HEARTCODE PALS QUESTIONS AND
ANSWERS
u temperature of 36.3 C (97.3 F) - -Monitor and support ABCs
- The infant is placed on the ambulance stretcher and responds with a groan when stimulated and has a
Establish IV/IO access
-Monitor heart rate, blood pressure, and pulse oximetry
-Call for assistance if needed
When you evaluate the patient, you find the lungs are clear, skin is cool and mottled, glucose is 97 mg/dL
and capillary refill time is 5 seconds. What are the warning signs that the patient is progressing from
compensated shock to hypotensive shock? - -Hypotension (late sign)
-Increasing tachycardia
The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as ___________
shock. - Hypotensive
What should be included in the initial treatment for this patient? - -Rapid fluid bolus administration
-Establishing IV/IO access
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? - Measure her by using color-coded length-
based tape
You measure the infant to be 7 kg and prepare to administer a fluid bolus of what type? - Normal saline
20 mL/kg
What is the most appropriate method of delivering rapid fluid boluses to this patient? - A syringe and 3-
way stopcock
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? - Deliver a second fluid bolus of 20 mL/kg and reassess
When should vasoactive therapy be considered be considered in managing distributive shock? - If the
child remains hypotensive and poorly perfused despite rapid bolus fluid administration
How does the clinical presentation of distributive shock compare with hypovolemic shock? - Distributive
shock has more variable presentation than that of hypovolemic shock
, For general shock management, administer an isotonic crytalloid bolus of __ mL/kg over __ to __
minutes - For general shock management, administer an isotonic crytalloid bolus of 20 mL/kg over 5 to
20 minutes
What signs distinguish anaphylactic shock from other types of shock? - -Angioedema (swelling of the
face, lips and tongue)
-Urticaria (hives)
-Respiratory distress with stridor, wheezing or both
in a child with anaphylactic shock, what is the most appropriate initial treatment? - IM epinephrine
How soon after exposure do symptoms typically occur in anaphylactic shock? - Seconds to minutes
What should you evaluate to recognize septic shock? - -Temp
-Heart rate
-Systemic perfusion
-Blood pressure
-Clinical signs of end-organ perfusion
When should antibiotics be administered in septic shock? - Within the first hour
What are the initial assessment findings for septic shock? - -Fever
-Hypothermia
-Normal, elevated or decreased WBC
For septic shock, how soon should fluid resuscitation begin? - Within 10 to 15 minutes after recognizing
shock
What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? - 5 to 10 mL/kg
over 10 to 20 minutes
What is the focus of the initial management of distributive shock? - -Correcting hypovolemia
-Filling expanded dilated vascular space
-Expanding intravascular volume
What are causes of obstructive shock? - -Pulmonary embolus
-Tension pneumothorax
-Congenital heart defects
-Cardiac tamponade
What signs are present as obstructive shock progresses? - -Increased respiratory effort
ANSWERS
u temperature of 36.3 C (97.3 F) - -Monitor and support ABCs
- The infant is placed on the ambulance stretcher and responds with a groan when stimulated and has a
Establish IV/IO access
-Monitor heart rate, blood pressure, and pulse oximetry
-Call for assistance if needed
When you evaluate the patient, you find the lungs are clear, skin is cool and mottled, glucose is 97 mg/dL
and capillary refill time is 5 seconds. What are the warning signs that the patient is progressing from
compensated shock to hypotensive shock? - -Hypotension (late sign)
-Increasing tachycardia
The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as ___________
shock. - Hypotensive
What should be included in the initial treatment for this patient? - -Rapid fluid bolus administration
-Establishing IV/IO access
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? - Measure her by using color-coded length-
based tape
You measure the infant to be 7 kg and prepare to administer a fluid bolus of what type? - Normal saline
20 mL/kg
What is the most appropriate method of delivering rapid fluid boluses to this patient? - A syringe and 3-
way stopcock
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? - Deliver a second fluid bolus of 20 mL/kg and reassess
When should vasoactive therapy be considered be considered in managing distributive shock? - If the
child remains hypotensive and poorly perfused despite rapid bolus fluid administration
How does the clinical presentation of distributive shock compare with hypovolemic shock? - Distributive
shock has more variable presentation than that of hypovolemic shock
, For general shock management, administer an isotonic crytalloid bolus of __ mL/kg over __ to __
minutes - For general shock management, administer an isotonic crytalloid bolus of 20 mL/kg over 5 to
20 minutes
What signs distinguish anaphylactic shock from other types of shock? - -Angioedema (swelling of the
face, lips and tongue)
-Urticaria (hives)
-Respiratory distress with stridor, wheezing or both
in a child with anaphylactic shock, what is the most appropriate initial treatment? - IM epinephrine
How soon after exposure do symptoms typically occur in anaphylactic shock? - Seconds to minutes
What should you evaluate to recognize septic shock? - -Temp
-Heart rate
-Systemic perfusion
-Blood pressure
-Clinical signs of end-organ perfusion
When should antibiotics be administered in septic shock? - Within the first hour
What are the initial assessment findings for septic shock? - -Fever
-Hypothermia
-Normal, elevated or decreased WBC
For septic shock, how soon should fluid resuscitation begin? - Within 10 to 15 minutes after recognizing
shock
What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? - 5 to 10 mL/kg
over 10 to 20 minutes
What is the focus of the initial management of distributive shock? - -Correcting hypovolemia
-Filling expanded dilated vascular space
-Expanding intravascular volume
What are causes of obstructive shock? - -Pulmonary embolus
-Tension pneumothorax
-Congenital heart defects
-Cardiac tamponade
What signs are present as obstructive shock progresses? - -Increased respiratory effort
