Pediatric CCRN Exam Questions and
Answers.
What does SIRS stand for? - Correct Answer Systemic Inflammatory Response
Syndrome
Key characteristics of Endotheliopathy - Correct Answer • Capillary leak
• Vasomotor paralysis tone of vessels not normal
• Leukocyte infiltrations
• Coagulopathy
• Myocardial depression
• Immune-compromise
Patient Qualifications of SIRS based off clinical findings. - Correct Answer Two
Abnormalities
-Must be abnormalities of temperature (greater than 38 rectal or less than 36 rectal) or
WBC in children
-Other abnormalities include:
1. HR (Tachycardia)
2. RR (Tachypnea)
3. PaCo2 Less than 32
4. Abnormal WBC>12,000 or less than 4,000
5. WBC bands greater than 10% differential
Management of SIRS - Correct Answer 1. Treat underlying Cause
2.Manage coagulopathies: thrombocytopenia← replace platelet, clot formation← give
thrombolytic, bleeding
3. Mange the endothelipathies: stop inciting insult, fluid resuscitate, increase plasma
oncotic pressure (colloid administration)
4. Promote Vasoconstriction: Alpha Agonist
, Septic Shock - Correct Answer - Sepsis plus CV dysfunction: Abnormal perfusion as well
as hypotension.
- Children able to maintain BP longer than Adults
Septic Shock Management Step One - Correct Answer - Recognition and Access:
Diminished LOC, begin HFNC, if hypoxic intubate
- Start IV access: peripheral or central
Septic Shock Management Step Two - Correct Answer - Fluid Resuscitation
- Rapid administration 20mL/Kg bolus of isotonic crystalloid
-Run over 5-10 minutes
• 0.9% NaCL (normal saline)
• Lactated ringers
Septic Shock Management Step Three - Correct Answer -Antibiotics (first 60 min)
-Broad Spectrum antibiotics
-Try to obtain culture first
-Consider IM administration if
hard to get IV access
- Start with Gram Negative spectrum before Gram Positive
Septic Shock Management Step Four - Correct Answer 4. Inotropic Agent support
WARM SHOCK - Correct Answer 1. High cardiac output
2. Low Systemic Vascular Resistance (SVR)
Inotropic Agent for Warm Shock? - Correct Answer 1. Dopamine
2. Nor-epi
*Utilize EPI or Vasopressin if not responsive
COLD SHOCK (normal or Low BP) - Correct Answer 1. Low Cardiac Output
2. High Systemic Vascular Resistance
Answers.
What does SIRS stand for? - Correct Answer Systemic Inflammatory Response
Syndrome
Key characteristics of Endotheliopathy - Correct Answer • Capillary leak
• Vasomotor paralysis tone of vessels not normal
• Leukocyte infiltrations
• Coagulopathy
• Myocardial depression
• Immune-compromise
Patient Qualifications of SIRS based off clinical findings. - Correct Answer Two
Abnormalities
-Must be abnormalities of temperature (greater than 38 rectal or less than 36 rectal) or
WBC in children
-Other abnormalities include:
1. HR (Tachycardia)
2. RR (Tachypnea)
3. PaCo2 Less than 32
4. Abnormal WBC>12,000 or less than 4,000
5. WBC bands greater than 10% differential
Management of SIRS - Correct Answer 1. Treat underlying Cause
2.Manage coagulopathies: thrombocytopenia← replace platelet, clot formation← give
thrombolytic, bleeding
3. Mange the endothelipathies: stop inciting insult, fluid resuscitate, increase plasma
oncotic pressure (colloid administration)
4. Promote Vasoconstriction: Alpha Agonist
, Septic Shock - Correct Answer - Sepsis plus CV dysfunction: Abnormal perfusion as well
as hypotension.
- Children able to maintain BP longer than Adults
Septic Shock Management Step One - Correct Answer - Recognition and Access:
Diminished LOC, begin HFNC, if hypoxic intubate
- Start IV access: peripheral or central
Septic Shock Management Step Two - Correct Answer - Fluid Resuscitation
- Rapid administration 20mL/Kg bolus of isotonic crystalloid
-Run over 5-10 minutes
• 0.9% NaCL (normal saline)
• Lactated ringers
Septic Shock Management Step Three - Correct Answer -Antibiotics (first 60 min)
-Broad Spectrum antibiotics
-Try to obtain culture first
-Consider IM administration if
hard to get IV access
- Start with Gram Negative spectrum before Gram Positive
Septic Shock Management Step Four - Correct Answer 4. Inotropic Agent support
WARM SHOCK - Correct Answer 1. High cardiac output
2. Low Systemic Vascular Resistance (SVR)
Inotropic Agent for Warm Shock? - Correct Answer 1. Dopamine
2. Nor-epi
*Utilize EPI or Vasopressin if not responsive
COLD SHOCK (normal or Low BP) - Correct Answer 1. Low Cardiac Output
2. High Systemic Vascular Resistance
