PALS

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

40 J

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

10 secs

A 6 yr old child is found unresponsive, not breathing, and without a pulse. One healthcare worker leaves to activate the emergency response system and get the resuscitation equipment. you and another healthcare provider immediately begin performing CPR. Which compression-to-ventilation ratio do you use?

15:2

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

2-4 J/kg

You are caring for a 3 month old boy with a 2 day hx of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190, temp is 101F, BP is 59/29, RR is 70 and shallow, an O2 sat is 94% on 100% O2. His cap refill time is 4 to 5 secs, and he has mottled, cool extremities. The infant weighs 6kg. You have decided that this infant needs fluid resuscitation. How much fluid should you administer?

20 mL/kg normal saline

You are caring for a 12 yr old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 102F, HR is 118, RR 36, BP is 100/40 and O2 sat is 96% on RA. Your assessment reveal mild increase in work of breathing, and bounding pulses. The child is receiving 100% oxygen by NRB. Which normal saline fluid bolus is most appropriate for this patient?

20mL/kg

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

88% on 4L NC

In postresusitation management after cardiac arrest, extra care should be taken to avoid reperfusion injury. What should the ideal oxygen saturation range most likely be?

94%-99%

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

A child who is grunting.

The parents of a 7 yr old child who is undergoing chemotherapy report that the child has been febrile and has not been felling well, with recent onset of lethargy. Assessment reveals that the child is difficult to arouse and her skin color is pale. The child's HR is 160/min, RR rate is 38, BP is 76/45, cap refill time is 5 to 6 secs, and temp is 103F. IV access has been established, and blood cultures have been obtained. Which action should you perform next?

Admin 20mL/kg of isotonic crystalloid over 5 to 10 mins

A 5 yr old child is brought to the emergency dept. by ambulance after being involved in a MVC. You are using the primary assessment to evaluate the child. When assessing the childs neurologic status, you note that he has spontaneous eye opening, is fully oriented, and is able to follow commands. How would you document this child's AVPU Pediatric Response Scale finding?

Alert

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

Allowing complete chest wall recoil after each compression

You are caring for a 5 yr old boy with a 4 day hx 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 saturation is 72% on RA and 89% when on a NRB. He has shallow respirations, with a respiratory rate of 38/min. Auscultation of the lungs reveals bilateral crackles. Which medication would be most appropriate?

An Antibiotic

You are caring for a 12 yr old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 102F, HR is 118, RR 36, BP is 100/40 and O2 sat is 96% on RA. Your assessment reveal mild increase in work of breathing, and bounding pulses. The child is receiving 100% oxygen by NRB. In addition to oxygen administration and appropriate fluid resuscitation, which additional early intervention should you provide to this patient?

Antibiotic administration

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

Ask for a new task or role

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

Audible inspiratory stridor

You are evaluating a 10 yr old child who is febrile and tachycardic. The child's capillary refill time is 5 secs. Which parameter will determine if the child is an compensated shock?

BP

You respond to 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?

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

You are caring for a 12 yr old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 102F, HR is 118, RR 36, BP is 100/40 and O2 sat is 96% on RA. Your assessment reveal mild increase in work of breathing, and bounding pulses. The child is receiving 100% oxygen by NRB. Which assessment finding is most important in your deterioration of the severity of the patient's condition?

Blood Pressure

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

Blood glucose

You are caring for a 3 month old boy with a 2 day hx of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190, temp is 101F, BP is 59/29, RR is 70 and shallow, an O2 sat is 94% on 100% O2. His cap refill time is 4 to 5 secs, and he has mottled, cool extremities. The infant weighs 6kg. Which assessment finding indicates that the infant has hypotensive shock?

Blood pressure

With which condition in a child should IO access most likely be attempted before vascular access?

Cardiac arrest

You are caring for a 12 yr old girl with acute lymphoblastic leukemia. She is responsive, but she does not feel well and appears to be flushed. Her temperature is 102F, HR is 118, RR 36, BP is 100/40 and O2 sat is 96% on RA. Your assessment reveal mild increase in work of breathing, and bounding pulses. The child is receiving 100% oxygen by NRB. Laboratory studies document a lactic acidosis. On the basis of the patient's clinical assessment and hx, which type of shock does this patient most likely have?

Distributive, septic

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

Crackles

An 8 yr old child is brought to the emergency department by ambulance after being involved in a motor vehicle collision. Which finding would suggest that immediate intervention is needed?

Decreased level of consciousness.

A 4 yr 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 consistent with your assessment?

Disordered control of breathing

You are caring for a 9 mo 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 infant's SpO2 is 94%. On auscultation, the lungs are clear bilaterally. Which medication should you administer first?

Epinephrine, Nebulized

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

Give 30 compressions to 2 breaths

A 10 yr old child is being evaluated for a headache. Which is a normal finding for this 10 yr old child?

HR of 88/min

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

Increased inspiratory effort with retractions

You are caring for a 3 month old boy with a 2 day hx of fever, vomiting, and diarrhea. His parents state that he has been sleeping much more. His heart rate is 190, temp is 101F, BP is 59/29, RR is 70 and shallow, an O2 sat is 94% on 100% O2. His cap refill time is 4 to 5 secs, and he has mottled, cool extremities. The infant weighs 6kg. On the basis of this infant's presentation, which type of shock does this infant have?

Hypovolemic

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

Hypoxia

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?

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

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?

Inspiratory stridor

A 2 week old infant is being evaluated for irritability and poor feeding. His bp is 55/40, and capillary refill time is 5 secs. Which statement best describes your assessment of this infant's BP?

It is hypotensive

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

Lower airway obstruction

You are caring for a 5 yr old boy with a 4 day hx 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 saturation is 72% on RA and 89% when on a NRB. 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?

Oxygen saturation

A 7 yr old child in cardiac arrest is brought to the emergency department by ambulance. No palpable pulses are detected. The child's ECG is shown here. How would you characterize this child's rhythm?

PEA

After rectal administration of diazepam, an 8 yr old boy with a hx of seizures is now unresponsive to painful stimulation. His respirations are shallow, at a rate of 10/min. His oxygen sat is 94% on 2L via NC. On examination, the child is snoring with poor chest rise and poor air entry bilaterally. If the patient continues to deteriorate after your initial intervention, which next step is most appropriate?

Provide BVM respirations

An unresponsive 9 yr old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His BP is 80/40, HR is 45, RR 6/min, and SpO2 is 60% on room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. (Sinus Brady) What action do you take next?

Provide bag-mask ventilations with 100% O2

After rectal administration of diazepam, an 8 yr old boy with a hx of seizures is now unresponsive to painful stimulation. His respirations are shallow, at a rate of 10/min. His oxygen sat is 94% on 2L via NC. On examination, the child is snoring with poor chest rise and poor air entry bilaterally. Which action should you take next?

Repositiion the patient and insert an oral airway.

A 3 yr old boy is brought to the emergency department by his mother. He is lethargic, with retraction and nasal flaring. He has a respiratory rate of 70, with warm extremities and brisk cap refill. To which immediate life-threatening condition could this child's condition most likely progress if left untreated?

Respiratory failure

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

Respiratory rate of 24/min

A 3 yr 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. (V-Fib) Defibrillation is attempted with a shock dose of 2 J/kg. After administration of the shock, what should you say to your team members?

Resume Compressions

An unresponsive 9 yr old boy is pale and cool to the touch. His BP is 70/45, HR is 190 , and respiratory rate is 12. The SpO2 is not detectable. Capillary refill time is 5 secs. An IV is in place. The cardiac monitor displays the rhythm shown here. (SVT.) Which rhythm is seen on the patient's cardiac monitor?

SVT

An unresponsive 9 yr old boy was given a dose of rectal valium by his caretaker for a prolonged seizure. His BP is 80/40, HR is 45, RR 6/min, and SpO2 is 60% on room air. He is unresponsive and cyanotic. The cardiac monitor displays the rhythm shown here. (Sinus Brady) What is the rhythm?

Sinus Brady

An unresponsive 9 yr old boy is pale and cool to the touch. His BP is 70/45, HR is 190 , and respiratory rate is 12. The SpO2 is not detectable. Capillary refill time is 5 secs. An IV is in place. The cardiac monitor displays the rhythm shown here. (SVT.) If initial treatment is unavailable or delayed, which intervention is indicated?

Synchronized cardioversion

You are evaluating a 1 yr old child for respiratory distress. His HR is 168, and his RR has decreased from 65 to 30. 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 child's condition?

The child has signs of probable respiratory failure

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

Upper airway obstruction

You are caring for a 9 mo 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 infant's SpO2 is 94%. On auscultation, the lungs are clear bilaterally. Which is the most likely cause of this infant's respiratory distress?

Upper airway obstruction