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PALS version B
You are treating an 8-year-old with ventricular tachycardia (VT) 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 Initiate overdrive pacing transcutaneously Consider possible metabolic and toxicologic causes Deliver an unsynchronized shock - Consider possible metabolic and toxicologic causes You are caring for a patient who developed a tension pneumothorax after several hours of positive- pressure ventilation. Which of the following would be the most appropriate site for needle decompression? Over the third rib (ie, second intercostal space) at the mid-clavicular line Under the eighth rib at the midaxillary line Over the fifth rib at the sternal border Under the sixth rib at the midclavicular line - Over the third rib (ie, second intercostal space) at the mid-clavicular line You are initiating treatment for a child with septic shock and hypotension. While administering high-flow oxygen, you determine that the child's respirations 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 colloidge Administer repeated fluid boluses of isotonic crystalloid Begin immediate dopamine infusion
Begin immediate dobutamine infusion - Administer repeated fluid boluses of isotonic crystalloid You are caring for a 5-year-old patient with supraventricular tachycardia (SVT) (heart rate is 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? Provide synchronized cardioversion at 0.5 to 1 J/kg 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 You attempted synchronized cardioversion for an infant with SVT and poor perfusion. The SVT persists after the initial shock of 1 J/kg. Which of the following should you attempt now? Synchronized cardioversion at a dose of 4 J/kg Synchronized cardioversion at a dose of 2 J/kg Unsynchronized cardioversion at a dose of 2 J/kg Unsynchronized cardioversion at a dose of 4 J/kg - Synchronized cardioversion at a dose of 2 J/kg 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 Using a resuscitation bag to provide manual ventilation with 100% oxygen Increasing tidal volume Increasing positive end-expiratory pressure (PEEP) -
Obtaining chest and abdominal radiographs Obtaining a venous blood gas - Soliciting a history from the caregiver or family Which of the following rhythms is shown on this ECG rhythm strip? Sinus bradycardia Ventricular fibrillation (VF) Asystole Supraventricular tachycardia) - Ventricular fibrillation (VF) You are caring for an 8-month-old with bradycardia and very poor perfusion that has persisted despite effective ventilations with high-flow oxygen. You should begin chest compressions if the heart rate is: More than 200/min More than 150/min Less than 100/min Less than 60/min - Less than 60/min You are caring for a 3-year-old with myocarditis and heart failure. She has become poorly responsive to a sternal rub and is difficult to rouse. She has a sinus rhythm with a heart rate of 175/min, and a blood pressure of 88/65 mm Hg. Her skin is cool and mottled, capillary refill time is 5 seconds and she has barely palpable distal pulses. Oxygen saturation is 90% on high-flow, high-concentration oxygen by face mask. Her respirations are labored at 50/min with moderate retractions, and crackles are heard at the bases. Which of the following would be the most appropriate therapy for this child? Obtain a STAT echocardiogram and chest x-ray Perform synchronized cardioversion at 0.5 joules/kg Provide assisted ventilations with 100% oxygen and prepare for endotracheal intubation
Administer epinephrine 0.1 mL/kg of 1:10,000 solution IV - Provide assisted ventilations with 100% oxygen and prepare for endotracheal intubation You are treating a 5-month-old with a 2-day history of vomiting and diarrhea. The patient is listless. The respiratory rate is 52/min and unlabored. The heart rate is 170/min and pulses are present but weak. Capillary refill is delayed. You are administering high-flow oxygen and intravenous access is in place. At this point the most important therapy is to: Administer an epinephrine bolus Begin bag-mask ventilation Provide a rapid 20 mL/kg isotonic crystalloid fluid bolus Administer a bolus of 0.5 g/kg of dextrose - Provide a rapid 20 mL/kg isotonic crystalloid fluid bolus Which of the following groups of clinical findings would be most consistent with categorizing a patient with compensated shock? Decreased level of consciousness, extensor posturing in response to pain, hypertension, and apnea Normal systolic blood pressure, decreased level of consciousness, cool extremities with delayed capillary refill, and faint or nonpalpable distal pulsesd. Normal blood pressure, normal level of consciousness, bounding distal pulses, hypercarbia, hypoxemia, and normal urine output Unresponsiveness, normal breathing, and good distal pulses - Normal systolic blood pressure, decreased level of consciousness, cool extremities with delayed capillary refill, and faint or nonpalpable distal pulsesd. You are treating a 10-year-old patient after a motor vehicle crash. The patient is unresponsive and flexes his arms at the elbow in response to a painful stimulus. An endotracheal tube is in place with position confirmed. You are ventilating using a resuscitation bag with oxygen, and the child has an Spot of 95% and good chest excursion bilaterally. Blood pressure is 130/70 mm Hg and heart rate is 90/min with good perfusion. You have established intravenous access. Which of the following actions would be most appropriate at this time?
Perform transcutaneous pacing Resume bag-mask ventilation Administer epinephrine IV Administer atropine IV - Resume bag-mask ventilation You are caring for a 7-year-old with respiratory distress that has worsened over the past few hours. The child is alert and in moderate respiratory distress with prolonged exhalation time. The respiratory rate is 28/min with bilateral expiratory wheezes. The heart rate is 112/min with good capillary refill. The wheezing in this patient indicates: Disordered control of breathing Lung tissue (parenchymal) lung disease Lower airway obstruction Upper airway obstruction - Lower airway obstruction Which of the following assessments is most useful in evaluating the effectiveness of bagmask ventilation? Hearing an air leak around the mask when the bag is fully compressed Seeing the abdomen rise during ventilationcation Observation of visible chest rise A normal systolic, diastolic, and mean arterial pressure - Observation of visible chest rise You are assessing a 6-year-old child who appears to be unconscious after striking his head on a concrete step. You pinch the patient's chest and the patient grabs your hand. You would document this response as:
Localization of a painful stimulus Withdrawal from a painful stimulus Decerebrate posturing Decorticate posturing - Localization of a painful stimulus You are treating a 10-year-old victim of multisystem trauma. The child is very anxious and confused. The respiratory rate is 44/min and unlabored. The pulse is rapid and weak. Capillary refill is delayed. High- flow oxygen and an intravenous line are in place. The most appropriate initial fluid for rapid volume expansion is: 10% dextrose in water 5% dextrose in Ringer's lactate 5% dextrose in normal saline Normal saline or Ringer's lactate - Normal saline or Ringer's lactate When monitoring the quality of chest compressions during a resuscitation, you should ensure that providers are: Pushing hard-ensure that the chest is compressed 3/4 of the anterior-posterior diameter Pushing fast-compress at a rate of 150/min Allowing complete recoil-let the chest return to its original position between compressions Minimizing interruptions-do not permit interruptions for more than 1 minute - Allowing complete recoil-let the chest return to its original position between compressions 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 a sinus bradycardia. The skin is cool, mottled, and moist; distal pulses are not palpable and central pulses are weak. Intravenous access has been established. The core temperature is 37.3°C. Based on the PALS bradycardia algorithm, which of the following should be provided first?
