PALS

You are evaluating an irritable 6-year old girl with mottled skin color. The patient is febrile (40C/104F), and her extemities are cold with capillary refill of 5 seconds. Distal pulses are absent and central pulses are weak. HR is 180/min, RR is 45/min. and BP is 98/56 mmHg. How would you categorized this child condition?

Compensated shock associated with tachycardia and inadequate tissue perfusion

You are called to help treat an infant with severe symptomatic bradycardia (HR 66/min) associated with respiratory distress. The bradycardia persists despite establishment of an effective airway, oxygenation, and ventilation. There is no heart block present. Which is the first drug you should administer?

Epinephrine

Which statement is correct about the effects of epinephrine during attempted resuscitation?

Epinephrine stimulates spontaneous contractions when asystole is present

You are supervising a student who is inserting an IO needle into an infant's tibia. The student asks you what she should look for to know that she has successfully inserted the needle into the bone marrow cavity. What do you tell her?

Fluids can be administered freely without local soft tissue swelling

You are alone and witness a child suddenly collapse. There is no suspected head or neck injury. A colleague responded to your shout for help and is activating the emergency response system and is retrieving the resuscitation equipment, including a defibrillator. After delivering 30 compressions, what would be your next action?

Open the airway with a head tilt-chin lift maneuver and give 2 breaths

An 8-year-old child was struck by a car. He arrives in the ER department alert, anxious, and in respiratory distress. His cervical spine is immobilized, and he is receiving a 10-L/min flow of 100% O2 by NRB face mask. His RR is 60/min, HR 150/min, systolic BP 70 mmHg, and SPO2 84%. Breath sounds are absent over the right chest but present over the left chest, and the trachea is deviated to the left. He has weak central pulses and absent distant pulses. Which intervention should be performed next?

Perform needle decompression of the right chest

During bag-mask ventilation, how should you hold the mask to make an effective seal between the child's face and the mask?

Position your fingers using the E-C clamp technique

You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout for nearby help, but no one arrives. What action should you take next?

Provide CPR about 2 minutes before leaving to activate the emergency response system

Paramedics are called to the home of a 1yo child. Their initial assessment reveals a child who responds only to painful stimuli and has irregular breathing, faint central pulses, bruises over the abdomen, abdominal distention, and cyanosis. Bag-mask ventilation with 100% oxygen is initiated. The child's heart rate is 36/min. Peripheral pulses cannot be palpated, and central pulses are barely palpable. The cardiac monitor shows sinus bradycardia. Two-rescuer CPR is started. Upon arrival to the emergency department, the child is intubated and ventilated with 100% oxygen, and IV access is established. The heart rate is now 150/min with weak central pulses but no distal pulses. Systolic blood pressure is 74 mmHg. Which intervention should be provided next?

Rapid bolus of 20 ml/kg of isotonic crystalloid

Which statement is correct about use of calcium chloride in pediatric?

Routine administration is not indicated during cardiac arrest

how to calculate tube size?

(age/4) + 4

Lowest acceptable systolic pressure

(age X 2) + 70

how to treat symptomatic hypoglycemia?

-D25W (2-4 ml/kg) -D10W (5-10 ml/kg) IV dextrose

DOPE

-Displacement -Obstruction -PTX -Equipment failure

Atropine dosage

0.02 mg/kg, may repeat once -minimum dose 0.1 mg -max dose 0.5 (single dose)

You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate for delivering breaths?

1 breath every 3 to 5 seconds

isotonic crystalloid dose

10-20 ml/kg over 5-10 minutes

2 rescuer compression to breath ratio?

15:2

How can rescuers ensure that they are providing effective breaths when using a bag-mask device?

By observing the chest rise with each breath

compression to breath ratio children with 1 rescuer

30:2

You are assisting in the elective intubation of an average-sized 4-year-old child with respiratory failure. A colleague is retrieving the color-coded length-based tape from the resuscitation cart. Which of the following is likely to be the estimated size of the uncuffed ET tube for this child?

5-mm tube

Amiodarone dose for kids

5mg/kg repeat up to 2 times for refractory VF/pulseless VT

child hypoglycemia

less than 60 mg/dL

A 1-year-old boy is brought to the emergency department for evaluation of poor feeding, irritability, and sweating. The child is lethargic but arousable. He has labored breathing, very rapid pulses, and dusky color. His RR is 68/min, HR 300/min, and BP 70/45 mmHg. He has weak brachial pulses and absent radial pulses, a capillary refill of 6 seconds, SPO2 85% on RA, and good bilateral BS. You administer high-flow O2 and place the child on a cardiac monitor and see the rhythm (SVT). The child has no history of congenital heart disease IV access has beeb established. Which therapy is most appropriate for this child?

Adenosine 0.1 mg/kg IV rapid push

You just assisted with elective endotracheal intubation of a child with respiratory failure and perfusing rhythm. Which provide reliable , prompt assessment of correct endotracheal tube placement in this child?

Adequate bilateral breath sounds and chest expansion plus detection of ETCO2 with waveform capnography.

newborn hypoglycemia

less than or equal to 45 mg/dl

4 types of shock

-hypovolemic -distributive -cardiogenic -obstructive

4 respiratory problems

-upper airway obstruction -lower airway obstruction -lung tissue disease -disordered control of breathing

A previously healthy infant with a history of vomiting and diarrhea is brought to the ER by her parents. During your assessment, you find that the infant responds only to painful stimulation. The infant's RR is 40/min, and central pulses are rapid and weak. The infant has good bilateral breath sounds, cool extremities, and a capillary refill time of ore than 5 seconds. The infant's blood pressure is 85/65 mmHg, and glucose is 30 mg/dL (1.56 mmol/L). You administer 100% oxygen via facemsk and start an IV. Which treatment is the most appropriate for this infant?

Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and also give D25W to 4 ml/kg IV

A 9-year old boy is agitated and leaning forward on the bed in obvious respiratory distress. The patient is speaking in short phrases and tells you that he has asthma but does not carry an inhaler. He has nasal flaring, severe suprasternal and intercoastal retractions, and decreased air movement with prolonged expiratory time and wheezing. You administer 100% oxygen by a NRB mask. His SpO2 is 92%. Which medication do you prepare to give to this patient?

Albuterol

You are a part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest. You delivered 2 unsynchronized shocks. A team member established IO access, so you give a dose of epinephrine, 0.01 mg/kg IO. At the next rhythm check, persistent ventricular fibrillation is present. You administer a 4-J/kg shock and resume CPR. Which drug and dose should be administered next?

Amiodarone 5 mg/kg

You are caring for a 3 year old with vomitting and diarrhea. The child's pulses are palpable but faint, and the child is now lethargic. The HR is variable (range, 44/min to 62/min). You begin bag-mask ventilation with 100% oxygen. When the HR does not improve, you begin chest comnpressions. The rhythm shown here is seen on the cardiac monitor (bradycardia). Which would be the most appropriate therapy to consider next?

Atropine 0.02 mg/kg IV

A 3 year old unresponsive, apneic child is brought to the ED. EMS personnel report that the child became unresponsive as they arrived at the hospital. The child is receiving CPR with bag-mask ventilation. The rhythm shown here is VFIB. A biphasic manual defibrilator is present. You quickly use the length-based resuscitation tape to estimate the approximate weight as 15 kg. Which therapy is most appropriate for this child at this time?

Attempt defibrillation at 30 J and then resume CPR, beginning with compressions

You are giving chest compressions for a child in a cardiac arrest. What is the proper depth of compressions for a child

Compress at least 1/3 the depth of the chest , about 2 inches (5cm).

An 8-month old infant is brought to the ER department for evaluation of severe diarrhea and dehydration. On arrival to the ER department, the infant becomes unresponsive, apneic, and pulseless. You shout for help and start CPR. Another provider arrives, at which point you switch to 2-rescuer CPR. The rhythm shown is bradycardia on the cardiac monitor. The infant is intubated and ventilated with 100% oxygen. An IO line is established, and a dose of epinephrine is given. While continuing high-quality CPR, what do you do next?

Give normal saline 20 mL/kg IO rapidly

A 7-year-old boy is found unresponsive, apneic, and pulseless. CPR is ongoing. The child is intubated, and vascular access is established. The ECG monitor shows an organized rhythm with a HR of 45/min, but a pulse check reveals no palpable pulses. High-quality CPR is resumed, and an initial IV dose of epinephrine is administered. Which intervention should you perform next?

Identify and treat reversible causes

You are preparing to use a manual defibrillator in the pediatric setting. Which best describes when it is appropriate to use the smaller, pediatric-sized paddles?

If the child weighs less than 10 kg or is less than 1 year old

Which statement is correct about endotracheal drug administration during resuscitative efforts for pediatric patients?

It is the least desirable route of administration

You find a 10 yo boy to be unresponsive. You shout for help, and after finding that he is not breathing and has no pulse, you and a colleague begin CPR. Another colleague activates the emergency response system, brings the emergency equipment, and places the child on a cardiac monitor/defibrillator, which reveals the rhythm shown here (Vtach). You attempt defibrillation at 2 J/kg and give 2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you attempt defibrillation with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose of epinephrine 0.01 mg/kg. If ventricular fibrillation or pulseless ventricular tachycardia persists after 2 minutes of CPR, you will administer another shock. Which drug and dose should be administered next?

Lidocaine 1mg/kg IV

An 18 month-old child has 1 week history of cough and runny nose. The child has diffuse cyanosis and responsive only to painful stimulation with slow respirations and rapid central pulses. The child's respiratory has decreased from 65/min to 10/min, severe inspiratory intercoastal retractions are present, HR is 160/min, SPO2 is 65% on RA, and capillary refill is less than2 seconds. Which are the most appropriate immediate interventions for this toddler?

Open the airway and provide positive-pressure ventilation using 100% O2 and a bag-mask device.

You are caring for a 6-year old patient who is receiving positive-pressure mechanical ventilation via ETT. The child begins to move his head and suddenly become cyanotic, and his HR decreases. His SPO2 is 65%. You remove the child from the mechanical ventilator and begin to provide manual ventilation with a bag via the ETT. During manual ventilation with 100% O2, the child's color and HR improved slightly and his BP remains adequate. Breath sounds and chest expansion are present and adequate on the right side and are present but consistently diminished on the left side. The trachea is not deviated, and the neck veins are not distended. A suction catheter passes easily beyond the tip of the ETT. Which of the following is the most likely cause of this child's acute deterioration?

Tracheal tube displacement into the right main bronchus.

A 3-year old boy presents with multiple-system trauma. The child was an unrestrained passenger in a high-speed motor vehicle crash. On primary assessment, he is unresponsive to voice or painful stimulation. His respiratory rate is 5/min, HR and pulses are 170/min, systolic BP is 60 mmHg, capillary refill is 5 seconds, and SPO2 is 75% on RA. Which action should you take first?

While colleague provides spinal motion restriction, open the airway with jaw thrust and provide bag-mask ventilation

A pale and very sleepy but arousable 3-year old child with a history of diarrhea is brought to the hospital. Primary assessment reveals a respiratory rate of 45/min with good breath sounds bilaterally. HR is 150/min, BP is 90/64, and SPO2 is 92% on RA. Capillary refill is 5 seconds, and peripheral pulses are weak. After placing the child on a NRB with 100% O2 and obtaining vascular access, which is the most appropriate immediate treatment for this child?

administer a bolus of 20 ml/kg isotonic crystalloid

A 10-month-old infant boy is brought to the emergency department. Your initial assessment reveals a lethargic, pale infant with slow respirations and slow, weak central pulses. One team member begins ventilation with a BVM with 100% O2. A second team member attaches the monitor/defibrillator and obtains vital signs while a third team member attempts to establish IV/IO access. The patient's HR is 38/min with the rhythm (bradycardia) on the monitor. The infant's BP is 58/38 mmHg, and capillary refill is 4 seconds. His central pulses remain weak, and distal pulses cannot be palpated. Chest compressions are started and IO access is obtained. Which medication do you anticipate will be given next?

epinephrine 0.01 mg/kg IV/IO

Initial impression of a 2-year old girl shows her to be alert with mild breathing difficulty during inspiration and pale skin color. On primary assessment, she makes high pitched inspiratory sound (mild stridor) when agitated; otherwise, intercoastal retractions. Lung auscultation reveals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Which is the most appropriate initial intervention for this child?

humidified oxygen as tolerated