Peds ACLS

The healthcare provider uses which acronym when completing the PALS primary assessment on a pediatric patient?

ABCDE

The healthcare provider understands that characteristics of asthma include which findings?

Inflammation and spasm of the lower airways

Which neuroprotective measures should the provider implement after achievement of return of spontaneous circulation (ROSC)?

Initiate TTM and optimize cerebral perfusion

Which assessment findings would the healthcare provider expect to note in a patient experiencing compensated shock?

Irritability, tachypnea and capillary refill of 3 seconds

Hypotension is a key characteristic of which type of shock?

decompensated shock

The nurse notes a change in the patient's breath sounds and suspects impending respiratory failure. Which new finding does the nurse most likely assess?

diminished breath sounds

Which statement correctly describes the completion of the typical ABCDE primary assessment of a patient in cardiac arrest?

The primary assessment (typical ABCDE) should be delayed in order to provide prompt CPR and cardiac arrest care, and should be performed as soon as resources permit

Which finding indicates adequate end-organ and tissue perfusion?

Urine output normal for age (1.5-2 mL/kg/h for infants and young children and 1 mL/kg/h for adolescents)

An epinephrine infusion has been administered to a patient in septic shock. Reassessment reveals that the patent has not met therapeutic endpoints and remains in septic shock. Septic shock that does not respond to an initial epinephrine infusion is called which of the following?

catecholamine resistant shock

Ensuring an adequate mean arterial pressure (MAP) post-cardiac arrest is critical to optimizing which factor?

cerebral perfusion

While conducting a rapid assessment, the healthcare provider notes the patient appears unresponsive. What is the provider's next initial action?

check for responsiveness

A child is being treated for mild croup in the urgent care clinic and is breathing warm, humidified air. Which additional medication does the healthcare provider consider giving?

corticosteroids

The pediatric clinical team is caring for a pediatric patient in cardiac arrest. During the resuscitation, the team leader notes changes in the patient's ECG rhythm and physical appearance. After quickly evaluating these new findings, the leader determines a new course of action. Which technique is the leader demonstrating?

critical thinking

A patient in asystole is receiving high-quality CPR and vascular access has been achieved. Which action should the team leader order?

epi

The team continues high-quality cardiopulmonary resuscitation (CPR). Dr. Kane asks Marco to stop chest compressions so that she can reassess Colton's rhythm. He continues to be bradycardic with a heart rate of 55 bpm and inadequate perfusion.

epi

Which of the following interventions should Mark include in next steps of care for Sullivan?

epi and dexamethasone

The PALS team leader consults with the pediatric critical care team regarding medication therapy for fluid-refractory septic shock. Which medications would be most appropriate to initially administer?

epi or levo

Decreased cardiac output in cardiogenic shock is typically caused by which disorder of the heart's function?

impaired contractility of the heart

Perfusion

inadequate

The healthcare provider determines that a patient is experiencing septic shock. Which assessment findings can be characteristic of septic shock?

increased and decreased body temp and AMS

The healthcare provider is caring for a patient with bradycardia with inadequate perfusion. While providing BVM ventilations with O2, the heart rate decreases to 51 bpm. Which is the priority action the provider should implement?

initiate CPR

elevated lactate

insufficient perfusion and O2 delivery

Cardiac tamponade is a common cause of which type of shock?

obstructive shock

In observing this ECG reading, you note which wave form is not clearly identifiable?

p wave

nurse is following the Pediatric Assessment Triangle (PAT) to assess a patient. The PAT is used during which stage of patient assessment?

rapid

The physician is informed by the nurse of a patient with possible partial upper airway obstruction. When examining the patient, which breath sound does the provider most likely anticipate?

stridor

After achievement of return of spontaneous circulation (ROSC), an indwelling arterial catheter is placed in the patient and connected to the cardiac monitor. Which finding should the provider report to the team leader given its association with poor outcomes after cardiac arrest?

hypotension

A pediatric nurse is preparing to deliver chest compressions to a child in cardiac arrest. In which location should the nurse's hands be placed?

Center of the chest on the lower half of the sternum

Which action should the healthcare provider perform to best assess the adequacy of perfusion in a child with an arrhythmia?

Check the capillary refill.

After participating in a resuscitation event in which the pediatric patient did not survive, you are feeling very stressed and having difficulty with daily activities. What is the best action to help you cope with the stress?

Consider a referral to a qualified mental health professional.

The PALS medication team member is unsuccessful with placing an IV for a fluid bolus in a patient experiencing shock. The team member understands which statement is true regarding what step to take next?

IO access

A 4-year-old patient is being treated for hypoglycemia. Assessment findings include tachycardia, pallor, irritability and refusal to eat or drink. Which intervention is most appropriate?

IV dextrose

he team understands that an important part of care for a child with bradycardia with inadequate perfusion includes which action?

Identify and treat underlying causes.

A newly admitted patient's ECG reveals the following image. Which intervention is recommended for this arrhythmia?

Identifying and treating the underlying cause

After completing a focused physical examination post-return of spontaneous circulation (ROSC), the provider suspects that a seizure may have caused cardiac arrest in an assigned patient. Which diagnostic test will the provider likely order?

eeg

A 7-year-old patient is brought to the emergency department with difficulty breathing and angioedema. The parent states, "My child is allergic to peanuts, but ate some during lunch today!" Which medication should the healthcare provider prepare first?

epi

During CPR in a cardiac arrest situation, the pediatric patient was successfully intubated with an endotracheal tube. At which rate should the respiratory therapist deliver ventilations?

1 breath every 2-3 seconds

Two providers are performing CPR on a pediatric patient in cardiac arrest. Which chest compression rate is correct?

100-120

Two healthcare providers are performing CPR on a child. The providers correctly deliver compressions and ventilations at which rate?

15:2

The PALS team leader correctly alternates the chest compressor role after which duration?

2

During a resuscitative event of a child in cardiac arrest, the team leader orders amiodarone to be administered. The medication team member determines which dose to be correct?

5

The PALS team is preparing a fluid bolus for a patient in cardiogenic shock. How many mL/kg should the team prepare to administer?

5-10

The provider would use pediatric AED pads for which children?

8 and under and 55lbs and under

The PALS team is actively attempting to resuscitate a 9-kg infant in cardiac arrest. The team leader instructs the monitor team member to administer a second defibrillation. How many joules should the team member administer?

9 x 4 = 36

The PALS team understands that the key treatment for most types of shock, in addition to supporting oxygenation and ventilation, includes which intervention?

fluids

Before you call the respiratory therapist, is there any other therapy that you might consider using at this point?

heliox

A child has been experiencing vomiting and diarrhea for over 36 hours. A bedside glucose test reveals a blood glucose of 20 mg/dl. A blood glucose level of 20 mg/dl indicates that the child is which of the following?

hypoglycemic

Which types of shock are classified as distributive?

neurogenic, anaphylactic, and septic

A 7-year-old patient is in obstructive shock after a bicycle accident. Assessment findings reveal hyperresonance and decreased breath sounds on the left side. These assessment findings most likely indicate which complication?

tension pneumothorax

After the second dose of adenosine, Noah's heart rhythm showed a brief period of AV block and then went back to SVT, but he still has adequate perfusion. Dr. Lewis consults with a pediatric cardiologist who says to proceed with pharmacologic cardioversion since Noah remains in SVT with adequate perfusion. What are medications the cardiologist may ask the team to prepare?

amio and procainamide

Based on the primary assessment, Mark suspects which of the following is the cause of Sullivan's respiratory distress?

croup

She asks the respiratory therapist Marta, who has by now entered the room, to begin bag-valve-mask ventilation. After 30 seconds of effective ventilation and despite being adequately oxygenated, Colton's heart rate falls to 53 bpm with continued inadequate perfusion.

CPR

You and additional providers have been caring for an infant in respiratory arrest with a central pulse rate of 50 bpm and inadequate perfusion despite adequate oxygenation and ventilation. After 2 minutes, you reassess the infant for breathing and a central pulse. What should you do if the central pulse rate increases to 65 bpm and perfusion improves?

Stop CPR but continue ventilations (1 every 2 to 3 seconds) until the patient is ventilating sufficiently.

Vagal maneuvers are appropriately used as an initial therapy for which cardiac arrhythmia?

Supraventricular tachycardia (SVT) with adequate perfusion.

Which characteristics contribute to an effective, high-performance PALS team?

The team practices mock codes together regularly. The team holds debriefing sessions after each resuscitation event.

While reviewing the health history of patients recently discharged from the pediatric cardiac care unit, the healthcare provider understands which arrhythmias may be normal findings in children?

sinus brady and AV blocks

A patient admitted to the pediatric emergency department is in cardiac arrest. The rhythm on the defibrillator monitor is ventricular fibrillation (VF). Which energy dose should the team leader order to administer an initial shock?

2j/kg

The pediatric charge nurse is training a newly hired RN. The charge nurse notes that the new hire documents a 10-year-old patient's heart rate is "within normal limits for age." The charge nurse would question this documentation when noting the patient's heart rate to be which value?

< 60

A 9-year-old child is brought to the emergency department because the child suddenly collapsed at school. The child's ECG reveals the following waveform, and primary assessment findings indicate that the child has inadequate perfusion. Which primary assessment findings indicate this?

AMS, hypotension, signs of shock

Which statement correctly describes the goal of O2 administration after return of spontaneous circulation (ROSC)?

Administer at the lowest concentration required to maintain O2 saturation of 94% to 99%.

Which medications may be used in the cardiac arrest care of a patient with a "shockable" rhythm?

epi, amio, lidocaine

The healthcare provider understands that an ischemia/reperfusion response during post-cardiac arrest syndrome (PCAS) is manifested by fever, hyperglycemia, infection, multiorgan failure and which additional key finding?

hypotension

A parent presents to the emergency department and states, "My baby has had diarrhea and has been vomiting for days now." The healthcare provider understands the infant is at risk for which type of shock?

hypovolemic

Children and infants who remain in shock despite adequate fluid resuscitation or who cannot tolerate ongoing aggressive fluid therapy are candidates for which type of supportive therapy?

vasopressors

The healthcare provider notes that an infant receiving post-cardiac arrest care has an increase in temperature. The provider should do which of the following?

adminster antipyretics or implement active cooling

While performing post-cardiac arrest care, the healthcare provider observes seizure activity. What should the provider do?

anti convulsant

What are the components of post-cardiac arrest syndrome (PCAS)?

brain injury, systemic response to ischemia/reperfusion, myocardial dysfunction

In children and infants, cardiac arrest most often arises from which complication?

respiratory failure

During a resuscitative event, the PALS team notes a change in cardiac rhythm on the defibrillator monitor. The monitor team member assesses for a central pulse, but notes that no pulse is present. The PALS team correctly identifies this as which rhythm?

respiratory failure and airway obstruction

A healthcare provider suspects that hyperkalemia may be the cause of the patient's cardiac arrest. Which should the provider order to confirm hyperkalemia?

serum electrolyte panel

COLTON ADAMS, what rhythm

sinus bradycardia

Which statement correctly describes the progression of first degree to third degree atrioventricular (AV) block?

NOT linear

What is considered inadequate perfusion when assessing/caring for a pediatric patient with an arrhythmia?

AMS, hypotension, diminished peripheral pulses

While reassessing an intubated patient receiving mechanical ventilation, the respiratory therapist notes the patient suddenly begins deteriorating and suspects a problem with the advanced airway therapy. The respiratory therapist uses which mnemonic to assess for complications?

DOPE

The pediatric intensive care team is caring for a child post-cardiac arrest. During which assessment should the need for an advanced airway be determined?

primary

Which statement correctly describes the etiology of sudden cardiac arrest from an arrhythmia in children and infants?

rare in children and infants

Which of the following is used to monitor chest compression adequacy in a patient experiencing cardiac arrest?

ETCO2

A patient with respiratory distress caused by increased intracranial pressure (ICP) is being treated in the pediatric intensive care unit. You know you need to ensure adequate cerebral perfusion pressure (CPP). Which of the following are measures used to ensure adequate CPP?

Ensure adequate CPP (head midline, pharmacologic therapy for ICP, avoid hypotension, aggressively treat fever)

What is the next immediate action the team should implement?

Ensure adequate oxygenation and assist ventilation as needed.

A 5-year-old patient is brought to the emergency department with a temperature of 102.4° F and a cough. Upon assessment, the healthcare provider observes decreased breath sounds and localized crackles and tachycardia. The provider suspects these findings most likely indicate which disorder?

PNA

A toddler is experiencing hemorrhagic shock and did not respond to an initial fluid bolus. What is the immediate next step of care?

PRBC or whole blood transfusion

Tachycardias can be further distinguished based on which ECG characteristic?

QRS

A 9-year-old patient is experiencing supraventricular tachycardia (SVT) with adequate perfusion, but vagal maneuvers have been unsuccessful. Which pharmacologic treatment should be initiated?

adenosine

A newly admitted patient's ECG reveals a wide-complex tachycardia and the patient has adequate perfusion. Which initial pharmacologic intervention could be considered for this arrhythmia if the rhythm is regular and QRS monomorphic?

adenosine

A patient's ECG reveals the following image. Which pharmacologic treatments may be initially recommended by the cardiologist if the patient has adequate perfusion?

amio

Which cardiac arrest rhythms does the healthcare provider correctly identify as "nonshockable" rhythms?

asystole and PEA

While performing a rapid assessment on a child, the nurse notes skin mottling and life-threatening bleeding. Which action should the nurse take first?

attempt to stop the bleeding

Providers have been assisting ventilation and ensuring oxygenation for a child in respiratory failure in the emergency department. Despite these measures, the child's pulse falls to 60 bpm and there are signs of inadequate perfusion. What is the priority action for the healthcare provider to take?

begin compressions

When reviewing the data of a pediatric patient, the healthcare provider notes the child has a history of second-degree AV block, type I. The provider understands this is which type of arrhythmia?

bradyarrhythmi

While performing CPR on a 7-month-old infant, the team leader reminds the compressor to maintain appropriate chest compression depth. The team member understands compressions should be delivered at about which depth?

1.5

Dr. Lewis administered 0.5 joule/kg for the first dose. Since Noah is still experiencing SVT with inadequate perfusion, she will administer a second dose. Which of the following doses of energy should she consider administering to Noah?

2

How many mg of adenosine would Dr. Lewis order based on Noah's weight of 33 kilograms?

3.3

Pediatric In-Hospital Cardiac Chain of Survival

6 links

After a brief asystole, the rhythm returned to SVT and remains SVT. Dr. Lewis orders an additional dose of adenosine, Ann confirms the order and is preparing to give an additional dose of adenosine. How many mg would Dr. Lewis order based on Noah's weight of 33 kilograms?

6.6

During a resuscitation event, the team leader instructs the medication team member to prepare IV epinephrine. The medication member prepares medication and approaches the patient for administration. Following closed-loop communication, which is the best action by the team leader to perform prior to the administration of medication?

Ask for feedback to ensure the medication member received the message.

A child is admitted to the pediatric intensive care unit with pulmonary edema (non-cardiogenic). Which of the following are included in the treatment for this lung tissue disease?

Manage oxygenation and ventilation according to protocols for PARDS Correct hypoxemia with ventilation strategies and PEEP Consider hypercapnia, as indicated

Which of the following oxygen delivery devices may be preferred for children younger than 5 years in respiratory distress who only need low concentration to maintain O2 saturation of 94% to 99%?

NC

The healthcare provider understands that which rhythm is the most common symptomatic arrhythmia in children?

Narrow-complex tachycardias (i.e., sinus tachycardia and supraventricular tachycardia)

The healthcare provider suspects impending respiratory failure in a recently admitted school-aged child. Which new assessment finding would the healthcare provider most likely observe?

Respiratory rate change from 25 to 11 breaths per minute

Which arrhythmia does the ECG reading indicate?

SVT

A newly admitted infant has been diagnosed with bronchiolitis. The provider understands bronchiolitis is most often caused by which pathogen?

RSV

The parents of a child in respiratory failure told the PALS team that their child ingested some of a grandparent's opioid pain medication that was left over from knee surgery. Which of the following might be an appropriate intervention?

naloxone

The healthcare provider is preparing treatment for a child with a moderate asthma exacerbation. Which medication does the provider anticipate to be included in the initial care measures?

nebulized albuterol

Which is the primary goal and focus of post-cardiac arrest care?

preservation of neurologic function

A pediatric patient presents with tachypnea, irritability, wheezing and pallor. Which disorder do these assessment findings most likely indicate?

respiratory distress?

A PALS team member caring for a patient experiencing a respiratory emergency suggests collecting a sputum culture and performing a chest x-ray. During which assessment stage should these actions be performed?

secondary assessment

The healthcare provider identifies that a pediatric patient is experiencing tachycardia with inadequate perfusion and 12-lead ECG reveals wide QRS complex ventricular tachycardia. What is the first action the provider should implement?

synchronized cardioversion

A pediatric patient is brought to the emergency department experiencing anaphylactic shock from exposure to an allergen. Which symptoms would the healthcare provider expect to assess in this patient?

tachycardia and hypotension

While conducting a community health class for local parents about common respiratory disorders, which statement about croup does the healthcare provider correctly include?

A term for a respiratory problem with symptoms including hoarseness, possibly stridor and barking cough

Just before administering the pharmacological cardioversion, Ann had re-assessed Noah and verbally reports that Noah is breathing faster with a respiratory rate of 30, his blood pressure is now lower at 90/50, he looks dusky (pale) and diaphoretic and he seems sleepier. What is the correct next order for Dr. Lewis to give?

Decide to immediately initiate synchronized electrical cardioversion.

A child is brought to the emergency department by the parents with complaints of a rapid heart rate and sweating. Cardiac monitoring and 12-lead ECG reveal the following rhythm. Vagal maneuvers and administration of adenosine have been unsuccessful and the child is now displaying signs of inadequate perfusion. Which intervention should be performed next?

Synchronized electrical cardioversion

Both the Pediatric In-Hospital Cardiac Chain of Survival and the Pediatric Out-of-Hospital Cardiac Chain of Survival include a link emphasizing the importance of continued followed-up during the recovery process. True or False?

T

Dr. Lewis arrived and received information from Ann and the team. Based on her review of the ECG findings and Noah's current condition, what will Dr. Lewis choose for first line intervention in this case?

Tell Ann to instruct Noah to perform a vagal maneuver by instructing him to "bear down" as if trying to pass a bowel movement for 20 seconds (while the team prepares for adenosine administration).

A provider is using a BVM to administer ventilations during CPR. The provider should make sure that each ventilation has which characteristics?

Lasts about 1 second and delivers an appropriate volume to make the chest begin to rise

Arrhythmias with a pulse can be further characterized by whether perfusion is adversely affected or not. True or False?

T

Which statement correctly describes one of the uses of a length-based resuscitation tape?

dosages of meds