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
... [Show More] 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
Epinephrine IV
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
Provide synchronized cardioversion at 0.5 to 1 J/kg
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 colloid
Administer repeated fluid boluses of isotonic crystalloid
Begin immediate dopamine infusion
Begin immediate dobutamine infusion
Administer repeated fluid boluses of isotonic crystalloid
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 transcutaneously
Deliver an unsynchronized shock
Consider possible metabolic and toxicologic causes
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
Using a resuscitation bag provide manual ventilation with 100% oxygen
You are caring for a 9-month-old patient with pronounced respiratory distress. 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 respiratory 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
Provide bag-mask ventilation
Which of the following is likely to be the most helpful technique to identify potentially reversible metabolic and toxic causes during the attempted resuscitation of a young child in cardiac arrest?
Obtaining a urine sample for toxicology screen
Obtaining chest and abdominal radiographs
Soliciting a history from the caregiver or family
Obtaining a venous blood gas
Soliciting a history from the caregiver or family
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 at the midclavicular 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 at the midclavicular line
You attempted synchronized cardioversion for an infant with supraventricular tachycardia (SVT) and poor perfusion. The SVT persists after the initial 1 J/kg shock. Which of the following should you attempt now?
Synchronized cardioversion at a dose of 2 J/kg
Synchronized cardioversion at a dose of 4 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 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?
Normal systolic blood pressure, decreased level of consciousness, cool extremities with delayed capillary refill, and faint or nonpalpable distal pulses
Decreased level of consciousness, extensor posturing in response to pain, hypertension, and apnea
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 pulses
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 SPO2 of 95% and good chest excursion bilaterally. The blood pressure is 130/70 mm Hg, and the 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?
Obtain a CT scan of the head and neck
Begin manual hyperventilation
Provide continuous positive airway pressure
Give an intravenous bolus of mannitol
Obtain a CT scan of the head and neck
You arrive on the scene of a 12-year-old child who suddenly collapsed on the playground. The child is unresponsive, apneic, and pulseless and CPR is in progress. A lay rescuer just brought the school AED, turned it on, and attached it. The AED recommends a shock. Which of the following should be done next?
Obtain intravenous access
Attempt defibrillation
Change compressions:ventilations from 30:2 to 15:2
Attempt endotracheal intubation
Attempt defibrillation
You are caring for a child in persistent ventricular fibrillation. Which of the following would best describe the child's cardiac condition?
The heart is not pumping blood at all
The heart is beating too slowly to maintain circulation
There is no electrical activity in the heart
The heart is pumping so fast that it cannot fill completely between beats
The heart is not pumping blood at all
You are called to treat a 5-year-old with a 3-day history of worsening respiratory distress. The child responds only to pain. The heart rate is initially 45/min and regular with poor capillary refill. You provide bag-mask ventilations (BMV) with high-flow oxygen that produces good chest rise with full and clear bilateral breath sounds. The heart rate rises in response to ventilation, but after you suction the posterior pharynx, bradycardia recurs (40/min). Which of the following interventions would be most appropriate for you to do first?
Perform transcutaneous pacing
Administer epinephrine IV
Administer atropine IV
Resume bag-mask ventilation
Resume bag-mask ventilation
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 2-year-old with a 1-day history of respiratory distress and stridor. The patient is alert. The child's respiratory rate is 32/min with good chest rise. SPO2 is 98% in room air. The heart rate is 128/min and capillary refill is normal. Skin is warm, pink, and dry. At this point you should:
Assist ventilations with bag-mask device
Use a nonrebreathing mask with tight mask seal
Keep the patient calm and comfortable
Give IV methylprednisolone (Solumedrol)
Keep the patient calm and comfortable
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:
Lung tissue (parenchymal) lung disease
Disordered control of breathing
Upper airway obstruction
Lower airway obstruction
Lower airway obstruction
Which of the following assessments is most useful in evaluating the effectiveness of bag-mask ventilations?
Hearing an air leak around the mask when the bag is fully compressed
Seeing the abdomen rise during ventilation
Observation of visible chest rise
A normal systolic, diastolic, and mean arterial pressure
Observation of visible chest rise [Show Less]