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1. An 8-year-old boy falls while riding his bicycle and sustains a handlebar injury to the right upper quadrant. He has a tense and tender abdomen and is in pain. His heart rate is 120 beats/min, blood pressure is 120/80, and capillary refill is normal. What level hemorrhage would you suspect?
A. Class I
B. Class II
C. Class III
D. Class IV
2. An advantage of lactated Ringer’s solution (LRS) over normal saline for IV resuscitation is:
A. the potassium in LRS replaces potassium lost due to traumatic injury.
B. LRS is less likely to cause pulmonary edema.
C. the lactate in LRS is converted to bicarbonate by the liver.
D. LRS is less expensive and easier to obtain than normal saline.
For Questions 3-5: A 6-year-old child was a restrained passenger (lap belt only) in a motor vehicle crash with fatalities. Extrication time was 20-30 minutes. On arrival, the patient is pale, anxious, has cool extremities and a distended abdomen. His heart rate is 150, blood pressure is 100/60, and you estimate his weight at 25 kg.
3. Two minutes after arrival, the trauma team is unable to establish IV access despite four attempts. The next step should be to:
A. place an intraosseous line in the sternum.
B. place an intraosseous line in the tibia.
C. place a central line in the subclavian vein.
D. place a central line in the femoral vein.
4. Approximately how much blood has this child lost?
A. Less than 15%
D. Greater than 40%
5. How much IV fluid should he receive before he receives blood?
A. 250 mL
B. 500 mL
C. 750 mL
D. 1000 mL
6. Which of the following is generally considered ineffective (and possibly injurious) to children with head injuries?
B. Lactated Ringer’s solution
C. Hypertonic saline
D. Normal saline
7. Burn resuscitation in children is more demanding than in adults for all of the following reasons except:
A. Young children have an increased mass to body surface area ratio.
B. Young children may require fluid resuscitation for relatively small burns.
C. Young children are more prone to hypothermia.
D. Young children have a limited physiologic reserve.
8. A 10-year-old male presents with an isolated injury consisting of a laceration of the right forearm, with active hemorrhage and a diminished radial pulse. The first step in treating this patient should be to:
A. apply a tourniquet to the injured extremity to stop bleeding.
B. apply direct pressure to the injured extremity to stop bleeding.
C. obtain vascular access.
D. examine the patient’s airway.
9. A child with blunt trauma to the abdomen, tachycardia, and poor perfusion should receive all of the following except:
A. 100% oxygen.
B. IV access.
C. 20 cc/kg 0.9 NS fluid bolus.
D. fluid restriction.
10. Which of the following statements regarding hypertonic saline is incorrect?
A. It improves systolic blood pressure.
B. It increases intercranial pressure.
C. It improves cardiac output.
D. It improves cerebral oxygen delivery.
Upon completing this program, the participants will be able to:
— Quickly recognize or increase index of suspicion for shock in the pediatric trauma patient;
— Correctly perform necessary diagnostic tests and take a meaningful patient history that will reveal the most important details about shock and/or the need for fluid resuscitation;
— Utilize state-of-the-art fluid resuscitation techniques (including the implications of pharmaceutical therapy discussed) to patients in shock and apply the appropriate type of resuscitation in the special situations described.