HEARTCODE PALS EXAM WITH ANSWERS

After 2 more minutes of CPR, you notice the patient is moving and his skin color improves. his vital signs are 114 RR 8/min and temperature 37.9 C (100.2 F). The infant is still slow to respond but is moving. What should be the next steps for this patient? - answer--Continue oxygen -Obtain expert consultation -Support ABC's -Identify and treat underlying causes After synchronized cardioversion of 6 J, the patient remains in a supraventricular tachycardia. A second synchronized cardioversion. What is the recommended energy selection? - answer-12 J After the chest tube is inserted, the patient's breathing and oxygenation are improved. Her vital signs are HR 98/min, BP 108/72 mm Hg, RR 18/min, SpO2 98%. How should proper chest tube placement be confirmed? - answer-Obtain a chest x-ray After the first fluid bolus is administered, the child is reassessed and her vital signs are HR 167, BP 58/44 mm Hg, RR 56/min and SpO2 92%. Her skin is still cool and pale and she is still lethargic and weak. What should be the next intervention? - answer-Deliver a second fluid bolus of 20 mL/kg and reassess After you attempt a vagal maneuver , the infrant's vital signs are HR 261/min, BP 72/50, RR 46/mm, SpO2 96% and he is crying. A 12 lead ECG is taken. What actions should be taken next? (IMG_8684) - answer-Administer adenosine Ausculating the patient's lungs demonstrates clear lung sounds on the left but absent lung sounds on the right. What is the most likely diagnosis for this patient? - answer-Tension pneumothorax Based on the child's blood pressure, what type of shock is the patient in? - answer-Hypotensive CPR has been ongoing and IV access has been established. A pulse and rhythm check are done. He has the rhythm. What intervention would be most appropriate at this time? - answer-Administer epinephrine During the initial assessment, you find that the infant is unresponsive and has an HR of less than 60/min. What should be your next action? - answer-Begin CPR For general shock management, administer an isotonic crytalloid bolus of __ mL/kg over __ to __ minutes - answer-For general shock management, administer an isotonic crytalloid bolus of 20 mL/kg over 5 to 20 minutes For septic shock, how soon should fluid resuscitation begin? - answer-Within 10 to 15 minutes after recognizing shock For stable patients with a regular wide complex, and monomorphic tachycardia consider: - answer-Adenosine How are tachycardia and tacharrhythmias classifed? - answer-By the width of the QRS complex How do you know if a needle decompression is successful? - answer-There is gush of air when the needle is placed How does the clinical presentation of distributive shock compare with hypovolemic shock? - answer-Distributive shock has more variable presentation than that of hypovolemic shock How is bradycardia defined in pediatric patients? - answer-A heart rate that is slow in comparison with a normal heart rate range for the child's age, level of activity and clinical condition. How is tachycardia defined in pediatric patients? - answer-A heart rate that is fast compared with the normal heart rate for the child's age How should appropriate endotracheal tube placement be confirmed? - answer-End-tidal carbon dioxide or capnography How should sinus tachycardia be treated? - answer-By treating the underlying cause How soon after exposure do symptoms typically occur in anaphylactic shock? - answer-Seconds to minutes Identify this rhythm (IMG_8654) - answer-Supraventricular tachycardia If amiodarone or procainamide does not terminate the rapid rhythm, why should adenosine be considered? - answer-A wide-complex tachycardia could be supraventricular tachycardia with aberrant ventricular conduction if bradycardia persists after initial treatment and the heart rate remains less than 60/min, what action should be taken next? - answer-Begin CPR If myocardial function remains poor in a post-cardiac arrest child, what medication(s) should be considered? - answer--Milrinone -Epinephrine in a child with anaphylactic shock, what is the most appropriate initial treatment? - answer-IM epinephrine In children with severe cardiovascular compromise from pulmonary embolism, what treatment should be considered? - answer-Fibrinolytic agents In the setting of impending or actual pulseless arrest when there is a strong suspicion of pericardial tamponade, what is the appropriate management? - answer-Emergency pericardiocentesis In what conditions is atropine preferred over epinephrine as the first-choice treatment of symptomatic bradycardia? - answer--Increased vagal tone -Cholinergic drug toxicity (orgranophosphates) -Atrioventricular block due to primary bradycardia In which patients would bradycardia be an expected finding and not be considered problematic? - answer--A healthy child who is sleeping This is due to reduced metabolic demand -A well-conditioned athlete This is due to high stroke volume and increased vagal tone In whom should you suspect a tension pneumothorax? - answer--Victim of chest trauma -Any intubated child who deteriorates suddenly while receiving in positive-pressure ventialtion -A child who deteriorates suddenly while receiving bag-mas ventialtion Most patients in cardiogenic shock will need inotropic support with medications. Which of the following could be used? - answer--Milrinone -Epinephrine Needle decompression is performed on the patient. As the needle is inserted, there is a rush of air coming from the hub of the needle. Vital signs are reassessed and are now Hr 134/min, BP 70/40 mm Hg and SpO2 82%. The patient still has labored breathing. Her SpO2 does not go above 82%; lung sounds are more present but are still diminished on the right side. Which of the following interventions is the most incorporate to do next? - answer-Performs a thoracostomy for chest tube placement Oxygen should be titrated to maintain a pulse oximetry saturation level between what range? - answer-94% to 99% Pulmonary embolisms are ____ in children. - answer-Rare The child is awake, responsive and anxious. Her initial vitals signs are HR 168/min, BP 61/43 mm Hg, RR 44/min, SpO2 66%. What is the initial priority in treatment for this patient? - answer-Administer oxygen (nonrebreating mask) The infant does not respond to the initial dose of adenosine for supraventricular tachycardia and now has these vital signs HR 265 SpO2 96% - answer-Administer a second dose of adenosine at 0.2 mg/kg (maximum second dose 12 mg) The infant is placed on the ambulance stretcher and responds with a groan when stimulated and has a temperature of 36.3 C (97.3 F) - answer--Monitor and support ABCs -Establish IV/IO access -Monitor heart rate, blood pressure, and pulse oximetry -Call for assistance if needed The most common cause of cardiac arrest in infants, children and adolescents is ___________, which is the end result of progressive hypoxia and acidosis. - answer-hypoxic/asphyxial arrest The mother does not recall the infant's most recent weight. What is the most appropriate way to rapidly determine her weight and calculate correct medication? - answer-Measure her by using color-coded length-based tape The patient has characteristics of supraventricular tachycardia, including a heart rate of more than 220/in. How would P waves appear on an ECG in a supraventricular tachycardia? - answer--Abnormal -Absent The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as ___________ shock. - answer-Hypotensive Treatment for tension pneumothorax should not be delayed. Based on the child's assessment, what immediate intervention should be performed? - answer-Needle decompression