OB and Pediatrics

You have delivered a baby in the field. The neonate is limp and not crying at 1 minute. His skin is centrally cyanotic. His heart rate is 82. His APGAR score calculated is 3 out of 10. After drying and stimulating the neonate with no improvement what is the NEXT intervention?

• A.Chest compressions at 30:2
• B.Apply supplemental oxygen via blow-by only
• C.Positive pressure ventilation with a neonatal BVM at 40-60 breaths per minute
• D.Administer epinephrine 0.1 mg IM

At a soccer field, a 31-year-old female child has a fever-related seizure and is now postictal. What is the priority?

• A.Airway and monitoring
• B.Restrain tightly
• C.Put food in mouth
• D.Give aspirin

At a warehouse, a 27-year-old male breech birth is in progress. What is the EMT-B priority?

• A.Support and rapid transport
• B.Pull forcefully
• C.Wait alone
• D.Push infant back

You respond to a 32-year-old female at 37 weeks gestation who reports a sudden gush of fluid from her vagina 30 minutes ago. She is having mild contractions every 8 minutes. The fluid appears clear with a greenish-brown tint. She reports the fluid had an unusual smell. What does greenish-brown amniotic fluid indicate?

• A.Blood-stained amniotic fluid is being mistaken for meconium
• B.Normal amniotic fluid — the color varies with gestational age
• C.The fluid color is from a vaginal
• D.Meconium-stained amniotic fluid

A 30-year-old female at 38 weeks delivers a baby. McRoberts maneuver and suprapubic pressure have not resolved shoulder dystocia after 90 seconds. What is the next maneuver?

• A.Place the mother on hands and knees (Gaskin maneuver)
• B.Apply firmer traction to the baby's head
• C.Have the patient bear down harder
• D.Perform fundal pressure to push the baby down

You respond to a call for a 2-year-old male with difficulty breathing. His mother says he has had a barking cough since last night that sounds like a seal. He has mild inspiratory stridor and moderate retractions. He is alert and his SpO2 is 94%. He becomes more distressed when you try to examine him. Vital signs: HR 148, RR 34, temp 38.2°C. What is this presentation and how do you manage it?

• A.Epiglottitis — examine the throat immediately
• B.Croup — cool mist oxygen or blow-by oxygen
• C.Asthma — administer albuterol 2 puffs via MDI
• D.Foreign body obstruction — perform abdominal thrusts

A 24-year-old female at 36 weeks has severe headache, visual flashing lights, facial swelling, BP 166/112, 3+ pitting edema, and 3+ urine protein. What do these findings indicate?

• A.Normal late pregnancy hypertension — transport non-urgently
• B.Preterm labor triggered by hypertension
• C.Severe pre-eclampsia with severe features
• D.Normal edema and headache from the third trimester

You respond to a 5-year-old male with fever of 40.1 degrees C and a petechial rash that appeared over the past 2 hours. He has a severe headache and is very irritable. He is still conscious with GCS 14 but is difficult to examine. He cannot tolerate bright lights. HR 148, BP 88/58. His parents say the rash was not present this morning. The petechiae have become purple in some areas. What does purple petechiae (purpura) combined with fever and meningismus in a 5-year-old indicate?

• A.Meningococcal septicemia with purpura fulminans
• B."Immune thrombocytopenic purpura — this is not an emergency"
• C.Normal viral rash — reassure and transport
• D.This is a drug reaction — discontinue all medications

At a mall corridor, a 44-year-old female delivery is imminent and the infant's head is crowning. What should you do?

• A.Tell mother not to push
• B.Pull the infant
• C.Prepare and support delivery
• D.Transport sitting only

A 34-year-old female at 38 weeks gestation delivered 30 minutes ago but the placenta has not delivered. There is mild bleeding. What is the management of a retained placenta?

• A.Transport Priority 1
• B.Fundal massage will deliver the placenta within minutes
• C.Perform bimanual compression through the abdomen
• D.Apply firm traction to the umbilical cord

You respond to a 31-year-old female at 38 weeks gestation who has had 3 previous deliveries. She reports she has been having contractions every 2 minutes for the past 30 minutes. You can visualize the baby's head at the vaginal opening. The hospital is 8 minutes away. Your partner says to load and transport immediately. What is the correct decision?

• A.Transport only if contractions slow below every 3 minutes
• B.Prepare for field delivery
• C.Load and transport standing up to use gravity to delay delivery
• D.Load immediately — the hospital is only 8 minutes away

You deliver a neonate at scene. The baby is born limp and not crying. You dry and stimulate the infant vigorously for 30 seconds. After 30 seconds the baby makes a weak cry but HR is 82 by auscultation and breathing is shallow and irregular. What is the next intervention?

• A.Wrap in warm blankets and reassess in 2 minutes
• B.Begin positive pressure ventilation (PPV) with a neonatal BVM at 40-60 breaths per minute
• C.Begin chest compressions — HR 82 is critically low
• D.Apply oxygen by blow-by only — avoid the mask

You respond to a 29-year-old female at 34 weeks gestation who is 48 hours postpartum after home birth. She reports she has had a severe headache since this morning that is the worst of her life. Her BP is 158/106. She has 2+ pitting edema. She reports she had normal BP throughout her pregnancy. What postpartum complication does severe headache with hypertension in the first week after delivery represent?

• A.Postpartum pre-eclampsia
• B.Migraine triggered by hormonal changes after delivery
• C.Normal postpartum hypertension
• D.Normal postpartum headache from dehydration

At a parking garage, a 75-year-old female newborn is delivered and not breathing after drying and stimulation. Pulse is 90. What should you do?

• A.Give oral glucose
• B.Begin ventilations
• C.Start aspirin
• D.Delay care

A postpartum patient delivered 10 minutes ago. The uterus is FIRM but she is saturating 2 pads with bright red blood. What does firm uterine tone with ongoing hemorrhage indicate about the cause?

• A.Retained placental fragments causing continued bleeding
• B.Normal postpartum bleeding
• C.Uterine atony — firm tone is a misperception
• D.A laceration

A child with vomiting and diarrhea is lethargic with poor skin turgor. What is your concern?

• A.Hyperventilation only
• B.Cardiac chest pain
• C.Routine refusal
• D.Dehydration and shock

You respond to a 5-year-old male in cardiac arrest. He is pulseless and apneic. You are the only provider on scene for the first 2 minutes. What is the correct 1-rescuer pediatric CPR compression-to-ventilation ratio and what compression technique do you use?

• A.30:2 with the 2-thumb encircling technique
• B.15:2 with the 2-finger technique
• C.15:2 with the 2-thumb encircling technique
• D.30:2 with the 2-finger technique

At a office lobby, a 57-year-old female child is pale and quiet after trauma. Why is that concerning?

• A.Refusal ready
• B.No vitals needed
• C.Always normal
• D.Late shock sign

You respond to a 24-year-old female at 32 weeks gestation with severe pelvic pressure, lower back pain, and a sensation she is going to deliver soon. On assessment contractions are every 90 seconds lasting 60 seconds. You can see the presenting part at the vaginal opening. She is in active labor and delivery is imminent. What specific neonatal preparation is unique to preterm delivery at 32 weeks?

• A.Preterm neonates need no special preparation
• B.Prepare for a preterm neonate who will likely need resuscitation
• C.Administer corticosteroids to the mother before delivery
• D.Preterm neonates are always healthier than term neonates

You respond to a 16-year-old male who fell off his bicycle and has a suspected wrist fracture. He is conscious with GCS 15. His parents are not immediately available. He is in pain and requests treatment. He says he can make his own medical decisions. Can a 16-year-old consent to medical treatment?

• A.minors over 14 can always consent to medical treatment
• B.minors can never consent to anything
• C.any person who requests treatment has implied consent
• D.This depends on your jurisdiction

At a assisted-living room, a 68-year-old male breech birth is in progress. What is the EMT-B priority?

• A.Push infant back
• B.Pull forcefully
• C.Support and rapid transport
• D.Wait alone

At a college dorm, a 21-year-old female child has mild croup symptoms but suddenly becomes quiet and tired. What does this suggest?

• A.Improvement
• B.Normal sleep
• C.No transport need
• D.Worsening respiratory failure

At a college dorm, a 20-year-old female child is pale and quiet after trauma. Why is that concerning?

• A.Late shock sign
• B.Always normal
• C.Refusal ready
• D.No vitals needed

A child with a fever has a brief seizure and is now sleepy but breathing. What is the priority?

• A.Airway and cooling support
• B.Food by mouth
• C.Aspirin therapy
• D.No transport advice

At a train platform, a 37-year-old female newborn is delivered and not breathing after drying and stimulation. Pulse is 90. What should you do?

• A.Begin ventilations
• B.Start aspirin
• C.Delay care
• D.Give oral glucose