become hypovolemic and is demonstrating signs of shock. Which of the following would also be anticipated along with this?

A 6-year-old patient has ingested eight peach pits. What is the toxicology concern for this type of ingestion?

After receiving a massive transfusion with packed red blood cells (PRBCs), the patient is experiencing cellular hypoxia secondary to what?

An 8-year-old has an orbital wall and floor fracture which can be associated with which of the following findings?

An 8-year-old male patient has suffered a snake bite of unknown species to the right calf. The snakebite occurred approximately 45 minutes ago. What would be the best initial intervention?

Black and blue ecchymosis around the umbilicus is called what?

During the transport of a 14-year-old burn patient, you notice an absent P-wave and an increased QRS interval on the ECG. Initial ECG showed sinus tachycardia in the 160s with peaked T-waves. What electrolyte abnormality do you suspect?

Fractures of the 1st-3rd ribs should indicate a high index of suspicion for which injury?

Injury patterns associated with rear impact collisions are?

Minimum urine output for the pediatric burn patient with non-suspected rhabdomyolysis would be?

Pediatric patients will not demonstrate hypotension secondary to hemorrhage, until approximately ________ loss of blood volume.

Spinal cord injuries that cause respiratory and diaphragmatic paralysis would be at what level?

The family of a witnessed cardiac arrest victim has been informed that the patient was not successfully resuscitated and has died.  The most appropriate communication with the family includes which of the following statements:

The team is currently transferring a 3-year-old patient suffering from severe hypothermia.  Approximately 10 minutes out from the receiving facility, the pediatric patient goes pulseless and apneic. Current esophageal temperature reads 28°C.  Medications should be withheld until the core temperature reaches what?

The team is caring for a five-year-old, 20-kilogram victim of a motor vehicle accident.  The patient’s blood pressure was 64/43 mmHg and received a 400 mL bolus of IV fluid.  The next blood pressure obtained is 72/50 mmHg.  The best action is to:

The team is called to a campsite for a patient bitten by a snake.  The first responders have placed a tourniquet proximal to the snakebite on the leg.  Upon your assessment of the leg, you find that it is cool to the touch and pulseless. What would be the next best thing?

The team is caring for a patient with a circumferential, full thickness burn to the anterior and posterior thorax.  The patient has been sedated, intubated, and paralyzed for transport and is being mechanically ventilated.  During transport, the patient’s peak inspiratory pressure has increased from 15 cmH₂0 to 50 cmH₂0, with a corresponding plateau pressure increase from 10 cmH₂0 to 45 cmH₂0 with poor chest excursion.  The next best action is to:

What is the normal progression for rewarming a hypothermic patient?

When assessing a patient’s fractured elbow, damage to the radial and ulnar nerves would present as:

When inserting a chest tube, the recommended insertion site is?

Which of the following represents the consensus formula calculation for hourly fluid replacement in the pediatric burn patient?

Which of the following statements below is inaccurate regarding heat stroke?

You are caring for a pediatric burn patient weighing 20kg with second- and third-degree burns involving 45% total body surface area (TBSA). The injury occurred approximately 26 hours ago.  The physician reports that the patient has had a total of 3 liters of fluid in 24 hours because he does not want the patient to get cerebral edema.  Using the consensus formula, how much fluid should this pediatric patient have received in the first 24 hours of post-burn care?

You are caring for a pediatric burn patient weighing 20kg with second- and third-degree burns involving 45% total burn surface area (TBSA). The injury occurred two hours previously, and the referring facility administered 300 mL of LR thus far. Using the consensus formula, what would the fluid resuscitation amount be for the first 8 hours, taking into account volume already administered?

You are transferring a 4-year-old patient suffering from hyperthermia with a core temperature of 104°F. The hallmark indicator that rhabdomyolysis is occurring is?

You are transporting an 8-year-old patient that was involved in a head-on collision. They are currently on a non-rebreather at 15 L/min but are demonstrating signs of hypoxia. Current vital signs are as follows: BP 100/70, HR 139, RR 28 (shallow and rapid). Assessment reveals a GCS of 10, and the skin is pale, dry and warm. The patient’s current hemoglobin and hematocrit are 7 and 19 with a current urine output of 0.5 mL/kg/hr for the past 3 hours.  What type of shock is the patient suffering from?

You have a 7kg pediatric patient involved in a motor vehicle collision where the vehicle caught fire.  They have received first-degree burns to their abdomen and lower back, and second and third-degree burns to the face, head, and both arms.  What are the calculated total body surface area (TBSA) burns?