PALS- Practical Application
A 1-year-old boy is brought to the emergency department for evaluation of poor
feeding, irritability, and sweating. The child is lethargic but arousable. He has
labored breathing, very rapid pulses, and a dusky color. His respiratory rate is
68/min, heart rate 300/min, and blood pressure 70/45 mm Hg. He has weak
brachial pulses and absent radial pulses, a capillary refill of 6 seconds, SpO2 85%
in room air, and good bilateral breath sounds. You administer high-flow oxygen
and place the child on a cardiac monitor and see the rhythm shown here. The
child has no history of congenital heart disease. IV access has been established.
Which therapy is most appropriate for this child?
A) Consult with pediatric cardiology
B) Administer isotonic crystalloid fluid of 20 mL/kg
C) Administer adenosine 0.1 mg/kg IV rapid push
D) Perform immediate defibrillation - ANS - C) Administer adenosine 0.1 mg/kg IV
rapid push
\A 10-month-old infant boy is brought to the emergency department. Your initial
assessment reveals a lethargic, pale infant with slow respirations and slow, weak
central pulses. One team member begins ventilation with a bag-mask device with
100% oxygen. A second team member attaches the monitor/defibrillator and
obtains vital signs while a third team member attempts to establish IV/IO access.
The patient's heart rate is 38/min with the rhythm shown here. The infant's blood
pressure is 58/38 mm Hg, and capillary refill is 4 seconds. His central pulses
remain weak, and distal pulses cannot be palpated. Chest compressions are
started and IO access is obtained. Which medication do you anticipate will be
given next?
A) Atropine 0.02 mg/kg IV/IO
B) Epinephrine 0.01 mg/kg IV/IO
C) Adenosine 0.1 mg/kg rapid IV/IO
D) Epinephrine 0.1 mg/kg IV/IO - ANS - B) Epinephrine 0.01 mg/kg IV/IO
, \A 3-year-old boy presents with multiple-system trauma. The child was an
unrestrained passenger in a high-speed motor vehicle crash. On primary
assessment, he is unresponsive to voice or painful stimulation. His respiratory
rate is 5/min, heart rate and pulses are 170/min, systolic blood pressure is 60 mm
Hg, capillary refill is 5 seconds, and SpO2 is 75% on room air. Which action
should you take first?
A) While a colleague provides spinal motion restriction, open the airway with a
jaw thrust and provide bag-mask ventilation
B) Establish immediate vascular access
C) Perform immediate endotracheal intubation
D) Provide 100% oxygen by simple mask - ANS - A) While a colleague provides
spinal motion restriction, open the airway with a jaw thrust and provide bag-mask
ventilation
\A 3-year-old unresponsive, apneic child is brought to the emergency department.
EMS personnel report that the child became unresponsive as they arrived at the
hospital. The child is receiving CPR with bag-mask ventilation. The rhythm shown
here is on the cardiac monitor. A biphasic manual defibrillator is present. You
quickly use the length from head to heel of the child on a color-coded
length-based resuscitation tape to estimate the approximate weight as 15 kg.
Which therapy is most appropriate for this child at this time?
A) Attempt defibrillation at 30 J, and then resume CPR, beginning with
compressions
B) Attempt defibrillation at 10 J, and then resume CPR, beginning with
compressions
C) Attempt defibrillation at 30 J, and then open the airway and check for a pulse
D) Establish IV/IO and administer epinephrine 0.01 mg/kg IV/IO - ANS - A) Attempt
defibrillation at 30 J, and then resume CPR, beginning with compressions
\A 4-year-old boy is in pulseless arrest in the pediatric intensive care unit.
High-quality CPR is in progress. You quickly review his chart and find that his
baseline-corrected QT interval on a 12-lead ECG is prolonged. The monitor shows
recurrent episodes of the rhythm shown here. The patient has received 1 dose of
epinephrine 0.01 mg/kg, but the rhythm shown here continues. If this rhythm
A 1-year-old boy is brought to the emergency department for evaluation of poor
feeding, irritability, and sweating. The child is lethargic but arousable. He has
labored breathing, very rapid pulses, and a dusky color. His respiratory rate is
68/min, heart rate 300/min, and blood pressure 70/45 mm Hg. He has weak
brachial pulses and absent radial pulses, a capillary refill of 6 seconds, SpO2 85%
in room air, and good bilateral breath sounds. You administer high-flow oxygen
and place the child on a cardiac monitor and see the rhythm shown here. The
child has no history of congenital heart disease. IV access has been established.
Which therapy is most appropriate for this child?
A) Consult with pediatric cardiology
B) Administer isotonic crystalloid fluid of 20 mL/kg
C) Administer adenosine 0.1 mg/kg IV rapid push
D) Perform immediate defibrillation - ANS - C) Administer adenosine 0.1 mg/kg IV
rapid push
\A 10-month-old infant boy is brought to the emergency department. Your initial
assessment reveals a lethargic, pale infant with slow respirations and slow, weak
central pulses. One team member begins ventilation with a bag-mask device with
100% oxygen. A second team member attaches the monitor/defibrillator and
obtains vital signs while a third team member attempts to establish IV/IO access.
The patient's heart rate is 38/min with the rhythm shown here. The infant's blood
pressure is 58/38 mm Hg, and capillary refill is 4 seconds. His central pulses
remain weak, and distal pulses cannot be palpated. Chest compressions are
started and IO access is obtained. Which medication do you anticipate will be
given next?
A) Atropine 0.02 mg/kg IV/IO
B) Epinephrine 0.01 mg/kg IV/IO
C) Adenosine 0.1 mg/kg rapid IV/IO
D) Epinephrine 0.1 mg/kg IV/IO - ANS - B) Epinephrine 0.01 mg/kg IV/IO
, \A 3-year-old boy presents with multiple-system trauma. The child was an
unrestrained passenger in a high-speed motor vehicle crash. On primary
assessment, he is unresponsive to voice or painful stimulation. His respiratory
rate is 5/min, heart rate and pulses are 170/min, systolic blood pressure is 60 mm
Hg, capillary refill is 5 seconds, and SpO2 is 75% on room air. Which action
should you take first?
A) While a colleague provides spinal motion restriction, open the airway with a
jaw thrust and provide bag-mask ventilation
B) Establish immediate vascular access
C) Perform immediate endotracheal intubation
D) Provide 100% oxygen by simple mask - ANS - A) While a colleague provides
spinal motion restriction, open the airway with a jaw thrust and provide bag-mask
ventilation
\A 3-year-old unresponsive, apneic child is brought to the emergency department.
EMS personnel report that the child became unresponsive as they arrived at the
hospital. The child is receiving CPR with bag-mask ventilation. The rhythm shown
here is on the cardiac monitor. A biphasic manual defibrillator is present. You
quickly use the length from head to heel of the child on a color-coded
length-based resuscitation tape to estimate the approximate weight as 15 kg.
Which therapy is most appropriate for this child at this time?
A) Attempt defibrillation at 30 J, and then resume CPR, beginning with
compressions
B) Attempt defibrillation at 10 J, and then resume CPR, beginning with
compressions
C) Attempt defibrillation at 30 J, and then open the airway and check for a pulse
D) Establish IV/IO and administer epinephrine 0.01 mg/kg IV/IO - ANS - A) Attempt
defibrillation at 30 J, and then resume CPR, beginning with compressions
\A 4-year-old boy is in pulseless arrest in the pediatric intensive care unit.
High-quality CPR is in progress. You quickly review his chart and find that his
baseline-corrected QT interval on a 12-lead ECG is prolonged. The monitor shows
recurrent episodes of the rhythm shown here. The patient has received 1 dose of
epinephrine 0.01 mg/kg, but the rhythm shown here continues. If this rhythm
