PALS

15:2

A 6 year old child is found unresponsive, not breathing, and without a pulse. one health care worker leaves to activate the emergency response system and get the resuscitation equipment. You and another healthcare provider immediatly begin CPR. Which compression to ventilation ratio do you use?

Heart rate of 88/min

A 10 year old child is being evaluated for a head ache. Which is a normal finding for this 10 year old child?

88% on 4L of Nasal oxygen

A 10 year old child is brought to the ED for fever and cough. You obtain an O2 sat on the child. Which oxygen saturation would indicate that immediate intervention is needed?

It is Hypotensive

A 2 week old infant is being evaluated for irritability and poor feeding. His BP is 55/40 mmHg, and cap refill time is 5 seconds. Which statement best describes your assessment of this infants BP?

respiratory failure

A 3 year old boy is brought to the ED by his mother. His is lethargic, with retractions and nasal flaring. He has a respiratory rate of 70/min, with warm extremities and brisk cap refill. To which immediate life treating condition could this Childs condition most likely progress if left untreated?

Respiratory rate of 24/min

A 3 year old child is brought to the emergency department by his mother. Which is a normal finding for a 3 year old child?

Increased inspiratory effort with retractions

A 3 year old child is having difficulty breathing. Which finding would most likely lead you to suspect an upper airway obstruction in this child?

"resume compressions"

A 3 year old child is in cardiac arrest, and high quality CPR is in progress. You are the team leader. The first rhythm check reveals the rhythm shown here. Defibrillation is attempted with a shock dose of 2 J/kg. after administration of the shock, what should you say to you team members?

40 Joules

A 4 year old child in cardiac arrest is brought to the emergency department by ambulance. High quality CPR is being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20 kg. As the team leader, how many joules do you tell your team member to use to perform initial Defib?

2-4 J/kg

A 4 year old child in cardiac arrest is brought to the emergency department by ambulance. High quality CPR is being performed. The cardiac monitor displays the rhythm strip shown here. The estimated weight of the child is 20 kg. What dose range should you use for the initial defibrillation?

Disordered Control of Breathing

A 4 year old child is brought to the emergency department for seizures. The seizures stopped a few minutes ago, but the child continues to have slow and irregular respirations. Which condition is most consistent with your assessment?

Alert

A 5 year old child is brought to the emergency department by ambulance after being involved in a MVC. You are using the primary assessment to evaluate the child. When assessing the Childs neurological status, you note that he has spontaneous eye opening, is fully oriented, and is able to follow command. How would you document this Childs AVPU pediatric response scale finding?

Hypoxia

A 6 month old infant is being evaluated for bradycardia. Which is the most likely cause of bradycardia?

10 seconds

A 6 month old infant is unresponsive. You begin checking for breathing at the same time you check for the infants pulse. Which is the maximum time you should spend when trying to simultaneously check for breathing and palpate the infants pulse before starting CPR?

Audible inspiratory stridor

A 6 year old boy is being evaluated for difficulty breathing. Which finding would suggest this child has respiratory distress?

Pulseless Electrical Activity

A 7 year old child in cardiac arrest is brought to the ED by ambulance. No palpable pulses are detected. The Childs ECG is shown here. How would you characterize this Childs rhythm?

Ask for a new task or role

A team member is unable to perform an assigned task because it is beyond the team members scope of practice. Which action should the team member take?

Provide bag mask ventilation

After rectal administration of diazepam, an 8 year old boy with a history of seizures is no unresponsive to painful stimuli. His respirations are shallow, at a rate of 10/min. His Oxygen saturation is 94% on 2L of NC oxygen. On examination, the child is snoring with poor chest rise and poor air entry bilaterally. After repositioning the patient and you insert an Oral airway, the patient continues to deteriorate. What next step is the most appropriate?

Reposition the patient, and insert an oral airway

After rectal administration of diazepam, an 8 year old boy with a history of seizures is no unresponsive to painful stimuli. His respirations are shallow, at a rate of 10/min. His Oxygen saturation is 94% on 2L of NC oxygen. On examination, the child is snoring with poor chest rise and poor air entry bilaterally. What action should you take next?

Decreased level of consciousness

An 8 year old child is brought to the ED by ambulance after being involved in a MVC. Which finding would suggest that immediate intervention is needed?

upper airway obstruction

An 8 year old child is brought to the ED by his mother for difficulty breathing. He has a history of asthma and nut allergies. He's mother tells you that he recently ate a cookie at a family picnic. Which condition is most likely to be present in this child?

blood glucose

An 8 year old child is brought to the emergency department with a 2 day history of lethargy and polyuria. The child has new onset rapid, deep, and labored breathing. Which diagnostic test should you order first?

Syncronized cardioversion.

An unresponsive 9 year old boy is pale and cool to the touch his blood pressure is 70/45 mmHg, heart rate is 190/min and respiratory rate is 12/min. The SpO2 is not detectable Cap refill time is 5 seconds. An IV is in place. The cardiac monitor displays the rhythm shown here. If initial treatment is unavailable or delayed, which intervention is indicated?

Supraventricular tachycardia

An unresponsive 9 year old boy is pale and cool to the touch his blood pressure is 70/45 mmHg, heart rate is 190/min and respiratory rate is 12/min. The SpO2 is not detectable Cap refill time is 5 seconds. An IV is in place. The cardiac monitor displays the rhythm shown here. What rhythm is seen on the patient cardiac monitor?

Provide bag-mask ventilation with 100% oxygen

An unresponsive 9 year old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His BP is 80/40 mmHg, HR is 45/min, respiratory rate is 6/min, and SpO2 is 60% no room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. What is your next action?

Sinus Bradycardia

An unresponsive 9 year old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His BP is 80/40 mmHg, HR is 45/min, respiratory rate is 6/min, and SpO2 is 60% no room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. Which rhythm is most consistent with this patients presentation and ECG findings?

"I think the correct dose is 0.01 mg/kg. should I give that dose instead?"

During a resuscitation attempt, the team leader asks you to administer an initial dose of Epinephrine at 0.1 mg/kg to be given IO. How should you respond?

94%-99%

In post resuscitation management after cardiac arrest, extra care should be taken to avoid repercussion injury. what should the ideal oxygen saturation range most likely be?

Administer 20 ml/kg of isotonic crystalloid over 5 to 10 mins

The parents of a 7 year old child who is undergoing chemotherapy report that the child has been febrile and has not been feeling well, with recent onset of lethargy. Assessment reveals that the child is difficult to arouse and her skin color is pale. The Childs HR is 160/min, respiratory rate is 38/min, blood pressure is 76/45 mmHg, cap refill time is 5 to 6 seconds, and temp is 39.4 degrees C (103 F). IV access has been established, and blood cultures have been obtained. which action should you perform next?

Give 30 compressions to 2 breaths

What ratio for compressions to breaths should be used for 1 rescuer infant CPR

crackles

Which abnormality helps identify children with acute respiratory distress caused by lung tissue disease?

cardiac arrest

Which condition in a child would IO access most likely be attempted before vascular access?

Lower airway obstruction

Which condition is characterized by a prolonged excretory phase and wheezing?

upper airway obstruction

You are Caring for a 9 month old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infants SpO2 is 94% On auscultation, the lungs are clear bilaterally. Which is the most likely cause of this infants respiratory distress?

Epinephrine, nebulized

You are Caring for a 9 month old girl who has increased work of breathing, a fever, and a cough. On assessment, you find an alert infant with stridor and retractions. The infants SpO2 is 94% On auscultation, the lungs are clear bilaterally. Which medication should you administer first?

Antibiotic Administration

You are caring for a 12 year old girl with acute lymphoblastic leukemia. She is responsive but she does not feel well and appears to be flushed. Her Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% Oxygen by NRB mask.--- In edition to oxygen administration and appropriate fluid resuscitation, which additional early intervention should you provide to the patient?

Distributive Septic Shock

You are caring for a 12 year old girl with acute lymphoblastic leukemia. She is responsive but she does not feel well and appears to be flushed. Her Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% Oxygen by NRB mask.--- Laberatory studies document a lactic acidosis. On the basis of the patients clinical assessment and history. Which type of shock does this patient most likely have?

20 ml/kg

You are caring for a 12 year old girl with acute lymphoblastic leukemia. She is responsive but she does not feel well and appears to be flushed. Her Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% Oxygen by NRB mask.--- Which NS bolus is most appropriate for this patient?

blood pressure

You are caring for a 12 year old girl with acute lymphoblastic leukemia. She is responsive but she does not feel well and appears to be flushed. Her Temp is 39 degrees C (102.2 F), HR is 118/min, respiratory rate is 36/min, BP is 100/40 mmHg, and oxygen sat is 96% on room air. Your assessment reveals mild increase in work of breathing and bounding pulses. The child is receiving 100% Oxygen by NRB mask.--- Which assessment finding is the most important in your determination of the severity of the patients condition?

hypovolemic shock

You are caring for a 3 month old boy with a 2 day history of fever, vomiting and diarrhea. His parents state that he has been sleeping much more. His HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/29 mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100% oxygen. His capillary refills time is 4-5 seconds, and he has mottled, cool extremities. The infant weighs 6 Kg. On the basis of this infants presentation, which type of shock does this infant have?

blood pressure

You are caring for a 3 month old boy with a 2 day history of fever, vomiting and diarrhea. His parents state that he has been sleeping much more. His HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/29 mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100% oxygen. His capillary refills time is 4-5 seconds, and he has mottled, cool extremities. The infant weighs 6 Kg. Which assessment finding indicates that the infant is in hypotensive shock?

20 ml/kg normal saline

You are caring for a 3 month old boy with a 2 day history of fever, vomiting and diarrhea. His parents state that he has been sleeping much more. His HR is 190/min, temp is 38.3 degrees C (101 F) blood pressure is 59/29 mmHg, Resp rate is 70/min and shallow, and oxygen sat is 94% on 100% oxygen. His capillary refills time is 4-5 seconds, and he has mottled, cool extremities. The infant weighs 6 Kg. You have decided that this infant Needs fluid resuscitation. How much fluid should you administer?

oxygen saturation

You are caring for a 5 year old boy with a 4 day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His O2 sat is 72% on room air and 89% when on a NRB O2 mask. He has shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles. Which assessment finding is consistent with respiratory failure in this child?

an antibiotic

You are caring for a 5 year old boy with a 4 day history of high fever and cough. He is having increasing lethargy, grunting, and sleepiness. Now he is difficult to arouse and is unresponsive to voice commands. His O2 sat is 72% on room air and 89% when on a NRB O2 mask. He has shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles. Which medication would be most appropriate?

A child who is grunting

You are caring for patients in the emergency department. Which 2 year old child requires immediate intervention?

The child has signs of probable respiratory failure

You are evaluating a 1 yer old child for respiratory distress. His HR is 168/min, and his respiratory rate has decreased from 65/min to 30/min. He now appears more lethargic and continues to have severe subcostal retractions. On the basis of your assessment, which is the most likely reason for this change in the Childs condition.

blood pressure

You are evaluating a 10 year old child who is febrile and tachycardia. The Childs cap refill times 5 seconds. which parameter will determine if the child is in compensated shock?

inspiratory stridor

You are performing the airway component of the primary assessment. Which finding would lead you to conclude that the child has an upper airway obstruction?

Allowing complete chest wall recoil after each compression

You are the team leader during a pediatric resuscitation attempt. which action is an element of high quality CPR?

Begin CPR for 2 mins before leaving to activate the emergency response system.

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