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PALS ALL QUESTIONS AND ANSWERS

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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

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