PALS ALL QUESTIONS AND
ANSWERS
Youxsarexscaringxsforxsaxschildxswhoxswasxsresuscitatedxsafterxsaxsdrowningxsevent.xsThex
schildxsisxsintubatedxsandxsventilatedxswithxs100%xsoxygenxswithxsequalxsbreathxssoundsx
sandxsexhaledxsCO2xsdetected.xsThexsheartxsratexsisxsslowxsandxsthexsmonitorxsshowsxssi
nusxsbradycardia.xsThexsskinxsisxscool,xsmottled,xsandxsmoist;xsdistalxspulsesxsarexsnotxsp
alpablexsandxsthexscentralxspulsesxsarexsweak.xsIntravenousxsaccessxshasxsbeenxsestabli
shed.xsThexscorexstemperaturexsisxs37.3oC.xsBasedxsonxsthexsPALSxsbradycardiaxsalgorit
hm,xswhichxsofxsthexsfollowingxsshouldxsbexsprovidedxsfirst?
EpinephrinexsIV
Transcutaneousxspacing
AtropinexsIV
DobutaminexsIVxsinfusionxs-xsxsans-EpinephrinexsIV
Youxsarexscaringxsforxsaxs5-year-
oldxspatientxswithxssupraventricularxstachycardiaxs(heartxsratexs=xs220/
min).xsThexschildxsisxslethargic.xsThexsskinxsisxspalexsandxscoolxswithxsdelayedxscapillaryxs
refill.xsDistalxspulsesxsarexsnotxspalpable.xsWhichxsofxsthexsfollowingxswouldxsbexsthexsbest
xstreatmentxstoxsprovidexswithoutxsdelay?
Placexscoldxspacksxsonxsthexsdistalxsupperxsandxslowerxsextremities
Askxsthexschildxstoxsblowxsthroughxsaxssmallxsstraw
Exertxslightxspressurexsonxsthexseyesxsbilaterally
Providexssynchronizedxscardioversionxsatxs0.5xstoxs1xsJ/kgxs-xsxsans-
Providexssynchronizedxscardioversionxsatxs0.5xstoxs1xsJ/kg
Youxsarexsinitiatingxstreatmentxsforxsaxschildxswithxssepticxsshockxsandxshypotension.xsWhi
lexsadministeringxshigh-
flowxsoxygenxsyouxsdeterminexsthatxsthexschild'sxsrespirationsxsarexsadequatexsandxsSpO
2xsisxs100%.xsYouxshavexsjustxsestablishedxsvascularxsaccessxsandxsobtainedxsbloodxssa
mples.xsWhichxsofxsthexsfollowingxsisxsthexsnextxsmostxsappropriatexstherapyxstoxssupportx
ssystemicxsperfusion?
Administerxsrepeatedxsfluidxsbolusesxsofxsisotonicxscolloid
Administerxsrepeatedxsfluidxsbolusesxsofxsisotonicxscrystalloid
Beginxsimmediatexsdopaminexsinfusion
Beginxsimmediatexsdobutaminexsinfusionxs-xsxsans-
Administerxsrepeatedxsfluidxsbolusesxsofxsisotonicxscrystalloid
, Youxsarexstreatingxsanxs8-year-
oldxswithxsventricularxstachycardiaxswithxspulsesxsandxsadequatexsperfusion.xsYouxsattem
ptedxssynchronizedxscardioversionxswithoutxssuccess.xsWhilexsseekingxsexpertxsconsultat
ion,xsitxswouldxsbexsmostxsappropriatexsto:
Administerxsaxsloadingxsdosexsofxsmilrinone
Considerxspossiblexsmetabolicxsandxstoxicologicxscauses
Initiatexsoverdrivexspacingxstranscutaneously
Deliverxsanxsunsynchronizedxsshockxs-xsxsans-
Considerxspossiblexsmetabolicxsandxstoxicologicxscauses
Youxsarexscaringxsforxsaxs2-year-
oldxsunconsciousxspatientxswhoxsisxsintubatedxsandxsreceivingxsmechanicalxsventilation.xs
Thexschild'sxsheartxsratexssuddenlyxsdropsxstoxs40/
minxsandxshisxscolorxsbecomesxsmottled.xsYouxsshouldxsrespondxstoxsthesexschangesxsby
:
Increasingxsthexsventilatorxsrate
Increasingxstidalxsvolume
Increasingxspositivexsend-expiratoryxspressurexs(PEEP)
Usingxsaxsresuscitationxsbagxsprovidexsmanualxsventilationxswithxs100%xsoxygenxs-
xsxsans-Usingxsaxsresuscitationxsbagxsprovidexsmanualxsventilationxswithxs100%xsoxygen
Youxsarexscaringxsforxsaxs9-month-
oldxspatientxswithxspronouncedxsrespiratoryxsdistress.xsYouxsinitiatedxshigh-
flowxsoxygenxsusingxsaxsnonrebreathingxsmaskxsaboutxs10xsminutesxsagoxsandxsestablish
edxsintravenousxsaccess.xsInitiallyxsthexsinfant'sxsheartxsratexswasxsinxsthexs150/
minxsrangexswithxsstrongxspulses.xsSuddenlyxsthexsinfant'sxsrespiratoryxsratexsfallsxstoxs6/
minxswithxssignificantxsintercostalsxsretractions,xsandxslittlexsairxsmovementxsisxsheard.xsT
hexsinfantxsbecomesxscyanoticxsandxsthexsheartxsratexsdecreasesxstoxs95/
min.xsWhichxsofxsthexsfollowingxstreatmentsxswouldxsbexsbestxsforxsyouxstoxsprovidexsnow
?
AdministerxsepinephrinexsIV
Providexsbag-maskxsventilation
AdministerxsmagnesiumxssulfatexsIV
Intubatexsandxsventilatexs-xsxsans-Providexsbag-maskxsventilation
Whichxsofxsthexsfollowingxsisxslikelyxstoxsbexsthexsmostxshelpfulxstechniquexstoxsidentifyxsp
otentiallyxsreversiblexsmetabolicxsandxstoxicxscausesxsduringxsthexsattemptedxsresuscitati
onxsofxsaxsyoungxschildxsinxscardiacxsarrest?
Obtainingxsaxsurinexssamplexsforxstoxicologyxsscreen
Obtainingxschestxsandxsabdominalxsradiographs
Solicitingxsaxshistoryxsfromxsthexscaregiverxsorxsfamily
ANSWERS
Youxsarexscaringxsforxsaxschildxswhoxswasxsresuscitatedxsafterxsaxsdrowningxsevent.xsThex
schildxsisxsintubatedxsandxsventilatedxswithxs100%xsoxygenxswithxsequalxsbreathxssoundsx
sandxsexhaledxsCO2xsdetected.xsThexsheartxsratexsisxsslowxsandxsthexsmonitorxsshowsxssi
nusxsbradycardia.xsThexsskinxsisxscool,xsmottled,xsandxsmoist;xsdistalxspulsesxsarexsnotxsp
alpablexsandxsthexscentralxspulsesxsarexsweak.xsIntravenousxsaccessxshasxsbeenxsestabli
shed.xsThexscorexstemperaturexsisxs37.3oC.xsBasedxsonxsthexsPALSxsbradycardiaxsalgorit
hm,xswhichxsofxsthexsfollowingxsshouldxsbexsprovidedxsfirst?
EpinephrinexsIV
Transcutaneousxspacing
AtropinexsIV
DobutaminexsIVxsinfusionxs-xsxsans-EpinephrinexsIV
Youxsarexscaringxsforxsaxs5-year-
oldxspatientxswithxssupraventricularxstachycardiaxs(heartxsratexs=xs220/
min).xsThexschildxsisxslethargic.xsThexsskinxsisxspalexsandxscoolxswithxsdelayedxscapillaryxs
refill.xsDistalxspulsesxsarexsnotxspalpable.xsWhichxsofxsthexsfollowingxswouldxsbexsthexsbest
xstreatmentxstoxsprovidexswithoutxsdelay?
Placexscoldxspacksxsonxsthexsdistalxsupperxsandxslowerxsextremities
Askxsthexschildxstoxsblowxsthroughxsaxssmallxsstraw
Exertxslightxspressurexsonxsthexseyesxsbilaterally
Providexssynchronizedxscardioversionxsatxs0.5xstoxs1xsJ/kgxs-xsxsans-
Providexssynchronizedxscardioversionxsatxs0.5xstoxs1xsJ/kg
Youxsarexsinitiatingxstreatmentxsforxsaxschildxswithxssepticxsshockxsandxshypotension.xsWhi
lexsadministeringxshigh-
flowxsoxygenxsyouxsdeterminexsthatxsthexschild'sxsrespirationsxsarexsadequatexsandxsSpO
2xsisxs100%.xsYouxshavexsjustxsestablishedxsvascularxsaccessxsandxsobtainedxsbloodxssa
mples.xsWhichxsofxsthexsfollowingxsisxsthexsnextxsmostxsappropriatexstherapyxstoxssupportx
ssystemicxsperfusion?
Administerxsrepeatedxsfluidxsbolusesxsofxsisotonicxscolloid
Administerxsrepeatedxsfluidxsbolusesxsofxsisotonicxscrystalloid
Beginxsimmediatexsdopaminexsinfusion
Beginxsimmediatexsdobutaminexsinfusionxs-xsxsans-
Administerxsrepeatedxsfluidxsbolusesxsofxsisotonicxscrystalloid
, Youxsarexstreatingxsanxs8-year-
oldxswithxsventricularxstachycardiaxswithxspulsesxsandxsadequatexsperfusion.xsYouxsattem
ptedxssynchronizedxscardioversionxswithoutxssuccess.xsWhilexsseekingxsexpertxsconsultat
ion,xsitxswouldxsbexsmostxsappropriatexsto:
Administerxsaxsloadingxsdosexsofxsmilrinone
Considerxspossiblexsmetabolicxsandxstoxicologicxscauses
Initiatexsoverdrivexspacingxstranscutaneously
Deliverxsanxsunsynchronizedxsshockxs-xsxsans-
Considerxspossiblexsmetabolicxsandxstoxicologicxscauses
Youxsarexscaringxsforxsaxs2-year-
oldxsunconsciousxspatientxswhoxsisxsintubatedxsandxsreceivingxsmechanicalxsventilation.xs
Thexschild'sxsheartxsratexssuddenlyxsdropsxstoxs40/
minxsandxshisxscolorxsbecomesxsmottled.xsYouxsshouldxsrespondxstoxsthesexschangesxsby
:
Increasingxsthexsventilatorxsrate
Increasingxstidalxsvolume
Increasingxspositivexsend-expiratoryxspressurexs(PEEP)
Usingxsaxsresuscitationxsbagxsprovidexsmanualxsventilationxswithxs100%xsoxygenxs-
xsxsans-Usingxsaxsresuscitationxsbagxsprovidexsmanualxsventilationxswithxs100%xsoxygen
Youxsarexscaringxsforxsaxs9-month-
oldxspatientxswithxspronouncedxsrespiratoryxsdistress.xsYouxsinitiatedxshigh-
flowxsoxygenxsusingxsaxsnonrebreathingxsmaskxsaboutxs10xsminutesxsagoxsandxsestablish
edxsintravenousxsaccess.xsInitiallyxsthexsinfant'sxsheartxsratexswasxsinxsthexs150/
minxsrangexswithxsstrongxspulses.xsSuddenlyxsthexsinfant'sxsrespiratoryxsratexsfallsxstoxs6/
minxswithxssignificantxsintercostalsxsretractions,xsandxslittlexsairxsmovementxsisxsheard.xsT
hexsinfantxsbecomesxscyanoticxsandxsthexsheartxsratexsdecreasesxstoxs95/
min.xsWhichxsofxsthexsfollowingxstreatmentsxswouldxsbexsbestxsforxsyouxstoxsprovidexsnow
?
AdministerxsepinephrinexsIV
Providexsbag-maskxsventilation
AdministerxsmagnesiumxssulfatexsIV
Intubatexsandxsventilatexs-xsxsans-Providexsbag-maskxsventilation
Whichxsofxsthexsfollowingxsisxslikelyxstoxsbexsthexsmostxshelpfulxstechniquexstoxsidentifyxsp
otentiallyxsreversiblexsmetabolicxsandxstoxicxscausesxsduringxsthexsattemptedxsresuscitati
onxsofxsaxsyoungxschildxsinxscardiacxsarrest?
Obtainingxsaxsurinexssamplexsforxstoxicologyxsscreen
Obtainingxschestxsandxsabdominalxsradiographs
Solicitingxsaxshistoryxsfromxsthexscaregiverxsorxsfamily
