AHA Pediatric Advanced Life Support Exam with questions and answers

AHA Pediatric Advanced Life Support Exam with questions and answers You are caring for a 6-year-old patient who is receiving positive-pressure mechanical ventilation via an endotracheal tube. Child begins to move his head and suddenly becomes cyanotic, and his heart rate decreases. His SpO2 is 65%. You remove child from mechanical ventilator and begin to provide manual ventilation with a bag via endotracheal tube. During manual ventilation with 100% oxygen, child's color and heart rate improve slightly and his BP remains adequate. Breath sounds and chest expansion are present and adequate on right side and are present but consistently diminished on left side. Trachea not deviated, and neck veins are not distended. Suction catheter passes easily beyond tip of the endotracheal tube. Most likely cause of this child's acute deterioration? - ANSWERS*Tracheal tube displacement into right main bronchus* You are giving chest compressions for a child in cardiac arrest. What is the proper depth of compressions for a child? - ANSWERS*Compress the chest at least one third the depth of the chest, about 2 inches (5 cm)* During PALS, you and another rescuers begin CPR. Your colleague begins compressions, and you noticed that the compression rate is too slow. What should you say to offer constructive feedback? - ANSWERS*You need to compress at a rate of 100 to 120 per minute* You are preparing to use a manual defibrillator in the pediatric setting. What best describes when it is appropriate to use the smaller pediatric sized paddles? - ANSWERS*If the child weighs less than 10 kg or is less than 1 year old* You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate for delivering breaths? - ANSWERS*1 breath every 3 to 5 seconds* You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout for nearby help, but no one arrives. What action should you take next? - ANSWERS*Provide CPR for about 2 minutes before leaving to activate the emergency response system* 3 yo boy presents with multiple-system trauma. Child was an unrestrained passenger in a high-speed MVC. On primary assessment, he is unresponsive to voice or painful stimulation. His RR is 5/min, HR and pulses are 170/min, systolic BC is 60 mmHg, capillary refill is 5 seconds, and SpO2 is 75% on room air. What action should you take first? - ANSWERS*While a colleague provides spinal motion restriction, 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 resuscitation chart. What is likely to be the estimated size of the uncuffed endotracheal tube for this child? - ANSWERS*5 mm tube* What oxygen delivery system most reliably delivers a high (90% of greater) concentration of inspired oxygen to a 7-year-old child? - ANSWERSNonrebreathing face mask You are called to help treat an infant with severe symptomatic bradycardia (heart rate 66/min) associated with respiratory distress. Bradycardia persists despite establishment of an effective airway, oxygenation, and ventilation. There is no heart block present. What first drug should you administer? - ANSWERS*Epinephrine* You are part of a team attempting to resuscitate a child with ventricular fibrillation cardiac arrest. You deliver 2 unsynchronized shocks. A team member established IO access, so you give a dose of epinephrine, 0.01 mg/kg IO. At next rhythm check, persistent ventricular fibrillation is present. You administer a 4-J/kg shock and resume CPR. What drug and dose should be administered next? - ANSWERS*Amiodarone 5 mg/kg IO* - can be used for shock-refractory VF or pVT Initial impression of a 2-year-old girl shows her to be alert with mild breathing difficulty during inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her SpO2 is 92% on room air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Most appropriate initial intervention for this child? - ANSWERS*Humidified oxygen as tolerated* 7-year-old boy found unresponsive, apneic, and pulseless. CPR is ongoing. Child is intubated, and vascular access is established. ECG monitor shows organized rhythm with heart rate of 45/min, but a pulse check reveals no palpable pulses. High-quality CPR is resumed, and an initial IV dose of epinephrine is administered. What intervention should you perform next? - ANSWERS*Identify and treat reversible causes* You find a 10 yo boy to be unresponsive. You shout for help, and after finding that he is not breathing and has no pulse, you and a colleague begin CPR. Another colleague activates the emergency response system, brings the emergency equipment, and places the child on a cardiac monitor/defibrillator, which reveals ventricular tachycardia. You attempt defib at 2 J/kg and give 2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you attempt defibrillation with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose of epinephrine 0.01 mg/kg. If v fib or pulseless ventricular tachycardia persists after 2 minutes of CPR, you will administer another shock. What drug and dose should be administered? - ANSWERS*Lidocaine 1 mg/kg IV* During bag-mask ventilation, how should you hold the mask to make an effective seal between the child's face and the mask? - ANSWERS*Position your fingers using the E-C clamp technique* Age of infants - ANSWERS1 yo (excluding the newly born) Age of children - ANSWERSfrom 1 year of age to puberty To perform a pulse check in an infant, palpate a - ANSWERSbrachial pulse - if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning with chest compressions To perform a pulse check in a child, palpate a - ANSWERScarotid or femoral pulse - if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning with chest compressions Compression depth in infants - ANSWERSat least 1/3 the AP diameter of the chest or about 1 1/2 inches (4 cm) If a head or neck injury is suspected, use what to open the airway? - ANSWERSjaw-thrust maneuver - if jaw thrust does not open the airway, use the head tilt-chin lift The primary assessment (primary survey) uses a hands-on ABCDE approach and includes assessment of the patient's vital signs .. what does ABCDE stand for? - ANSWERSAirway Breathing Circulation Disability Exposure During PALS, determine the respiratory rate by ... - ANSWERScounting the number of times the chest rises in 30 seconds and multiply by 2 Rectractions accompanied by stridor or inspiratory snoring suggest - ANSWERSupper airway obstruction - seesaw respirations also usually indicated upper airway obstruction + may also be observed in severe lower airway obstruction Rectractions accompanied by expiratory wheezing suggest - ANSWERSmarked lower airway obstruction (asthma or bronchiolitis), causing obstruction during both inspiration and expiration Cause of seesaw breathing in most kids with neuromuscular dz is - ANSWERSweakness of abdominal and chest wall muscles - caused by strong contraction of diaphragm that dominates weaker abdominal and chest wall muscles - result = retraction of chest and expansion of abdomen during inspiration Normal tidal volume - ANSWERSappx 5-7 mL/kg of body weight throughout life - difficult to measure unless chi