PALS 2021

an 8 month old boy is brought to the hospital by his parents. He has a hoarse cry and barking cough. His mother says that during the night, her son had difficulty breathing, which has progressively worsened throughout the day. the infant most likely has what type of respiratory emergency?

Upper airway obstruction

which is most likely to present in a child who has respiratory distress (not respiratory failure)?

ability to maintain patent airway

what are the common cause of upper airway obstruction?

airway swelling thick secretions tonsillar hypertrophy (airway swelling)

for general shock management, administer an isotonic crystalloid bolus of 20 mL/kg over 5 to 20 min

20 mL/kg over 5 to 20 min

a chest compression fraction of at least 60% is recommended, and a goal of 80% is often achievable with good teamwork

60%, 80%

How can the CPR coach improve CPR quality in a resuscitation event?

Coach to midrange targets

which signs and symptoms are consistent with sinus tachycardia?

HR <220/min in an infant or <180 min in a child hr varies with activity or stimulation present and normal p waves

in whom should you suspect a tension pneumothorax?

any intubated child who deteriorates suddenly while receiving positive-pressure ventilation victim of chest trauma a child who deteriorates suddenly while receiving bag-mask ventilation

how should sinus tachycardia be treated?

by treating the underlying cause

what element of team dynamics describes when a team member needs to correct actions?

constructive intervention

the anticipated results of the nebulized treatment should include which of the following improvements in the patient?

decreased bronchoconstriction decreased respiratory effort decreased airway edema

how do infants initially respond to lower airway obstruction?

decreased interpleural pressure

what are the characteristics of shock?

decreased level of consciousness inadequate peripheral perfusion decreased end-organ perfusion

What is the most appropriate precautionary action to minimize gastric inflation during bag-mask ventilation?

deliver each breath over about 1 sec

what are the major functions of the cardiopulmonary system?

deliver oxygen to body tissues removes metabolic by-products of cellular metabolism

if myocardial function remains poor in a post- cardiac arrest child, what medications should be considered?

epinephrine milrinone

what is the focus of the initial management of distributive shock?

expanding intravascular volume filling expanded dilated vascular space correcting hypovolemia

which diagnosis may present with upper airway obstruction?

foreign body obstruction epiglottitis croup

when calculating the tube size based on the child's age, to avoid injury to the subglottic area, you should use an endotracheal tube that is:

half a size smaller than predicted for the child

when should vasoactive therapy be considered in managing distributive shock?

if the child remains hypotensive and poorly perfused despite rapid bolus fluid administration

in what conditions is atropine preferred over epinephrine as the 1st-choice treatment of symptomatic bradycardia?

increased vagal tone av block due to primary bradycardia cholinergic drug toxicity (organophosphates)

according to the systematic approach algorithm, what are the correct assessments to perform during the evaluation phase?

initial, primary, secondary

in a less severe case of upper airway obstruction in a child, what intervention can relieve obstruction caused by the tongue?

insert an oral airway

which anatomical features may contribute to upper airway obstruction in infants?

large tongue large occiput

what are the components of breathing assessment?

lung and airway sounds chest expansion and air movement oxygen saturation respiratory rate respiratory effort

Which is true of increased carbon dioxide tension in arterial blood?

may be caused by disordered control of breathing

What happens to the arterial oxygen level in a child with severe anemia?

may increase when dissolved oxygen is increased

which of the following statements about respiratory failure is true?

may occur without signs of respiratory distress

a child presents with a barking cough, good air entry during auscultation, a pulse oximetry reading of 93% on room air, and retractions at rest. what is the severity of the child's presentation?

moderate croup

if the patient does not improve with medication, what is your next intervention to ensure oxygenation?

noninvasive positive-pressure ventilation

what will occur if adequate oxygen delivery to the tissues is not mainatined?

organ dysfunction

the patient still has a bp of 58/38 mm Hg. Her condition would be classified as hypotensive shock

other answer: compensated obstructive anaphylactic

steps of treating asystole/PEA

provide cpr administer epinephrine consider advanced airway establish IV/IO access

what signs distinguish anaphylactic shock from other types of shock?

respiratory distress with stridor, wheezing or both angioedema (swelling of the face, lips, and tongue) urticaria (hives)

the infant is responsive and is breathing. what is an initial measure that you can perform to maintain his airway?

sit him up

what are the signs of upper airway obstruction?

stridor use of accessory muscles

what is the first step for an intubated child whose condition deteriorates?

support oxygenation and ventilation

what circulation findings are specific to pericardial tamponade?

tachycardia muffled or diminished heart sounds narrowed pulse pressures

The evaluate-identify-intervene sequence should be continued until

the child is stable

when may pulse oximetry be inaccurate?

the displayed heart rate does not correlate with the child's heart rate

what should be checked to ensure proper function of a bag-mask system?

the pop-off valve can be closed oxygen tubing is connected to the device and the oxygen source

which of the following is required to appropriately ventilate a child with a flow-inflating bag?

tidal volume needs to be delivered at the correct rate

what is an assessment finding unique to tension pneumothorax?

tracheal deviation

signs of cardiac arrest in children

unresponsiveness no pulse felt agonal gasps

what best assess a child's response to each fluid bolus?

vital signs physical examination urinary output

As more time passes between the onset of signs of shock and the restoration of adequate oxygen delivery and organ perfusion, the outcome is worse

worse