Pediatric Advanced Life Support Exam with Complete Solution

Pediatric Advanced Life Support Exam with Complete Solution Recognize *supraventricular tachycardia* - 2. Recognize *wide-complex tachycardia*: 3. Recognize *SVT converting to sinus rhythm after adenosine administra- tion*: 4. What oxygen delivery system most reliably delivers a high (90% concentration of inspired oxygen to a 7-year-old child?: Nonrebre mask 5. 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?: *Ep- inephrine* 6. You are part of a team attempting to resuscitate a child with ventricular fib- rillation 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?: *Amiodarone 5 mg/kg IO* - can be used for shock-refractory VF or pVT 7. Initial impression of a 2-year-old girl shows her to be alert with mild breath- ing difficulty during inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory sounds (mild stridor) when agitated; oth- erwise, 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?: *Humidified oxygen as tolerated* 8. 7-year-old boy found unresponsive, apneic, and pulseless. CPR is ongoing. Child is intubated, and vascular access is established. ECG monitor shows or- ganized 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?: *Identify and treat reversible causes* 9. 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 venti- lation 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?: *Tracheal tube displacement into right main bronchus* 10. You are giving chest compressions for a child in cardiac arrest. What is the proper depth of compressions for a child?: *Compress the chest at least one third the depth of the chest, about 2 inches (5 cm)* 11. 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?: *You need to compress at a rate of 100 to 120 per minute* 12. 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?: *If the child weighs less than 10 kg or is less than 1 year old* 13. You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate for delivering breaths?: *1 breath every 3 to 5 seconds* 14. 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?: *Provide CPR for about 2 minutes before leaving to activate the emergency response system* 15. 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?: *While a colleague provides spinal motion restriction, open the airway with a jaw thrust and provide bag-mask ventilation* 16. You are assisting in the elective intubation of an average-size with respiratory failure. Colleague is retrieving the color-coded l tape from the resuscitation chart. What is likely to be the estimat uncuffed endotracheal tube for this child?: *5-mm tube* 17. 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 a an IV, and administers 1 dose of epinephrine 0.01 mg/kg. If v fib o ventricular tachycardia persists after 2 minutes of CPR, you will another shock. What drug and dose should be administered?: *Lidocaine 1 mg/kg IV* 18. During bag-mask ventilation, how should you hold the mask effective seal between the child's face and the mask?: *Position y using the E-C clamp technique* 19. Age of infants: <1 yo (excluding the newly born) 20. Age of children: from 1 year of age to puberty 21. To perform a pulse check in an infant, palpate a: brachial puls - if you don't definitely feel a pulse within 10 seconds, starts CPR, be chest compressions 22. To perform a pulse check in a child, palpate a: carotid or femoral - if you don't definitely feel a pulse within 10 seconds, starts CPR, begi chest compressions 23. Compression depth in infants: at least 1/3 the AP diameter of the chest or about 1 1/2 inches (4 cm) 24. If a head or neck injury is suspected, use what to open the airway?: - jaw-thrust maneuver - if jaw thrust does not open the airway, use the head tilt-chin lift 25. The primary assessment (primary survey) uses a hands-on ABCDE ap- proach and includes assessment of the patient's vital signs .. what does ABCDE stand for?: Airway Breathing Circulation Disability Exposure 26. During PALS, determine the respiratory rate by ...: counting the number of times the chest rises in 30 seconds and multiply by 2 27. Rectractions accompanied by stridor or inspiratory snoring suggest: up- per airway obstruction - seesaw respirations also usually indicated upper airway obstruction + may also be observed in severe lower airway obstruction 28. Rectractions accompanied by expiratory wheezing suggest: marked lower airway obstruction (asthma or bronchiolitis), causing obstruction during both inspi- ration and expiration 29. Cause of seesaw breathing in most kids with neuromuscular dz is: weak- ness of abdominal and chest wall muscles - caused by strong contraction of diaphragm that dominates weaker a chest wall muscles - result = retraction of chest and expansion of abdomen during inspiration 30. Normal tidal volume: appx 5-7 mL/kg of body weight throughout life - difficult to measure unless child is mechanically ventilated --> clinical assessment is important 31. Auscultation of air movement is critical. In a child, listen for the intensity of breath sounds and quality of air movement in the following areas:: 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 32. Most common cause of bradycardia in children: hypoxia - if child with bradycardia has signs of poor perfusion (decreased responsiveness, weak peripheral pulses, cool mottled skin), immediately support ventilation with bag and mask and administer supplementary O2 - be prepared to start chest compressions if heart rate remains less than 60/min with signs of poor perfusion despite adequate oxygenation and ventilation 33. Heart rate that warrants further assessment and may be a serious condi- tion in kids: HR > 180/min in infant or toddler and >160/min in child older than 2 yo 34. Normal capillary refill time: 2 seconds or less 35. Children with septic shock may have warm skin and extremities with very rapid (less than 2 seconds) capillary refill time, often called: flash capillary refill 36. When perfusion deteriorates in children and O2 delivery to tissues be- comes inadequate, what are typically affected first?: hands and feet - they may become coo, pale, dusky, or mottled 37. You respond to a child or an infant that is found down. What is the next action after determining unresponsiveness?: *Tell a bystander to call 911.* - Early activation is key. - Send any available bystander to call 911. Many pediatric cardiac arrest situations are the result of a respiratory problem, and immediate intervention can be life-saving. 38. Which of the following describes the brachial pulse location?: *Upper arm - inside* - The brachial pulse is located in the upper arm. 39. What is a simple mnemonic for aid in the assessment of mental status?: - *AVPU* - AVPU (alert, voice, pain, unresponsive) is a simple assessment tool to assess for adequate brain perfusion. 40. Adenosine dosage of SVT in PALS for children: 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. 41. A child has an advanced airway in place during cardiac arrest. How fre- quently should ventilations be given?: *Every six seconds* - The latest AHA guidelines recommend one ventilation every six seconds, or 10 per minute, when an advanced airway is in place. 42. In small children, a rescue breath should be given:: *over one second* - Rescue breaths and ventilations should be delivered over one second, regardless of the patient's age. 43. What is the normal range of heart rates for an 8-year-old child?: *60-140 per minute* 44. An elevated respiratory rate is a sign of early respiratory compromise. In late stages or overt respiratory failure, the respiratory rate is: low or barely detectable. 45. The 8-year-old child you are treating has a palpable pulse and a heart rate of 200. You look at the monitor and see a rapid rhythm with narrow QRS complexes. There are no discernible P waves on the monitor. The rhythm is probably:: *superventricular tachycardia* - The absence of P waves rules out a sinus rhythm, even sinus tachycardia. Ventric- ular tachycardia creates a wide QRS complex. 46. You are doing CPR on a child with symptomatic bradycardia. An intra- venous line is in place. What is the first drug of choice for the patient?: *Epi- nephrine* - If oxygenation and ventilation fail to correct symptomatic bradycardia in a child, epinephrine should be given. - While atropine is the recommended initial treatment choice for symptomatic brady- cardia in adults, in children it is a secondary choice. - Atropine is the initial treatment in children with AV block due to primary bradycardia, however. 47. 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 activity. This rhythm is most likely:: *ventricular fibrilla- tion* - The ECG waveform described is most likely ventricular 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. 48. In school age children and infants, the two most common initial rhythms seen in pediatric cardiac arrest are:: *asystole and PEA* - While cardiac arrest in children is usually preceded by respiratory distress and failure, the two most common, immediate causes of cardiac arrest in children are asystole and PEA. 49. Cyanosis is not apparent until: at least 5 g/dL of hemoglobin are desaturated (not bound to O2) 50. The most determining factor in relation to a child's cardiac output is the:: *heart rate*