PALS Combined Sets 6 Exams - PALS 2025 Exam (2024/2025 Latest Update) Questions and Verified Answers| 100% Correct| Grade A

Where can you check a pulse on an infant and child? infant - brachial child - femoral What are signs of increased respiratory effort that can lead to fatigue and respiratory failure? Select all that apply nasal flaring seesaw respirations retractions head bobbing Determine the respiratory rate by counting the number of times the chest rises in _____ seconds and multiplying by _____. 30 2 Tachypnea is often the first sign of respiratory ______ in infants distress Hypotension fro children 1 to 10 years of age is a systolic blood pressure of less than 40mmHg + 2 x age in years 50mmHg + 2 x age in years 60mmHg + 2 x age in years 70mmHg + 2 x age in years 70mmHg + 2 x age in years What sequence is used when care for a seriously ill or injured child to help determine the best treatment or intervention? The __________ ___________ ____________ sequence Evaluate Identify Intervene Automated blood pressure cuffs may provide _________ ________ readings when the child is in shock. inaccurately high The primary assessment included the ABCDE approach. What does it assess? Airway, breathing, circulation, disability, exposure What does a prolonged capillary refill time indicate? low cardiac output ________ is usually high-pitched breathing during inspiration, whereas ___________ is usually during expiration Stridor wheezing Normal capillary refill time is _____ seconds or less 2 What pulses should be assessed to monitor systemic perfusion in a child? Peripheral and central What do weak central pulses indicate a need for immediate intervention to prevent? Cardiac arrest When oxygenation delivery to the extremities becomes inadequate, the _______ and ________ are the first to exhibit designs. Hands Feet What should be used to assess skin temperature? the back of the hand What is the preferred technique for infant compressions when there are 2 or more rescuers present? 2 thumb-encircling hands technique If pupils to not _________ in response to light consider increased _____________ pressure Constrict intracranial pressure If ________ is not identified and treated immediately, it can result in ________ injury hypoglycemia brain What are the 4 indicators of the AVPU scale that are used to determine responsiveness? Alert Responds to pain Unresponsive Responds to voice If the child does not respond to voice, assess the child's response to ______ pain What should you look for when exposing the child? Bruising purpura bleeding What does the mnemonic SAMPLE stand for? Signs & symptoms allergies medications PMH last meal events leading to illness/injury What should be included in the history when asking about medications? OTC medications current prescribed medications Which component of SAMPLE assesses immunization status? PMH What are some examples of diagnostic assessments? ABG VBG Hemoglobin Concentration What dictates the timing of diagnostic assessments? clinical situation Which component of effective high-performance teams is represented by the use of real-time feedback devices? Quality Crackles happen during ________ and grunting happens during ________ inspiration expiration What is an advantage of effective teamwork? division of tasks What is the best example of the team leader role? models excellent team behavior What is the best example of a team member role? committed to success What is the primary purpose of the CPR coach on a resuscitation team? improve cpr quality How can the CPR coach improve CPR quality in a resuscitation event? coach to midrange targets Which high performance team member has the responsibility for assigning roles (positions)? team leader What element of team dynamics describes when a team member needs to correct actions? constructive intervention Which of the following describe how to communicate? closed-loop communications clear messaging Which resuscitation strategy will result in an improved chest compression fraction? hovering over the chest during compression pauses What is one way to increase chest compression fraction during a code? Charging the defibrillator 15 seconds before a rhythm check A chest compression fraction of at least ____ is recommended, and a goal of ____ is often achievable with good teamwork 60% 80% What is chest compression fraction? proportion of time that compressions are performed For an unwitnessed cardiac arrest, what should you do after determining unresponsiveness and there is no breathing or pulse? perform high-quality CPR for 2 mins What is the definition of oxygen saturation? the amount of oxygen bound to hemoglobin Children develop hypoxemia and tissue hypoxia more quickly than adults because of their? higher metabolic rate In infants and toddlers, the young and epiglottis, relative to those of an adult are ________ large How can normal spontaneous breathing be characterized? quiet unlabored inspiration Increased WOB can be associated with ________ airway resistance and/or ________ lung compliance. increased decreased What happens when airway resistance increases? WOB increases Which of the following describes laminar or normal airflow? low airway resistance and a small driving pressure what is the role of the diaphragm contraction during normal breathing in infants? pulls the ribs slightly inward which is a characteristic of muscle weakness? seesaw breathing Which of the following is true about airway resistance? when airway resistance increases, work of breathing increases During spontaneous breathing, what are the inspiratory muscles attempting to do? increase intrathoracic volume Which of these factors can override brainstem control of breathing in an infant? breath holding what do central chemoreceptors respond to? hydrogen ions in the cerebrospinal fluid why may excessive ventilation during CPR be harmful? - it increases intrathoracic pressure - it impedes venous return What should you do if you cannot achieve effective ventilation with a bag-mask device? reposition the airway verify the mask size How are effective oxygenation and ventilation assessed? oxygen saturation visible chest rise exhaled carbon dioxide How can gastric inflation impair bag mask ventilation? It decreases lung compliance What is the most appropriate precautionary action to minimize gastric inflation during bag-mask ventilation? Deliver each breath over 1 second Hypoxemia is defined as oxygen saturation less than _____ 94% Which is true about the difference between hypoxemia and tissue hypoxia? Tissue hypoxia can occur with normal arterial spo2 What does hyperventilation, which refers to increase alveolar ventilation result in PaCO2 <35mmHg What happens to the arterial oxygen level in a child with severe anemia? may increase when dissolved oxygen is increased Which is true of increased CO2 tension in the arterial blood? it may be caused by disordered control of breathing What happens when ventilation is inadequate? CO2 levels rise and pH falls What is a critical sign of hypercarbia? Decreased level of consciousness What can indicate mild respiratory distress? What can indicate mild respiratory distress? Which of the following indicates severe respiratory distress? marked tachypnea and/or apnea Which of the following statements about respiratory failure is true? may occur without signs of respiratory distress Which is most likely to be present in a child who has respiratory distress (not respiratory failure)? ability to maintain a patent airway What steps should be taken as a part of initial management of a child in respiratory distress? Monitor O2 by pulse ox Monitor hr, rhythm, and bpSupport open airway Which are ideal characteristic of face masks for ventilation? covers mouth & nose has soft rim transparent What is the rationale for using a transparent mask? allows you to see the color of the childs lips What is the function of the nonrebreathing outlet valve of a self-inflating bag prevents retreating of carbon dioxide Which of the following is required to appropriately ventilate a child with a flowinflating bag? tidal volume needs to be delivered at the correct rate. What should be checked to ensure proper function of a bag mask system? Oxygen Tubing is connected to the device and oxygen source Pop off valve can be closed How is the sniffing position achieved in an infant or a child? Ensure the external ear canal is anterior to the shoulder Where may padding be needed under a child 2 years and older to maintain an patent airway? the occiput What actions are appropriate when providing 1 person bag mask ventilation? Perform a head tilt, insert and oral airway, and squeeze the bag until chest rise What does the E-C clamp technique include? using the third, fourth & fifth fingers of one hand along the jaw to lift it forward using the thumb and index finger of the same hand to hold the face mask When may a 2-person bag-max technique be preferable? when making a seal is difficult when there is significant airway resistance When suctioning a patient, which of the following should be monitored? HR O2 saturation clinical appearance What should you do to help reduce the risk of hypoxemia during suctioning? limit suction attempts to 10 seconds or less Under what circumstance should you use an oropharyngeal airway? the child must me unconscious What can happen if the oropharyngeal airway is too large? it can block the airway When measuring for an oropharyngeal airway, it should extend from the corner of the mouth to the angle of the jaw The inspired oxygen concentration fo a low-flow oxygen delivery system is between ____% to ____% 22 60 The appropriate flow rate for a simple mask is ___ to ____ L/min 6 10 For a nonrebreathing mask to be effective, the oxygen flow rate must be at least ____ L/min 10 High-flow oxygen systems reliably deliver an oxygen concentration of greater than _____% 60% The gas flow rate for a nebulizer treatment is ___ to ___ L/min 5 6 What is an indication that the nebulizer treatment is complete? No mist is visible When using a metered-dose inhaler with a spacer device, what should you? shake the MDI and spacer vigorously What are the signs of upper airway obstruction? stridor use of accessory muscles A child presents with a barking cough, good air entry during auscultation, a pulse oximetry reading 93% on room air and retractions at rest. What are appropriate initial interventions? consider dexamethasone administer O2 & nebulized epinepherine Which diagnosis may present with upper airway obstruction? foreign body obstruction epiglottitis croup When may pulse oximetry be inaccurate? the displayed heart rate does not correlate with the child's heart rate An 8 month old boy is brought to the hospital by his parents. He has a hoarse cry and barking cough. His mother says that during the night, her son had difficulty breathing, which has progressively worsened throughout the day. The infant most likely has what type of respiratory emergency? upper airway obstruction According to the systematic approach algorithm, what are the correct assessments to perform during the evaluation phase? initial, primary, secondary The infant is responsive and is breathing. What is an initial measure that you can perform to maintain his airway? Sit him up What are the components of breathing assessment? lung and airway sounds chest expansion and air movement oxygen saturation respiratory rate respiratory effort When calculating the tube size based on the child's age, to avoid injury to the subglottic area, you should use an endotracheal tube that is: half a size smaller than predicted for the child Which anatomical features may contribute to upper airway obstruction in infants? large tongue large occiput When monitoring pulse oximetry in a child, what finding would prompt immediate evaluation of the child? there is a decrease in oxygen saturation What are the common causes of lower airway obstruction? bronchiolitis asthma What are the common cause of upper airway obstruction? airway swelling thick secretions tonsillar hypertrophy (airway swelling) Bag-mask ventilation has been used on child with lower airway obstruction. Which complication may occur? Lung collapse decreased blood return to the heart Which of the following may cause lung tissue disease? PNA How can small airways be obstructed in acute lower airway obstruction? Smooth muscle bronchial constriction mucus plugging When should administration of magnesium sulfate be considered in a child with asthma? moderate to severe distress Which of the following are typical signs of lung tissue disease? tachypnea & hypoxemia Which of the following is characterized by fluid accumulation in the alveoli and or insterstitium? lung tissue disease Which interventions are helpful in the management of acute infectious pneumonia? ABX therapy perform diagnostic assessments What is the first priority in managing lower airway obstruction? restore adequate oxygenation What pulses should be assessed to monitor systemic perfusion in a child? Peripheral and central Which of the following signs of disordered control of breathing? variable RR decreased air movement shallow breathing What condition is characterized by signs of adequate carbon dioxide elimination and hypoxemia lung tissue disease Which of the following are most commonly associated with disordered control of breathing? neuro disorders drug overdose What intervention can reduce metabolic demand in a child with pneumonia? treat the fever What are the characteristics of shock? decreased level of consciousness inadequate peripheral perfusion decreased end-organ perfusion Which type of respiratory problem is most likely in a child with an altered level of consciousness and variable respiratory rate? disordered control of breathing What is the most accurate definition of shock? inadequate tissue perfusion What should you do before suctioning a child who has upper airway obstruction? determine the underlying cause of the obstruction If cardiac output is compromised, signed of poor perfusion will be _____ even if blood pressure is normal present Low blood pressure in children is defined as systolic blood pressure less than ______ percentile for age fifth For general shock management, administer an isotonic crystalloid bolus of __ mL/kg over __ to __min 20 ml 5-20min What do weak central pulses indicate a need for immediate intervention to prevent? Cardiac arrest What is the best example of the Team Leader role? Models excellent team behavior What happens when airway resistance increases? Work of breathing increase Which of the following describes laminar or normal airflow? Low airway resistance and a small driving pressure Conditions that ..... air resistance lead to increased respiratory.... increase, effort Which component of SAMPLE assesses immunization status Past medical history What sequence is used when caring for a seriously ill or injured child to help determine the best treatment or intervention? The.... sequence Evaluate, Identify, Intervene What dictates the timing of diagnostic assessments? Clinical situation What are the 4 indicators of the AVPU scale that are used to determine responsiveness? Responds to pain Responds to voice Alert unresponsive Which is a characteristic of muscle weakness? Seesaw breathing Why may excessive ventilation during CPR be harmful? It increase intrathoracic pressure. It impedes venous return. In infants and toddlers, the tongue and epiglottis, relative to those of an adult, are ... large How are effective oxygenation and ventilation assessed? Oxygen saturation Visible chest rise with each breath Exhaled carbon dioxide What should be included in the history when asking about medications? Current prescribed medications. Over-the-counter medications How can gastric inflation impair bag-mask ventilation? It decreases lung compliance During spontaneous breathing, what are the inspiratory muscles attempting to do? Increase intrathoracic volume Children develop hypoxemia and tissue hypoxia more quickly than adults because of their Higher metabolic rate Which is true about the difference between hypoxemia and tissue hypoxia? Tissue hypoxia can occur with normal arterial oxygen saturation. What is an advantage of effective teamwork? Division of tasks Automated blood pressure cuffs may provide .... readings when the child is in shock. inaccurately high What is the role of the diaphragm contraction during normal breathing in infants? Pulls the ribs slight inward Why does hyperventilation, which refers to increase alveolar ventilation, result in? PaCO2 less than 35 mm Hg Which of the following statements about respiratory failure is true? May occur without signs of respiratory distress Which of the following indicates mild respiratory distress? Mild increase in respiratory effort How can the CPR Coach improve CPR quality in a resuscitation event? Coach to midrange targets What steps should be taken as part of initial management of a child in respiratory distress? Monitor HR, rhythm, and BP. Support an open airway. Monitor O2 saturation by pulse oximetry. What is the best example of a team member role? Committed to success What should be checked to ensure proper function of a bag-mask system? Oxygen tubing is connected to the device and the oxygen source. The pop-off valve can be closed. Which of these factors can override brainstem control of breathing in an infant? Breath holding When may a 2-person bag-mask technique be preferable? When there is significant airway resistance. When making a seal is difficult. Where may padding be required under when properly positioning a child older than 2 years of age to maintain a patent airway? The occiput Which diagnoses may present with upper airway obstruction? Epiglottis Foreign body obstruction Croup What are common causes of upper airway obstruction? Airway swelling Thich secretions Tonsillar hypertrophy What are the signs of upper airway obstruction? Stridor Use of accessory muscles A child present with a barking cough, good air entry during auscultation, a pulse oximetry reading of 93% on room air, and retractions at rest. What are appropriate initial interventions? Consider dexamethasone. Administer oxygen and nebulized epinephrine. What should you do before suctioning a child who has upper airway obstruction? Determine the underlying cause of the obstruction A child presents with a barking cough, good air entry during auscultation, a pulse oximetry reading of 93% on room air, and retractions at rest. What is the severity of the child's presentation? Moderate croup In a less severe case of upper airway obstruction in a child, what intervention can relieve obstruction caused by the tongue? Insert an oral airway What is the treatment for a mild allergic reaction? Remove the offending agent. Consider an antihistamine. What is the most appropriate treatment for severe anaphylaxis? Administer IM epinephrine An 8 month old boy is brought to the hospital by his parents. He has a hoarse cry and a barking cough. His mother says that during the night, her son had difficulty breathing, which has progressively worsened throughout the day. The infant most likely has what type of respiratory emergency? Upper airway obstruction According to the Systematic Approach Algorithm, what are the correct assessments to perform during the evaluation phase? Initial, primary, secondary The infant is responsive and is breathing. What is an initial measure that you can perform to maintain his airway? Sit him up What are the components of breathing assessment? Respiratory rate Respiratory effort Chest expansion and air movement Oxygen saturation Lung and airway sounds Patient with croup What treatments would be most appropriate for this patient? Dexamethasone Nebulized epinephrine Infants who begin to display signs of becoming weaker, decreased respiratory effort, and poor air movement are at high risk for respiratory failure Infants and children who are at risk for respiratory failure should be ventilated and prepared for intubation by a team member with significant pediatric expertise. When calculating the tube size based on the child's age to avoid injury to the subglottic are, you should use an endotracheal tube that is: Half a size smaller than predicted for the child What does A-B-C in the Pediatric Assessment Triangle (PAT) stand for? A: Appearance, B: Work of breathing, C: Circulation When is the Pediatric Assessment Triangle (PAT) performed to make an initial assessment? During the "from the doorway" observation What sequence is used when caring for a seriously ill or injured child to help determine the best treatment or intervention? Evaluate, Identify, Intervene The evaluate-identify-intervene sequence should be continued until The child is stable The primary assessment includes the ABCDE approach. What does it assess? Airway, breathing, circulation, disability, and exposure How is the airway assessed? Determining if the airway is open/patent In the primary assessment, how should you open the airway of a child who is not suspected of having a cervical spine injury? With a head-tilt-chin lift In infants, the abdomen may move ______ the chest. more than What is a characteristic of normal chest rise? Symmetrical during inspiration ______ is usually high-pitched breathing during inspiration, whereas ______ is usually during expiration. Stridor / wheezing Snoring and gurgling are a result of ______ airway obstruction. upper Crackles happen during ______, and grunting happens during ______. inspiration / expiration Oxygen saturation less than ______ indicates low oxygen saturation, which is known as hypoxemia. 94% Pulse oximetry indicates oxygen ______ but not oxygen delivery. saturation Conditions that ______ air resistance lead to increased respiratory ______. increase / effort What are signs of increased respiratory effort that can lead to fatigue and respiratory failure? Head bobbing, Seesaw respirations, Nasal flaring, and Retractions Determine the respiratory rate by counting the number of times the chest rises in ______ seconds and multiplying by ______. 30 / 2 Tachypnea is often the first sign of respiratory ______ in infants. distress Hypotension for children 1 to 10 years of age is a systolic blood pressure of less than 70 mm Hg + (2 x the age in years) Automated blood pressure cuffs may provide ______ readings when the child is in shock. inaccurately high What does a prolonged capillary refill time indicate? Low cardiac output Normal capillary refill time is ______ seconds or less. 2 What pulses should be assessed to monitor systemic perfusion in a child? Peripheral and central What do weak central pulses indicate a need for immediate intervention to prevent? Cardiac arrest When oxygen delivery to the extremities becomes inadequate, the ______ and ______ are the first to exhibit signs. hands / feet What should be used to assess skin temperature? The back of the hand If pupils do not ______ in response to bright light, consider increased ______ pressure. constrict / intracranial If ______ is not identified and treated immediately, it can result in ______ injury. hypoglycemia / brain What are the 4 indicators of the AVPU scale that are used to determine responsiveness? Alert, Responds to voice, Responds to pain, Unresponsive If the child does not respond to voice, assess the child's response to ______. pain What should you look for when exposing the child? Bruising, Bleeding, Purpura What does the mnemonic SAMPLE stand for? Signs and symptoms Allergies Medications Past medical history Last meal Events leading up to illness/injury What should be included in the history when asking about medications? Over-the-counter medications Current prescribed medications What happens when airway resistance increases? Work of breathing increases What is the definition of oxygen saturation? The amount of oxygen bound to hemoglobin What component of SAMPLE assesses immunization status? Past medical history What should you do if you cannot achieve effective ventilation with a bag-mask device? Reposition the airway. Verify the mask size. How can normal, spontaneous breathing be characterized? Quiet, with unlabored inspiration Children develop hypoxemia and tissue hypoxia more quickly than adults because of their Higher metabolic rate What are some examples of diagnostic assessments? Arterial blood gas (ABG) Hemoglobin concentration Venous blood gas (VBG) How are effective oxygenation and ventilation assessed? Visible chest rise with each breath Exhaled carbon dioxide Oxygen saturation Which are ideal characteristics of face masks for ventilation? Covers the mouth and nose Transparent Has a soft rim What is the function of the nonrebreathing outlet valve of a self-inflating bag? Prevent rebreathing of carbon dioxide What dictates the timing of diagnostic assessments? Clinical situation What may excessive ventilation during CPR be harmful? It increases intrathoracic pressure. It impedes venous return. What anatomical features may contribute to upper airway obstruction in infants? Large tongue Large occiput What are the signs of upper airway obstruction? Stridor Use of accessory muscles What are the common causes of upper airway obstruction? Airway swelling Thick secretions Tonsillar hypertrophy What does the E-C clamp technique include? Using the thumb and index finger of the same hand to hold the face mask Using the third, fourth, and fifth fingers of one hand along the jaw to lift it forward A child presents with a barking cough, good air entry during auscultation, a pulse oximetry reading of 93% on room air, and retractions at rest. What are appropriate initial interventions? Consider dexamethasone. Administer oxygen and nebulized epinephrine. The gas flow rate for a nebulizer treatment is what? 5 to 6 L/min What is the most appropriate treatment for severe anaphylaxis? Administer IM epinephrine A child presents with a barking cough, good air entry during auscultation, a pulse oximetry reading of 93% on room air, and retractions at rest. What is the severity of the child's presentation? Moderate croup According to the Systematic Approach Algorithm, what are the correct assessments to perform during the evaluation phase? Initial, primary, secondary When calculating the tube size based on the child's age, to avoid injury to the subglottic area, you should use an endotracheal tube that is: Half a size smaller than predicted for the child What are appropriate interventions for an apneic child? Provide a breath every 2 to 3 seconds. Watch for chest rise. A child presents with audible wheezing, a heart rate greater than 120/min, a respiratory rate of 36/min, and the inability to talk in sentences. What is the severity of this presentation? Severe In a less severe case of upper airway obstruction in a child, what intervention can relieve obstruction caused by the tongue? Insert an oral airway. What should you do before suctioning a child who has upper airway obstruction? Determine the underlying cause of the obstruction. How can small airways be obstructed in acute lower airway obstruction? Mucus plugging Smooth muscle bronchial constriction The anticipated results of the nebulized treatment should include which of the following improvements in the patient? Decreased airway edema Decreased respiratory effort Decreased bronchoconstriction If the patient does not improve with medication, what is your next intervention to ensure oxygenation? Noninvasive positive-pressure ventilation Which are appropriate interventions for an apneic child? Watch for chest rise. Provide a breath every 2 to 3 seconds. Which of the following may cause lung tissue disease? Pneumonia Which of the following are signs of disordered control of breathing? Variable respiratory rate Decreased air movement Shallow breathing Which type of respiratory problem is most likely in a child with an altered level of consciousness and variable respiratory rate? Disordered control of breathing Which of the following are most commonly associated with disordered control of breathing? Drug overdose Neurologic disorders Which is true about the difference between hypoxemia and tissue hypoxia? Tissue hypoxia can occur with normal arterial oxygen saturation. When evaluating the child, you notice that he has an abnormal respiratory pattern that produces inadequate minute ventilation. What immediate interventions should be addressed for this child? Position the infant to open his airway Attach a pulse oximeter Begin bag-mask ventilation with 100% oxygen After the patient's oxygenation and ventilation are stabilized, the secondary assessment should be conducted. What is included in a secondary assessment? SAMPLE history Identification of reversible causes Physical examination What would be indications for endotracheal intubation for this patient? Failure to maintain a patent airway Inadequate spontaneous respiratory effort Signs of increased intracranial pressure How would you estimate the size of the cuffed or uncuffed endotracheal tube to use? The patient weighs 7kg and is 6 months old. (age in years)/4+3.5 (age in years)/4+4 What is the treatment for a mild allergic reaction? Consider an antihistamine. Remove the offending agent. What are the characteristics of shock? Inadequate peripheral perfusion Decreased level of consciousness Decreased end-organ perfusion What is the most accurate definition of shock? inadequate tissue perfusion What are typical clinical findings with compensated shock? Tachycardia Delayed capillary refill Decreased urine output Which interventions may be included in the management of disordered control of breathing due to increased intracranial pressure? Adequate oxygenation and ventilation Hypotension in children is calculated as a systolic blood pressure of less than 70 mm Hg plus 2 times the age in years. 70 / 2 What is included in the treatment of shock? Optimizing oxygen content in the blood What are the goals in treating shock? Prevent progression to cardiac arrest Improve oxygen delivery Balance tissue perfusion and metabolic demand Support organ function What is the preferred initial fluid for shock resuscitation? Isotonic crystalloids What are some common causes of hypovolemic shock? Large burns Hemorrhage Osmotic diuresis What is a characteristic clinical finding associated with hypovolemic shock? Tachypnea As more time passes between the onset of signs of shock and the restoration of adequate oxygen delivery and organ perfusion, the outcome is ______. worse Hypovolemic shock refers to a clinical state of Reduced extravascular volume Reduced intravascular volume Where may padding be required under when properly positioning a child older than 2 years of age to maintain a patient airway? The occiput The infant is placed on the ambulance stretcher and responds with a groan when stimulated. Her vital signs are HR 173/min, BP 58/38 mm Hg, RR 60/min, Spo2 92%, and temperature 36.3 Celsius. What are the appropriate next steps to treat this patient? Establish IV/IO access Monitor heart rate, blood pressure, and pulse oximetry Monitor and support ABCs Call for assistance if needed What best assesses a child's response to each fluid bolus? Vital signs Physical examination Urinary output What should you use to begin fluid resuscitation in hemorrhagic shock? Isotonic crystalloids What is the most common type of distributive shock? Septic What are the major functions of the cardiopulmonary system? What could be the reason a child with hypotensive shock does not improve after at least 3 fluid boluses? The initial assumption about the etiology may be incorrect. Septic shock often develops over ______, while anaphylactic shock may occur over ______. hours / minutes For general shock management, administer an isotonic crystalloid bolus of ______ mL/kg over ______ to ______ minutes. 20 / 5 / 20 What treatment should be implemented if a child remains hemodynamically unstable despite 2 to 3 boluses of 20 mL/kg isotonic crystalloids? Transfuse PRBCs The infant is placed on the ambulance stretcher and responds with a groan when stimulated. Her vital signs are HR 173/min, BP 58/38 mm Hg, RR 60/min, Spo2 92%, and temperature 36.3 Celsius (97.3 Fahrenheit) What are appropriate next steps to treat this patient? Monitor and support ABCs Establish IV/IO access Call for assistance if needed Monitor heart rate, blood pressure, and pulse oximetry What are the warning signs that the patient is progressing from compensated shock to hypotensive shock? Hypotension (late sign) Increasing tachycardia What should be included in the initial treatment for this patient? Establishing IV/IO access Rapid fluid bolus administration What signs distinguish anaphylactic shock form other types of shock? Angioedema (swelling of the face, lips, and tongue) Urticara (hives) Respiratory distress with stridor, wheezing, or both When is distributive shock present? When there is inadequate blood flow to some tissue beds but too much to others How soon after exposure do symptoms typically occur in anaphylactic shock? Seconds to minutes What best assesses a child's response to each fluid bolus? Vital signs Physical examination Urinary output When should vasoactive therapy be considered in managing distributive shock? If the child remains hypotensive and poorly perfused despite rapid bolus fluid administration What is the focus of the initial management of distributive shock? Correcting hypovolemia Expanding intravascular volume Filling expanded dilated vascular space What is the most appropriate vasoactive drug to use in fluid refractory septic shock? Epinephrine or norepinephrine When should antibiotics be administered in septic shock? Within the first hour What are common causes of cardiogenic shock? Congenital heart disease Arrhythmias Myocarditis Drug toxicity Most patients in cardiogenic shock will need inotropic support with medications. Which of the following could be used? Epinephrine Milrinone What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? 5 to 10 mL/kg over 10 to 20 minutes What signs are present as obstructive shock progresses? Signs of vascular congestion Increased respiratory effort Cyanosis What should you evaluate to recognize septic shock? Heart rate Blood pressure Temperature Systemic perfusion Clinical signs of end-organ perfusion What are causes of obstructive shock? Cardiac tamponade Tension pneumothorax Pulmonary embolus Congenital heart defects What are the initial assessment findings for septic shock? Fever Normal, elevated, or decreased WBC Hypothermia What is the first step for an intubated child whose condition deteriorates? Support oxygenation and ventilation. In whom should you suspect a tension pneumothorax? A child who deteriorates suddenly while receiving bag-mask ventilation Any intubated child who deteriorates suddenly while receiving positive-pressure ventilation Victim of chest trauma What is an assessment finding unique to tension pneumothorax? Tracheal deviation How does the clinical presentation of distributive shock compare with hypovolemic shock? Distributive shock has a more variable presentation than that of hypovolemic shock. Why is it important to immediately identify obstructive shock? Obstructive shock can rapidly progress to cardiopulmonary failure and then cardiac arrest. Why do children with cardiac tamponade improve temporarily with fluid administration? Fluid augment cardiac and tissue perfusion until pericardial drainage can be performed. What determines adequate fluid resuscitation in hypovolemic shock? Extent of volume depletion Type of volume loss What are causes of cardiac tamponade in children? Penetrating trauma Infection of the pericardium Cardiac surgery Where can you check a pulse on an infant and child? infant - brachial child - femoral What are signs of increased respiratory effort that can lead to fatigue and respiratory failure? Select all that apply nasal flaring unlabored breathing apnea seesaw respirations retractions head bobbing nasal flaring seesaw respirations retractions head bobbing Determine the respiratory rate by counting the number of times the chest rises in _____ seconds and multiplying by _____. 30 2 Tachypnea is often the first sign of respiratory ______ in infants distress Hypotension fro children 1 to 10 years of age is a systolic blood pressure of less than 40mmHg + 2 x age in years 50mmHg + 2 x age in years 60mmHg + 2 x age in years 70mmHg + 2 x age in years 70mmHg + 2 x age in years What sequence is used when care for a seriously ill or injured child to help determine the best treatment or intervention? The __________ ___________ ____________ sequence Evaluate Identify Intervene Automated blood pressure cuffs may provide _________ ________ readings when the child is in shock. inaccurately high The primary assessment included the ABCDE approach. What does it assess? Airway, breathing, circulation, disability, exposure What does a prolonged capillary refill time indicate? low cardiac output ________ is usually high-pitched breathing during inspiration, whereas ___________ is usually during expiration Stridor wheezing Normal capillary refill time is _____ seconds or less 2 What pulses should be assessed to monitor systemic perfusion in a child? Peripheral and central What do weak central pulses indicate a need for immediate intervention to prevent? Cardiac arrest When oxygenation delivery to the extremities becomes inadequate, the _______ and ________ are the first to exhibit designs. Hands Feet What should be used to assess skin temperature? the back of the hand What is the preferred technique for infant compressions when there are 2 or more rescuers present? 2 thumb-encircling hands technique If pupils to not _________ in response to light consider increased _____________ pressure Constrict intracranial pressure If ________ is not identified and treated immediately, it can result in ________ injury hypoglycemia brain What are the 4 indicators of the AVPU scale that are used to determine responsiveness? Alert Responds to pain Unresponsive Responds to voice If the child does not respond to voice, assess the child's response to ______ pain What should you look for when exposing the child? Bruising purpura bleeding What does the mnemonic SAMPLE stand for? Signs & symptoms allergies medications PMH last meal events leading to illness/injury What should be included in the history when asking about medications? OTC medications current prescribed medications Which component of SAMPLE assesses immunization status? PMH What are some examples of diagnostic assessments? ABG VBG Hemoglobin Concentration What dictates the timing of diagnostic assessments? clinical situation Which component of effective high-performance teams is represented by the use of real-time feedback devices? Quality Crackles happen during ________ and grunting happens during ________ inspiration expiration What is an advantage of effective teamwork? division of tasks What is the best example of the team leader role? models excellent team behavior What is the best example of a team member role? committed to success What is the primary purpose of the CPR coach on a resuscitation team? improve cpr quality How can the CPR coach improve CPR quality in a resuscitation event? coach to midrange targets Which high performance team member has the responsibility for assigning roles (positions)? team leader What element of team dynamics describes when a team member needs to correct actions? constructive intervention Which of the following describe how to communicate? closed-loop communications clear messaging Which resuscitation strategy will result in an improved chest compression fraction? hovering over the chest during compression pauses What is one way to increase chest compression fraction during a code? Charging the defibrillator 15 seconds before a rhythm check A chest compression fraction of at least ____ is recommended, and a goal of ____ is often achievable with good teamwork 60% 80% What is chest compression fraction? proportion of time that compressions are performed For an unwitnessed cardiac arrest, what should you do after determining unresponsiveness and there is no breathing or pulse? perform high-quality CPR for 2 mins What is the definition of oxygen saturation? the amount of oxygen bound to hemoglobin Children develop hypoxemia and tissue hypoxia more quickly than adults because of their? higher metabolic rate In infants and toddlers, the young and epiglottis, relative to those of an adult are ________ large How can normal spontaneous breathing be characterized? quiet unlabored inspiration Increased WOB can be associated with ________ airway resistance and/or ________ lung compliance. increased decreased What happens when airway resistance increases? WOB increases Which of the following describes laminar or normal airflow? low airway resistance and a small driving pressure what is the role of the diaphragm contraction during normal breathing in infants? pulls the ribs slightly inward which is a characteristic of muscle weakness? seesaw breathing Which of the following is true about airway resistance? when airway resistance increases, work of breathing increases During spontaneous breathing, what are the inspiratory muscles attempting to do? increase intrathoracic volume Which of these factors can override brainstem control of breathing in an infant? breath holding what do central chemoreceptors respond to? hydrogen ions in the cerebrospinal fluid why may excessive ventilation during CPR be harmful? - it increases intrathoracic pressure - it impedes venous return What should you do if you cannot achieve effective ventilation with a bag-mask device? reposition the airway verify the mask size How are effective oxygenation and ventilation assessed? oxygen saturation visible chest rise exhaled carbon dioxide How can gastric inflation impair bag mask ventilation? It decreases lung compliance What is the most appropriate precautionary action to minimize gastric inflation during bag-mask ventilation? Deliver each breath over 1 second Hypoxemia is defined as oxygen saturation less than _____ 94% Which is true about the difference between hypoxemia and tissue hypoxia? Tissue hypoxia can occur with normal arterial spo2 What does hyperventilation, which refers to increase alveolar ventilation result in PaCO2 <35mmHg What happens to the arterial oxygen level in a child with severe anemia? may increase when dissolved oxygen is increased Which is true of increased CO2 tension in the arterial blood? it may be caused by disordered control of breathing What happens when ventilation is inadequate? CO2 levels rise and pH falls What is a critical sign of hypercarbia? Decreased level of consciousness What can indicate mild respiratory distress? What can indicate mild respiratory distress? Which of the following indicates severe respiratory distress? marked tachypnea and/or apnea Which of the following statements about respiratory failure is true? may occur without signs of respiratory distress Which is most likely to be present in a child who has respiratory distress (not respiratory failure)? ability to maintain a patent airway What steps should be taken as a part of initial management of a child in respiratory distress? Monitor O2 by pulse ox Monitor hr, rhythm, and bpSupport open airway Which are ideal characteristic of face masks for ventilation? covers mouth & nose has soft rim transparent What is the rationale for using a transparent mask? allows you to see the color of the childs lips What is the function of the nonrebreathing outlet valve of a self-inflating bag prevents retreating of carbon dioxide Which of the following is required to appropriately ventilate a child with a flowinflating bag? tidal volume needs to be delivered at the correct rate. What should be checked to ensure proper function of a bag mask system? Oxygen Tubing is connected to the device and oxygen source Pop off valve can be closed How is the sniffing position achieved in an infant or a child? Ensure the external ear canal is anterior to the shoulder Where may padding be needed under a child 2 years and older to maintain an patent airway? the occiput What actions are appropriate when providing 1 person bag mask ventilation? Perform a head tilt, insert and oral airway, and squeeze the bag until chest rise What does the E-C clamp technique include? using the third, fourth & fifth fingers of one hand along the jaw to lift it forward using the thumb and index finger of the same hand to hold the face mask When may a 2-person bag-max technique be preferable? when making a seal is difficult when there is significant airway resistance When suctioning a patient, which of the following should be monitored? HR O2 saturation clinical appearance What should you do to help reduce the risk of hypoxemia during suctioning? limit suction attempts to 10 seconds or less Under what circumstance should you use an oropharyngeal airway? the child must me unconscious What can happen if the oropharyngeal airway is too large? it can block the airway When measuring for an oropharyngeal airway, it should extend from the corner of the mouth to the angle of the jaw The inspired oxygen concentration fo a low-flow oxygen delivery system is between ____% to ____% 22 60 The appropriate flow rate for a simple mask is ___ to ____ L/min 6 10 For a nonrebreathing mask to be effective, the oxygen flow rate must be at least ____ L/min 10 High-flow oxygen systems reliably deliver an oxygen concentration of greater than _____% 60% The gas flow rate for a nebulizer treatment is ___ to ___ L/min 5 6 What is an indication that the nebulizer treatment is complete? No mist is visible