AHA Pediatric Advanced Life Support 2023 Exam / PALS 2023 Exam (answered)

Recognize *supraventricu- lar tachycardia* Recognize *wide-complex tachycardia* Recognize *SVT convert- ing to sinus rhythm after adenosine administration* What oxygen delivery sys- tem most reliably delivers a high (90% of greater) concentration of inspired oxygen to a 7-year-old child? You are called to help treat an infant with se- vere symptomatic brady- cardia (heart rate 66/min) associated with respira- tory distress. Bradycar- dia persists despite es- tablishment of an effec- tive airway, oxygenation, and ventilation. There is no heart block present. Nonrebreathing face mask *Epinephrine* You are part of a team at- tempting to resuscitate a child with ventricular fibril- lation cardiac arrest. You deliver 2 unsynchronized shocks. A team member established IO access, so you give a dose of epi- nephrine, 0.01 mg/kg IO. At next rhythm check, per- sistent ventricular fibrilla- tion is present. You admin- ister a 4-J/kg shock and resume CPR. What drug and dose should be ad- ministered next? Initial impression of a 2-year-old girl shows her to be alert with mild breathing difficulty dur- ing inspiration and pale skin color. On primary assessment, she makes *Amiodarone 5 mg/kg IO* - can be used for shock-re- fractory VF or pVT high-pitched inspiratory sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her SpO2 is 92% on room air, and she has mild inspirato- ry intercostal retractions. Lung auscultation reveals transmitted upper airway sounds with adequate dis- tal breath sounds bilateral- ly. Most appropriate initial intervention for this child? 7-year-old boy found un- responsive, apneic, and pulseless. CPR is ongo- ing. Child is intubated, and vascular access is established. ECG monitor shows organized rhythm with heart rate of 45/min, but a pulse check re- veals no palpable puls- es. High-quality CPR is re- sumed, and an initial IV dose of epinephrine is ad- *Humidified oxygen as tol- erated* *Identify and treat re- versible causes* You are caring for a 6-year-old patient who is receiving positive-pres- sure mechanical ventila- tion via an endotracheal tube. Child begins to move his head and suddenly be- comes cyanotic, and his heart rate decreases. His SpO2 is 65%. You remove child from mechanical ven- tilator and begin to provide manual ventilation with a bag via endotracheal tube. During manual ventilation with 100% oxygen, child's color and heart rate im- prove slightly and his BP remains adequate. Breath sounds and chest expan- sion are present and ad- equate on right side and are present but consistent- *Tracheal tube displace- ment into right main bronchus* You are giving chest com- pressions for a child in car- diac arrest. What is the proper depth of compres- sions for a child? During PALS, you and another rescuers begin CPR. Your colleague be- gins compressions, and you noticed that the com- pression rate is too slow. What should you say to of- fer constructive feedback? You are preparing to use a manual defibrillator in the pediatric setting. What best describes when it *Compress the chest at least one third the depth of the chest, about 2 inches (5 cm)* *You need to compress at a rate of 100 to 120 per minute* is appropriate to use the smaller pediatric-sized paddles? You need to provide res- cue breaths to a child vic- tim with a pulse. What is the appropriate rate for de- livering breaths? You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout for nearby help, but no one ar- rives. What action should you take next? 3 yo boy presents with multiple-system trauma. Child was an unre- strained passenger in a high-speed MVC. On pri- mary assessment, he is unresponsive to voice or painful stimulation. His RR is 5/min, HR and pulses are 170/min, systolic BC is *If the child weighs less than 10 kg or is less than 1 year old* *1 breath every 3 to 5 sec- onds* *Provide CPR for about 2 minutes before leaving to activate the emergency re- sponse system* *While a colleague pro- vides spinal motion restric- tion, open the airway with a jaw thrust and provide bag-mask ventilation* You are assisting in the elective intubation of an average-sized 4 yo child with respiratory failure. Colleague is retrieving the color-coded length-based tape from the resuscita- tion chart. What is likely to be the estimated size of the uncuffed endotracheal tube for this child? You find a 10 yo boy to be unresponsive. You shout for help, and af- ter finding that he is not breathing and has no pulse, you and a col- league begin CPR. An- other colleague activates the emergency response system, brings the emer- *5-mm tube* gency equipment, and places the child on a cardiac monitor/defibrilla- tor, which reveals ventric- ular tachycardia. You at- tempt defib at 2 J/kg and give 2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you at- tempt defibrillation with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose of ep- inephrine 0.01 mg/kg. If v fib or pulseless ventric- ular tachycardia persists after 2 minutes of CPR, you will administer anoth- er shock. What drug and dose should be adminis- tered? During bag-mask ventila- tion, how should you hold *Lidocaine 1 mg/kg IV* *Position your fingers us- ing the E-C clamp tech- nique* Age of infants Age of children To perform a pulse check in an infant, palpate a 1 yo (excluding the newly born) from 1 year of age to pu- berty brachial pulse - if you don't definitely feel a pulse within 10 sec- onds, starts CPR, begin- ning with chest compres- sions carotid or femoral pulse - if you don't definitely feel a pulse within 10 sec- onds, starts CPR, begin- To perform a pulse check in a child, palpate a ning with chest compres- sions Compression depth in in- fants If a head or neck injury is suspected, use what to open the airway? The primary assessment (primary survey) uses a hands-on ABCDE ap- proach and includes as- sessment of the patient's vital signs .. what does ABCDE stand for? at least 1/3 the AP diame- ter of the chest or about 1 1/2 inches (4 cm) jaw-thrust maneuver - if jaw thrust does not open the airway, use the head tilt-chin lift Airway Breathing Circulation Disability Exposure During PALS, determine the respiratory rate by ... Rectractions accompa- nied by stridor or inspirato- ry snoring suggest Rectractions accompa- nied by expiratory wheez- ing suggest Cause of seesaw breath- ing in most kids with neu- romuscular dz is counting the number of times the chest rises in 30 seconds and multiply by 2 upper airway obstruction - seesaw respirations also usually indicated upper airway obstruction + may also be observed in se- vere lower airway obstruc- tion marked lower airway ob- struction (asthma or bron- chiolitis), causing obstruc- tion during both inspiration and expiration weakness of abdominal and chest wall muscles - caused by strong con- traction of diaphragm that dominates weaker abdom- inal and chest wall mus- cles - result = retraction of Normal tidal volume Auscultation of air move- ment is critical. In a child, listen for the intensity of breath sounds and quality of air movement in the fol- lowing areas: appx 5-7 mL/kg of body weight throughout life - difficult to measure un- less child is mechanically ventilated -- clinical as- sessment is important Anterior: mid-chest (just to the left and right of sternum) Lateral: under the armpits (best location for evaluating air movement into lower parts of lungs) Posterior: both sides of back Most common cause of bradycardia in children Heart rate that warrants further assessment and may be a serious condi- tion in kids Normal capillary refill time hypoxia - if child with bradycar- dia has signs of poor per- fusion (decreased respon- siveness, weak peripher- al pulses, cool mottled skin), immediately support ventilation with bag and mask and administer sup- plementary O2 - be prepared to start chest compressions if heart rate remains less than 60/min with signs of poor perfusion despite ad- equate oxygenation and ventilation HR 180/min in infant or toddler and 160/min in child older than 2 yo 2 seconds or less Children with septic shock may have warm skin and extremities with very rapid (less than 2 seconds) capillary refill time, often called When perfusion deterio- rates in children and O2 delivery to tissues be- comes inadequate, what are typically affected first? You respond to a child or an infant that is found down. What is the next ac- tion after determining un- responsiveness? flash capillary refill hands and feet - they may become coo, pale, dusky, or mottled *Tell a bystander to call 911.* - Early activation is key. - Send any available by- stander to call 911. Many pediatric cardiac arrest situations are the result of a respiratory problem, and immediate interven- tion can be life-saving. *Upper arm - inside* Which of the following de- scribes the brachial pulse location? What is a simple mnemon- ic for aid in the assess- ment of mental status? Adenosine dosage of SVT in PALS for children A child has an advanced airway in place during car- diac arrest. How frequent- - The brachial pulse is lo- cated in the upper arm. *AVPU* - AVPU (alert, voice, pain, unresponsive) is a simple assessment tool to assess for adequate brain perfu- sion. Adenosine is effective for the treatment of SVT. - The first dose is 0.1 mg/kg up to a maximum of 6 mg. - The second dose is 0.2 mg/kg up to a maximum of 12 mg. *Every six seconds* - The latest AHA guide- lines recommend one ven- tilation every six seconds, or 10 per minute, when In small children, a rescue breath should be given: What is the normal range of heart rates for an 8-year-old child? An elevated respiratory rate is a sign of early respi- ratory compromise. In late stages or overt respiratory failure, the respiratory rate is The 8-year-old child you are treating has a palpa- ble pulse and a heart rate of 200. You look at the monitor and see a rapid rhythm with narrow QRS *over one second* - Rescue breaths and ven- tilations should be deliv- ered over one second, re- gardless of the patient's age. *60-140 per minute* low or barely detectable. *superventricular tachy- cardia* - The absence of P waves rules out a sinus rhythm, even sinus tachy- complexes. There are no discernible P waves on the monitor. The rhythm is probably: You are doing CPR on a child with sympto- matic bradycardia. An in- travenous line is in place. What is the first drug of choice for the patient? cardia. Ventricular tachy- cardia creates a wide QRS complex. *Epinephrine* - If oxygenation and venti- lation fail to correct symp- tomatic bradycardia in a child, epinephrine should be given. - While atropine is the recommended initial treat- ment choice for symp- tomatic bradycardia in adults, in children it is a secondary choice. - Atropine is the initial treatment in children with AV block due to primary bradycardia, however. *ventricular fibrillation* - The ECG waveform de- scribed is most likely ven- You are the team leader on a team resuscitating a child without a pulse or respirations. When you look at the monitor, you see a disorganized rhythm with chaotic electrical ac- tivity. This rhythm is most likely: tricular fibrillation. - Ventricular tachycardia would create abnormal, but regular waveforms. Asystole is a "flat line" and PEA can be almost any rhythm, except asystole, ventricular tachycardia, or ventricular fibrillation. In school age children and infants, the two most com- mon initial rhythms seen in pediatric cardiac arrest are: Cyanosis is not apparent until *asystole and PEA* - While cardiac arrest in children is usually preced- ed by respiratory distress and failure, the two most common, immediate caus- es of cardiac arrest in children are asystole and PEA. at least 5 g/dL of hemoglo- bin are desaturated (not bound to O2) The most determining fac- tor in relation to a child's cardiac output is the: Hypotension is most likely to be present early in what type of shock? The most common type of shock in children world- wide is: The most common cause of nonsinus tachycardia in children is: You are have just run an EKG on a patient reveal- ing a Mobitz Type II block. You recognize that the PR interval will: Accurate blood pressure measurement requires a *heart rate* - at such an early age, the heart is too small to make a significant difference in cardiac output *septic shock* - due to the effects of sep- sis on systemic vascular resistance *hypovolemic shock* *accessory pathway SVT* remain constant properly sized cuff. The cuff bladder should cover about... An example of histotoxic hypoxia would be: Hypotension in term neonates (0-28 days) Hypotension in infants (1-12 months) Hypotension in children 1-10 yo Hypotension in children 10 yo Hypotension with hemor- rhage is thought to be con- 40% of the mid-upper arm circumference *carbon monoxide poison- ing.* systolic BP 60 mmHg systolic BP 70 mmHg Systolic BP 70 + (age in years x 2) - this estimates systolic BP that is less than the fifth BP percentile for age Systolic BP 90 20 to 25% of circulating blood volume Normal urine output in in- fants and young children Normal urine output in old- er children and adoles- cents Accurate measurement of urine output in critically ill or injured children re- quires an After it is determined that the child has no pulse, what should be done? Clinical factors that re- flect brain perfusion can 1.5 to 2 mL/kg per hour 1 mL/kg per hour indwelling catheter - increase in urine output = good indicator of positive response to therapy *Begin CPR* - After it is determined that a child is pulseless, always immediately begin CPR using CAB sequence of events. provide indirect evidence of circulatory function in the ill or injured pediatric patient. These signs in- clude level of conscious- ness and ... The disability assessment of kids is a quick eval of neuuro function. Standard evals include... To rapidly evaluate cere- bral cortex function in kids, use... TICLS: muscle Tone Interactiveness Consolability Look/gaze/stare Speech/cry 1. AVPU (Alert, respon- siveness to Voice, respon- sive to Pain, Unrespon- sive) Pediatric Response Scale 2. Glasgow Coma Scale 3. Pupil response to light 4. Blood glucose test AVPU Pediatric Response Scale = system for rating child's level of conscious- ness Alert If an ill or injured child has decreased respon- siveness, immediately as- sess The right branch of the PALS systematic ap- proach algorithm is a se- quence of three actions. In the proper sequence, the three actions are: oxygenation ventilation perfusion blood glucose Evaluate Identify Intervene primary assessment, sec- ondary assessment, diag- nostic tests - Primary assessment: This is a rapid hands-on assessment using the ABCDE evaluation tool to evaluate respiratory, cardiac, and neurological he evaluate-identify-inter- vene sequence consists of three assessment tools: In PALS, the three prima- ry characteristics that are included in the first quick "from the doorway" obser- vations. function. All vital signs are also included in this as- sessment. - Secondary assessment: This assessment consists of a focused history and a focused physical exam. - Diagnostic tests: This as- sessment tool can include a number of advanced tests that can help identify the cause of the pediatric emergency. Examples in- clude ABG, x-ray, and lab- oratory blood tests. Appearance, breathing, and circulation (color) Size of pupils (in millime- ters) Equality of pupil size During the disability as- sessment, assess and record the following for each eye Hypoglycemia refers to blood glucose less than what in children? In the PALS systematic approach algorithm, if the child is determined to be unresponsive or immedi- ate intervention is need- ed what will be your next step? Constriction of pupils to light (magnitude and rapid- ity of response to light) Acronym PERRL (Pupils Equal, Round, Reactive to Light) describes normal pupil responses to light less than or equal to 45 mg/dL in newly born less than or equal to 60 mg/dL in child *Activate emergency re- sponse* - If the child is unre- sponsive or immediate in- tervention is needed, the next step would be to ac- tivate the emergency re- sponse. This may involve shouting for help or acti- vating the code blue sys- tem or other similar emer- gency response systems. After the emergency re- sponse is activated, the next intervention is to . Components of the sec- ondary assessment are focuses history, focused physical exam, and on- going reassessment. One memory aid for obtaining a focused history is *Check for breathing and a pulse* SAMPLE Signs and symptoms - time course of symptoms Allergies Medications - meds that can be found in child's env't Past medical history - Immunization status - Premature birth - hospitalizations - past sx's Last meal Events 70-75%, assuming arterial O2 saturation is 100% - if arterial O2 saturation is not normal, SvO2 should be about 25-30% below Normal SvO2 arterial O2 sat - ex. if child has cyanotic heart disease and arteri- al O2 sat is 80%, SvO2 should be about 55% The following signs of car- diac arrest should be pre- sent for CPR to be initiat- ed: In children, which of the following is the most com- mon form of arrest? For asystole in a kid, the team should do CPR until IV or IO access is achieved. The drug of choice for asystole is: unresponsiveness no breathing or only gasp- ing (agonal breathing) No pulse or pulse 60 with signs of poor perfu- sion respiratory arrest epinephrine What is the most common form of infectious pneu- monia which often causes empyema? The recommended priori- ty of treatment of ischemic hypoxia is what? What should be the first priority when assisting a critically ill or injured child in shock? Monitoring of continuous arterial blood pressure can be accomplished with placement of a For cardiogenic shock in kids, you should deliver a fluid challenge (5 to 10 mL/kg bolus) over what length of time? In a case of sinus tachy- cardia, the heart rate is . staphylococcus pneumo- niae increase cardiac output positioning aterial catheter 10-20 minutes unsteady Each attempt for catheter insertion and suctioning of an infant should not sur- pass: What age period is croup most common to occur? What is the recommended first energy level used for defibrillation in kids? What agent is added to increase the half-life of imipenem? Which would be consid- ered a normal serum potassium? The proximal aorta is de- rived from which struc- ture? 10 seconds 6 months - 3 years 2.0 joules/kg cilastatin 4 mEq per L truncus arteriosus Decreased vesicular sounds What is the best posi- tion for a hospitalized pa- tient experiencing difficul- ty breathing? What is required for the di- agnosis of respiratory fail- ure? What does a carotid pulse indicate? The right neck vein is pre- ferred for central line over high fowler's PACO250mmHg or PAO260mmHg The circulating blood vol- ume is reaching end or- gans thoracic duct To relive a right tension pneumothorax, where should the needle should be placed? Why does the ACLS proto- col recommend epineph- rine? Cardioversion delivery is synchronized with: A chest tube will drain an effusion when the lumen is properly placed in which space? In PALS, The most com- mon rhythm identified in 2nd intercostal space right of the mediastinum Enhances myocardial con- tractility R wave pleural space ventricular fibrillation The size of the endotra- cheal tube for a child is usually the same size What is the best first step in patient with angina and ST ECG changes? In the femoral triangle, the order of the neurovascu- lar bundles, from LATER- AL TO MEDIAL, runs in what sequence? Which of the following is the superior marker for myocardial injury? What is the estimated time a person's brain can be anoxic from cardiopul- monary failure and not develop permanent brain damage? as the child's 5th finger aspirin Nerve, artery, vein troponin 5 minutes What is the best initial treatment for paroxysmal supraventricular tachycar- dia? A patient collapses, a car- diac monitor is placed, and the rhythm is deter- mined to be ventricular fibrillation. Despite three defibrillation shocks, intra- venous epinephrine, and further attempt at defibril- lation, there is no change. The patient is uncon- scious. What is most ap- propriate for the next step in this patient's manage- ment? How is the bradycardia caused by acetylcholine treated? Adenosine Administer amiodarone atropine *adenosine* - best initial therapy for paroxysmal SVT What is the drug of choice for supraventricular tachy- cardia? What is the drug of choice for the treatment of ventric- ular dysrhythmias? Predominant cause of death in children 6 months of age through young adulthood You are treating hy- poglycemia in a three-week-old. What con- centration of IV fluids is recommended? What should be the ini- tial temporizing measure in a patient with hypoten- sion following the onset of 3rd degree heart block? - DOC for hemodynamical- ly stable pt iwth paroxys- mal SVT lidocaine Trauma D10 transcutaneous pacing Most common initial rhythms seen in both in-hospital and out-of-hos- pital pediatric cardiac ar- rest, especially in children 12 yo More likely terminal rhythms in older children with sudden collapse or in children with underlying cardiovascular conditions Which of the following rhythms carries the worst long-term prognosis for survival? Which of the following is a lethal heart rhythm? Which of the following is the most common arrhyth- mia in patients with car- diac arrest? Asystole and PEA VF and pVT asystole pulseless ventricular tachycardia ventricular fibrillation The trachea deviate with tension pneumothorax to the: In a neonate, what is the proper method of perform- ing chest compressions for two rescuers? On ECG, no conduction through the atrioventricu- lar (AV) node is consid- ered Placement of subclavian venous line unaffected side Two thumb-encircling hands chest compression third-degree av block - Place the needle one centimeter inferior to the junction of the middle and medial third of the clavicle - Place the needle inferior to the clavicle at the del- topectoral groove - Place the needle lateral to the mid-clavicular line For aspiration of pericar- dial fluid the needle should be inserted through which of the following intercostal spaces? What is used to measure the degree of ST segment elevation or depression on an ECG? What is progressive pro- longation of the PR inter- val until a QRS complex is not generated on an elec- trocardiogram (ECG)? Which ECG wave repre- sents the repolarization of the ventricles? It is seen during cardiac tamponade resulting in a Fifth intercostal space J wavev Mobitz I Second-Degree AV Block t wave pulsus paradoxus The Sellick maneuver min- imizes the chances of: What is the treatment for unstable patient with tor- sades de pointes? For pediatric patients, what volume of fluid re- suscitation should be giv- en initially in the setting of shock? During resuscitation, your intubated patient's intra- venous fluid infiltrates. You know that you may deliver the following drugs via the endotracheal tube: Regurgitation during intu- bation defibrillation 10 to 20 mL/kg of Ringers lactate Lidocaine, atropine, nalox- one, epinephrine Compare to monophasic shock for cardioversion, biphasic shock requires: P wave on ECG normally has duration of What is used in the emer- gency treatment of a slow junctional heart rhythm? Atrial repolarization and ventricular depolarization are represented on an ECG by: Which drug can be given to terminate a refractory paroxysmal supraventricu- lar tachycardia (PSVT)? less energy 0.11 seconds or less atropine QRS complex verapamil A patient with stable paroxysmal supraventric- ular tachycardia (PSVT) does not respond to vagal maneuvers. What is the next step in management? *adenosine* - best initial therapy for paroxysmal SVT - DOC for hemodynamical- ly stable pt with paroxys- mal SVT - -DOC for SVT kids 1st dose = 0.1 mg/kg 2nd dose = 0.2 During the Heimlich ma- neuver, inward and up- ward thrusts are delivered: Between the xiphoid process and above the umbilicus *lidocaine* - ventricular dysrhythmias - DOC for symptomatic Which of the following is best used for treatment of ventricular tachycardia (VT)? PVCs - may be used for shock re- fractory VF or pVT in kids What is the treatment of choice for complete heart block with repeated paus- es? Transcutaneous pacing is maintained at a level of Select the treatment of choice for a hemodynam- ically stable patient with paroxysmal supraventricu- lar tachycardia. transvenous cardiac pac- ing 1.25 times the capture threshold adenosine right atrium What is the initial therapy for a patient with ventricu- lar fibrillation? An adult patient pre- sents with a pulse of 40 and blood pressure 80/60. What is the first step in management? Which of the following ma- neuvers is used to open an airway in a patient with a suspected spinal cord in- jury? When assessing an acute- ly desaturated patient, the first step is to note pres- ence of what condition? What is prolongation of the PR interval on an unsynchronized cardiover- sion atropine jaw thrust hypoventilation first degree AV block Which is the most appro- priate size for an uncuffed endotracheal tube for a 6-year-old child? Which pharmacologic property of aspirin is im- portant in the treatment of myocardial infarction? ROSC (return of sponta- neous circulation) is the immediate goal of ther- apeutic interventions for cardiac arrest. ROSC has occurred when there is... Which is the most likely consequence of high-dose intravenous ep- inephrine? What is the initial pedi- atric standard defibrillat- ing dosage of energy? 5.5 mm ID antithrombotic resumption of organized cardiac electrical rhythm on the monitor + palpable central pulses tachycardia 2 joules/kg To improve drug delivery to the central circulation during PALS, do the fol- lowing when administer- ing drugs into a peripher- al IV catheter infusion sys- tem What is the minimum coro- nary perfusion pressure required for a successful outcome during a cardiac arrest? At what point does cere- bral blood flow cease? In a patient with a ten- sion pneumothorax who has a needle placed in the chest, what is the next step in the management of their condition? - give drug by bolus injec- tion - give drug while chest compressions are being performed - follow with 5-mL flush of normal saline to move drug from peripheral to the central circulation 15 mmHg 60 mmHg chest tube AV dissociation What is the first priority in the treatment of an uncon- scious patient? What is the preferred blade for use in pediatric endotracheal intubation? What is the most effec- tive method of monitoring the success of resuscita- tion during CPR? If a shock eliminates VF ... What would you expect when using an end tidal carbon dioxide (CO2) de- tector in a deceased per- son? check the pulse curved blade reactivity of pupils to light continue CPR because most victims have aystole or PEA immediately after shock delivery No CO2 What is the best treat- ment for most patients with premature ventricular contractions (PVCs)? Which of the following can lower hyperkalemia quick- ly? What is the most common reason for the chest not to rise with each breath dur- ing CPR? What is the best route of drug administration during ACLS and PALS? Used for cardiac arrest as- sociated with VF/pVT as well as asystole/PE. High doses may be considered for special resuscitation circumstances, such as beta-blocker overdose no treatment Albuterol (salbutamol) airway is not clear subclavian central line Epinephrine May be used for treatment of shock-refractory VF or pVT in children What is the best method of opening the airway in a pa- tient who is unconscious and vomiting? The laryngeal mask is usually seated over the which structure? What is the first step in treating an unresponsive patient? The external non-invasive pacemaker units are for which of the following? What is the treatment of choice for symptomatic bradycardias? lidocaine place in recovery position Pyriform fossa Check pulses ventricular pacing Transcutaneous external cardiac pacing Indicated for treatment of bradycardia, especially if it results from excessive vagal tone, cholinergic drug toxicity (organophos- phates), or complete AV block atropine - can cause paradoxic bradycardia - used in emergency of slow junctional heart rhythm - first for symptomatic bradycardia in adults - DOC for AV block in kids due to primary bradycar- dia What is often caused by carotid massage? What is the first step when a male presents with asys- tole? The laryngeal mask air- way is contraindicated in patients with what condi- tion? bradycardia CPR + epinephrine propensity to aspirate What is the treatment of choice for ventricular fibril- lation? What is the drug of choice for treatment of sympto- matic premature ventricu- lar contractions (PVCs)? Which of the following is the correct therapy for a hypotensive patient with third degree heart block and a pulse of 38 beats per minute? When properly performed, closed-chest cardiac mas- sage can provide what percentage of normal, pre-arrest cardiac output? immediate defibrillation lidocaine transcutaneous pacing 25% midsternum What phase of the action potential corresponds to the T wave on an ECG? What is the next best step in management for a pa- tient with second-degree atrioventricular (AV) block and congestive heart fail- ure (CHF)? In which patients can an oropharyngeal airway be used? How many chest com- pressions should be per- formed each minute when giving CPR to children and adults? phase 3 Atropine, transcutaneous pacing and evaluation for pacemaker no gag reflex 100 Nonparoxysmal junction- al tachycardia originates from: Which of the follow- ing drugs can be given to terminate a refractory paroxysmal supraventricu- lar tachycardia (PSVT)? What is the initial defibrilla- tor dose for ventricular fib- rillation in adults? What is the most danger- ous side effect of atropine in infants? A 55 year old male is seen in the ER with an ECG showing a repolarizing ar- rhythmia of varying ampli- tude. This arrhythmia may be caused by what med- ication? AV node verapamil 200 joules fever sotalol 30-40 breaths per minute Which of the following medications is used for tachycardia and short term for hypertension? A trauma patient is rapidly intubated and capnograph is hooked up to the outflow line. After five breaths the capnography tracings falls off. What is the next step in the management? What ECG finding might you expect to find in a pa- tient with hypothermia? What is the most common cause of a seizure in a child up to the age of 5 years old? esmolol Immediately remove the endotracheal tube and reintubate Osborne waves Fever *deliver 1 breath every 8 seconds* You are on the scene of a 10 year old female who is in cardiac arrest. An ALS crew has already placed an advanced air- way and asks you to take over the ventilations. You should deliver Neurogenic shock is most often caused by: Synchronized shocks should always be deliv- ered to pediatrics in lower energy doses to Single most important fac- tor influencing survival in drowning - Once an advanced air- way is in place, the rate of ventilations should be delivered approximately 1 every 8 seconds in an adult/adolescent. - The compressions should be given at a rate of 100 per minute and there is no longer a need to pause while those ventila- tions are being delivered. cervical spine injury avoid triggering VF Immediate high-quality CPR 40 minutes and prolonged duration of CPR (greater In cardiac arrest associ- ated with hypothermia, it is often difficult to know when to terminate resusci- tative efforts. In victims of drowning in icy water, sur- vival is possible after sub- mersion times of as long as... Most rapid and effective technique for rewarming severely hypothermic car- diac arrest victims after submersion in icy water O2 consumption in infants is... than 2 hours) - when drowning occurs in ice water, rewarming to a core temp of at least 30 C is recommended be- fore CPR efforts are aban- doned - heart may be unrespon- sive to resuscitative efforts until core temp is achieved Extracorporeal circulation 6 to 8 mL/kg per minute - compared with 3 to 4 mL/kg per minute in adults - hypoxemia and tissue hy- poxia can develop more rapidly in a child than in an adult if apnea or inad- Narrowest portion of the pediatric airway Cuffed tubes have a risk of Most common cause of acute cardiogenic pul- monary edema in children is Important thing to remem- ber about GCS Cushing's triad Most common airway ob- struction Bradypnea in infant Bradypnea in toddler level of the *cricoid carti- lage* - in adult airway, narrowest portion of airway = at the vocal cords tracheal necrosis left ventricular myocardial dysfunction Less than 8 -- intubate combo of irregular breath- ing or apnea, increase in MAP, and bradycardia tongue 30 24 Bradypnea in school-age Bradypnea in adolescent Bradycardia in neonates Bradycardia in infants - 10 yo Bradycardia in children 18 12 80 75 60