NREMT Emergency Medical Technician (EMT) Cognitive ExamMedical EmergenciesMedium
An EMT is assessing an 8-month-old infant who is lethargic, has a sunken fontanelle, dry mucous membranes, and has not had a wet diaper in 12 hours. The infant's heart rate is 160 bpm and capillary refill is 4 seconds. Which of the following is the MOST appropriate initial intervention?
- AInitiate rapid transport to a pediatric facility.
- BAdminister a fluid bolus of 20 mL/kg of normal saline intravenously.
- CAdminister oral rehydration solution (ORS).
- DProvide supplemental oxygen via nasal cannula.
Show answer & explanationAnswer & explanation
Correct answer: A. Initiate rapid transport to a pediatric facility.
The infant exhibits multiple signs of severe dehydration and hypovolemic shock (lethargy, sunken fontanelle, dry mucous membranes, prolonged capillary refill, tachycardia). While fluid resuscitation is indicated, EMTs typically do not initiate IV fluids; rapid transport to a facility that can provide advanced care, including IV fluids, is the priority.
Why the other options are wrong
- B. Administering IV fluids is typically beyond the scope of practice for an EMT. This would be initiated by paramedics or hospital staff.
- C. Oral rehydration is appropriate for mild to moderate dehydration in a conscious, alert infant, not for severe dehydration with signs of shock and lethargy.
- D. While oxygen may be beneficial, the primary problem is severe dehydration leading to hypovolemia. Addressing fluid loss is more critical than oxygen alone.
Pediatric Severe Dehydration
A critical condition in infants characterized by significant fluid loss, leading to signs of hypovolemic shock such as lethargy, sunken fontanelles, tachycardia, and prolonged capillary refill.
- Infants are highly susceptible to dehydration due to higher metabolic rate and body surface area.
- Signs include lethargy, sunken fontanelle, dry membranes, absent tears, prolonged cap refill, tachycardia.
- Requires rapid transport to advanced care for IV fluid resuscitation.
Memory trick: Rapid Ride to Rehydrate!