You are met at the door by a frantic female who directs you into the child’s bedroom. You find an 8-month-old male baby weighing approximately 8 kg lying supine in his crib, whimpering softly. The mother reports the baby awoke cry­ing so she went in to pick him up, but he cried even harder when she held him. He appeared to stiffen and seize in her arms. She says he turned blue and reports the seizure lasted approximately one to two minutes. Afterwards she laid him back in the crib and he has remained as you find him. The seizure occurred approximately 10 minutes ago.

The mother reports the baby has been “out of sorts” the past two days with a slight fever. He has not been feeding well. At approximately 6 p.m. tonight she noticed the baby had developed a rash. He also had some vomiting and diar­rhea this evening. The mother had made an appointment with her family physician for the next morning.

Your assessment of the baby reveals him to be irritable and not comforted by his mother. He appears tachypneic but no accessory muscle use is evident. Any touching appears to increase his irritability. He neck appears stiff and sore. The baby’s skin is warm to touch, capillary refill is four seconds and there is some cyanosis in the lower extremities. There is a petechial rash present on the trunk and back.

Blood Pressure	68/40
Pulse	l8O beats per minute
Respiration	44 per minute
Temperature	38.4 rectal
E.C.G. Reveals:

1. Your tentative diagnosis is:  A. Meningitis B.  Febrile seizures C.  Ear infection D. Chicken pox   

2. Oxygen administration for this patient should be:  A. Withheld due to the patient’s age B.  Delivered at high flow and high concentration C.  Delivered at low flow and low concentration D. Delivered only if the condition worsens   

3. At the B.L.S level this patient should be transported:  A. As a load and go B.  As a stay and stabilize   

4. The normal heart rate range for an 8-month-old is:  A. 60-80 B. 120-140 C. 140-160 D. 160-180   

5. A disease that is caused by the invasion of a virus, bacterium or fungus is:  A. A communicable disease B.  An immunosuppressant disease C.  An infectious disease D. None of the above 

6. Not all infections are communicable.  A. True B.  False 

7. Infectious diseases are transmitted by:  A. Direct contact - touching the infected body area or fluid B. Indirect contact - touching an object or surface that may have organisms on it C.  Airborne transmission D. All of the above   

8. Viral meningitis is highly communicable.  A. True B.  False   

9. A patient with bacterial meningitis can be differentiated from viral by:  A. Fever in bacterial B.  Headache in bacterial only C.  Nausea and vomiting in viral only D. None of the above   

10. Herpes simplex transmitted by:  A. Indirect contact B.  Airborne particles C.  Direct contact D. All of the above   

11. Incubation period is the interval between exposure to infection and appearance of the first symptom.  A. True B.  False 

12. Tuberculosis patients should be transported:  A. With provider wearing properly fitting mask and gloves B.  With patient wearing a properly fitting face mask C.  As any other patient, no special considerations D. A and B 

13. If a worker has been exposed to a patient with lice:  A.  All uniform clothing should be burned B.  All clothing should be laundered with soap and hot water C.  All clothing should be laundered with Kwell lotion D.  None of the above   

14. EMS personnel who have not had chicken pox and have been exposed to a patient who has:  A.  Should be immediately removed from duty B.  Should be removed from duty from the 10th day of exposure to 21st day C.  Should receive an immediate vaccination D.  None of the above   

15. You should protect yourself from the patient in the scenario by:  A.  Wearing   gown, gloves and mask B.  Wearing gloves only C.  Seeking follow up and possible antibiotic treatment D.  None of the above E.  A and C 

16. This patient’s E.C.G indicates: 

17. This rhythm should be treated by:  A. Cardio version B. Defibrillation C. Oxygenation D. A and B   

18. The correct dose of Diazepam for this patient should he seize again is:  A. 0.2 mg/kg IV. B. 0.5mg/kg rectal C. 1.6 mg 1.0. D. All of the above   

19. This patient’s vitals and presentation indicate:  A. Hypovolemic shock B. Neurogenic shock C. Septic shock D. None of the above    

20. I.V. administration for this patient:  A. Should be T.K.V.O. only B. Should be run in 20 ml/kg bolus therapy C. Should be run in 2.0 ml/kg therapy D. Should be pressure infused 1,000 ml 

21. The primary risk for health care workers in developing AIDS is:  A.  Mucous membrane contact B.  Contact with secretions C.  Contact with open lesions D.  Needle stick injury   

22. Should the patient in the scenario deteriorate and require intubation, the best size E.T. tube would most likely be:  A. 3.5 un-cuffed B.  3.5 cuffed C.  Equal to the diameter of the little finger D.  A and C E.  B and C   

23. The term ‘universal precautions’ means that:  A. The same precautions are applied to all patients B. Precautions are applied only to AIDS patients C. Precautions apply to all body fluids D. B and C   

24. A tuberculosis patient left some sputum on the floor of the ambulance. This should be:  A.  Exposed to sunlight for 30 minutes B.  Soaked in high level disinfectant C.  Soaked in low level disinfectant D.    Immediately wiped up with paper towels 

25. Ways to prevent contracting communicable diseases include:  A.  Practicing universal precautions B. Maintaining your immune system C. Stress management D. Keeping current immunizations E. All of the above 

Eichelberger, Martin R. et. Al.; Pediatric Emergencies, Brady, New Jersey 1992.

Jones, Shirley A. Et. Al; Advanced Emergency Care for Paramedic Practice, J.B. Lippincott Company, Philadelphia 1992.

Grant, Murray, and Bergeron; Emergency Care Fifth Edition; Brady, New Jersey, 1990.

T

The answers to these questions are to industry standards and may not necessarily be correct according to local protocol. If there is any discrep­ancy between these answers and local protocol, please follow the protocol for your area as set out by your Medical Director.

Heather MacKenzie-Carey is a paramedic who has 15 years of EMS experience in Nova Scotia and Alberta. She is currently teaching in the Paramedic Program at the Southern Alberta Institute of Technology. She has a Bachelor of Science degree in Health Education from Dalhousie University in Nova Scotia and a certificate in Social Work from the University of Waterloo. She can be reached at geomac@cadvision.com or www.turningpointgroup.com.

Canadian Emergency News and the author of this quiz grant permission for readers to copy it for personal and departmental educational purposes. All other reproduction and re-publication without written consent is prohibited.

This Article is reprinted by permission from the author (Heather MacKenzie-Carey) and the Canadian Emergency News. It originally appeared in the February - March 1997 issue (volume 20, number 1).