1.You are caring for a child who was resuscitated after a drowning event.
The child is intubated and ventilated with 100% oxygen with equal breath
sounds and exhaled CO2 detected. The heart rate is slow and the monitor
shows sinus bradycardia. The skin is cool, mottled, and moist; distal pulses
are not palpable and the central pulses are weak. Intravenous access has
been established. The core temperature is 37.3oC. Based on the PALS
bradycardia algorithm, which of the following should be provided first?
Epinephrine IV
Transcutaneous pacing
Atropine IV
Dobutamine IV infusion
Answer Epinephrine IV
2.You are caring for a 5-year-old patient with supraventricular tachycardia
(heart rate = 220/min). The child is lethargic. The skin is pale and cool with
delayed capillary refill. Distal pulses are not palpable. Which of the
following would be the best treatment to provide without delay?
Place cold packs on the distal upper and lower extremities
Ask the child to blow through a small straw
Exert light pressure on the eyes bilaterally
Provide synchronized cardioversion at 0.5 to 1 J/kg
,Answer Provide synchronized car- dioversion at 0.5 to 1 J/kg
3.You are initiating treatment for a child with septic shock and
hypotension. While administering high-flow oxygen you determine that the
child's respi- rations are adequate and SpO2 is 100%. You have just
established vascular access and obtained blood samples. Which of the
following is the next most appropriate therapy to support systemic
perfusion?
Administer repeated fluid boluses of isotonic colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
Answer Administer repeated fluid boluses of iso- tonic crystalloid
4.You are treating an 8-year-old with ventricular tachycardia with pulses
and adequate perfusion. You attempted synchronized cardioversion without
success. While seeking expert consultation, it would be most appropriate to
Administer a loading dose of milrinone
Consider possible metabolic and toxicologic causes
Initiate overdrive pacing trans-cutaneously
Deliver an unsynchronized shock
Answer Consider possible metabolic and toxicologic causes
5.You are caring for a 2-year-old unconscious patient who is intubated and
, receiving mechanical ventilation. The child's heart rate suddenly drops to
40/min and his color becomes mottled. You should respond to these
changes by
Increasing the ventilator rate
Increasing tidal volume
Increasing positive end-expiratory pressure (PEEP)
Using a resuscitation bag provide manual ventilation with 100% oxygen
Answer Using a resuscitation bag provide manual ventilation with 100%
oxygen
6.You are caring for a 9-month-old patient with pronounced respiratory dis-
tress. You initiated high-flow oxygen using a nonrebreathing mask about 10
minutes ago and established intravenous access. Initially the infant's heart
rate was in the 150/min range with strong pulses. Suddenly the infant's
respi- ratory rate falls to 6/min with significant intercostals retractions, and
little air movement is heard. The infant becomes cyanotic and the heart rate
decreases to 95/min. Which of the following treatments would be best for
you to provide now?
Administer epinephrine IV
Provide bag-mask ventilation
Administer magnesium sulfate IV
Intubate and ventilate
Answer Provide bag-mask ventilation