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AND VERIFIED ANSWERS
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) - correct answers - Monitor and support ABCs
- 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? - correct answers - Hypotension (late sign)
- Increasing tachycardia The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as ___________ shock. - correct answers Hypotensive What should be included in the initial treatment for this patient? - correct answers - 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? - correct answers Measure her by using color-coded length-based tape
AND VERIFIED ANSWERS
You measure the infant to be 7 kg and prepare to administer a fluid bolus of what type?
- correct answers Normal saline 20 mL/kg What is the most appropriate method of delivering rapid fluid boluses to this patient? - correct answers 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? - correct answers Deliver a second fluid bolus of 20 mL/kg and reassess When should vasoactive therapy be considered be considered in managing distributive shock? - correct answers 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? - correct answers 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 - correct answers For general shock management, administer an isotonic crytalloid bolus of 20 mL/kg over 5 to 20 minutes
AND VERIFIED ANSWERS
- Normal, elevated or decreased WBC For septic shock, how soon should fluid resuscitation begin? - correct answers Within 10 to 15 minutes after recognizing shock What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? - correct answers 5 to 10 mL/kg over 10 to 20 minutes What is the focus of the initial management of distributive shock? - correct answers - Correcting hypovolemia
- Filling expanded dilated vascular space
- Expanding intravascular volume What are causes of obstructive shock? - correct answers - Pulmonary embolus
- Tension pneumothorax
- Congenital heart defects
- Cardiac tamponade What signs are present as obstructive shock progresses? - correct answers - Increased respiratory effort
- Cyanosis
- Signs of vascular congestion
AND VERIFIED ANSWERS
Most patients in cardiogenic shock will need inotropic support with medications. Which of the following could be used? - correct answers - Milrinone
- Epinephrine What is the main objective of managing obstructive shock? - correct answers - Correct the cause of cardiac output obstruction
- Restore tissue perfusion Why is it important to immediately identify obstructive shock? - correct answers Obstructive shock can rapidly progress to cardiopulmonary failure and then cardiac arrest What is an assessment finding unique to tension pneumothorax? - correct answers Tracheal deviation In whom should you suspect a tension pneumothorax? - correct answers - 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
AND VERIFIED ANSWERS
In the setting of impending or actual pulseless arrest when there is a strong suspicion of pericardial tamponade, what is the appropriate management? - correct answers Emergency pericardiocentesis Pulmonary embolisms are ____ in children. - correct answers Rare What is definitive treatment for most children with pulmonary embolism who are not in shock? - correct answers Anticoagulants In children with severe cardiovascular compromise from pulmonary embolism, what treatment should be considered? - correct answers Fibrinolytic agents What findings help distinguish pulmonary embolism from hypovolemic shock? - correct answers Systemic venous congestion and right heart failure What circulation findings are specific to pericardial tamponade? - correct answers - Tachycardia
- Narrowed pulse pressures
- Muffled or diminished heart sounds 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%.
AND VERIFIED ANSWERS
What is the initial priority in treatment for this patient? - correct answers Administer oxygen (nonrebreating mask) Based on the child's blood pressure, what type of shock is the patient in? - correct answers Hypotensive 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? - correct answers Tension pneumothorax Treatment for tension pneumothorax should not be delayed. Based on the child's assessment, what immediate intervention should be performed? - correct answers Needle decompression Where should the needle be inserted for proper needle decompression? - correct answers Right side of the chest, over the third rib (second intercostal space) in the midclavicular line
AND VERIFIED ANSWERS
Whenever a child has an abnormal heart rate of rhythm, what must be done quickly? - correct answers Determine if the arrhythmia is causing hemodynamic instability or other signs of deterioration. What is the priority in initially managing arrhythmias? - correct answers Support the airway, breathing and circulation What are the causes of secondary bradycardia? - correct answers - Hypoxia
- Acidosis
- Hypotension
- Hypothermia
- Drugs What are the electrocardiographic characteristics of bradycardia? - correct answers - Heart rate slow compared with normal heart rate for age
- P wave and QRS complex may be unrelrated
- QRS complex may be narrow or wide What is a THIRD-degree atrioventricular block? - correct answers None of the atrial impulses conduct to the ventricles What is a FIRST-degree atrioventricular block - correct answers A prolonged PR interval representing slowed conduction through the atrioventricular node
AND VERIFIED ANSWERS
Why do children with cardiac tamponade improve temporarily with fluid administration? - correct answers Fluids augment cardiac and tissue perfusion until pericardial drainage can be performed What is the initial dose of epinephrine in the treatment of symptomatic bradycardia? - correct answers 0.01 mg/kg IV/IO In which patients would bradycardia be an expected finding and not be considered problematic? - correct answers - 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 What is the IV/IO dose of atropine for pediatric bradycardia? - correct answers 0.0 2 mg/kg What should your next steps be? - correct answers - Maintains a patent airway
- Apply cardiac monitor to identify rhythm and monitor pulse, blood pressure, and oximetry
- Complete the initial and primary assessment During the initial assessment, you find that the infant is unresponsive and has an HR of less than 60/min.
AND VERIFIED ANSWERS
- Light-headedness
- Syncope How is tachycardia defined in pediatric patients? - correct answers A heart rate that is fast compared with the normal heart rate for the child's age Where do tacharrhythmias originate? - correct answers Atria or ventricles How are tachycardia and tacharrhythmias classifed? - correct answers By the width of the QRS complex What is initial treatment for pediatric bradycardia with cardiopulmonary compromise? - correct answers Provide bag-mask ventilation with 100% oxygen if bradycardia persists after initial treatment and the heart rate remains less than 60/min, what action should be taken next? - correct answers Begin CPR What are the characteristics of ventricular tachycardia? - correct answers - It is a wide QRS complex generated within the ventricles
- The rapid rate may deteriorate into pulseless ventricular tachycardia or ventricular fibrillation
- A rapid rate compromises ventricular filling
AND VERIFIED ANSWERS
Why does sinus tachycardia typically develop? - correct answers The body needs increased cardiac output What is characteristic feature of supraventricular tachycardia? - correct answers An abrupt increase in heart rate that does not vary with activity In what conditions is atropine preferred over epinephrine as the first-choice treatment of symptomatic bradycardia? - correct answers - Increased vagal tone
- Cholinergic drug toxicity (orgranophosphates)
- Atrioventricular block due to primary bradycardia What is heart rate is consistent with sinus tachycardia? - correct answers Infant: Less than 220/min Child: Less than 180/min What are the characteristics of atrial flutter? - correct answers - Atrial rate can exceed 300/min and ventricular rate is slow
- Can develop in children with congenital heart disease
- A narrow-complex tacharrhythmia What history is consistent with supraventricular tachycardia? - correct answers Symptoms of congenital heart disease
AND VERIFIED ANSWERS
If amiodarone or procainamide does not terminate the rapid rhythm, why should adenosine be considered? - correct answers A wide-complex tachycardia could be supraventricular tachycardia with aberrant ventricular conduction What is considered an initial management priority in managing tachyarrhythmias? - correct answers - Assess and support the airway, oxygenation and ventiliation
- Obtain a 12-lead electrocardiogram if practical
- Attach a continuous electrocardiographic monitor/defibrillator and a pulse oximeter Which signs and symptoms are consistent with supraventricular tachycardia? - correct answers - Absent or abnormal P waves
- Heart rate 220/min or greater in an infant or 180/min or greater in a child
- Heart rate does not vary with activity or stimulation For stable patients with a regular wide complex, and monomorphic tachycardia consider: - correct answers Adenosine Which of the following should be considered for stable supraventricular tachycardia? - correct answers - Ask an older child to try to blow through an obstructed straw
- Place a bag with ice water over the upper half of the infant's face What is the initial dose of denosine? - correct answers 0.1 mg/kg IV/IO
AND VERIFIED ANSWERS
Your initial assessment indicates that the child is irritable and breathing rapidly. Which of the following is the most appropriate initial intervention? - correct answers Maintain patent airway; administer oxygen What is the most likely rhythm? (IMG_8681) - correct answers Supraventricular tachycardia 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? - correct answers - Abnormal
- Absent Vagal maneuvers are indicated for an infant with supraventricular tachycardia who is stable and they should be performed while preparations are being made for admistering adenosine and synchronized cardioversion (if necessary). Ice for the face is vagal maneuver that can be performed in infants and children of all ages. What precautions should be taken when performing this vagal maneuver? - correct answers Do not cover the nose or mouth
AND VERIFIED ANSWERS
What are the common initial rhythms in both in-hospital and out-of-hospital pediatric cardiac arrest, especially in children younger than 12 years? - correct answers - Asystole
- PEA When _____ is present,m the heart has no organized rhythm and no coordinated contractions - correct answers VF What are signs of cardiac arrest in children? - correct answers - Unresponsiveness
- Agonal gasps
- No pulse felt When treating persistent VF/pVT during cardiac arrest, administer epinephrine - correct answers Every 3 to 5 minutes What are initial steps of treating asystole/PEA? - correct answers - Provide CPR
- Establish IV/IO access
- Administer epinephrine
- Consider advanced airway What is considered part of the post-cardiac arrest care? - correct answers - Providing adequate oxygenation and ventilation
AND VERIFIED ANSWERS
- Correcting acid-base and electrolyte imbalances
- Ensuring adequate analgesia and sedation What is included in the SECOND phase of post-cardiac arrest management? - correct answers Provide broad multiorgan supportive care What is included in the FIRST phase of post-cardiac arrest management? - correct answers Continued advanced life support for immediate life-threatening conditions What are the initial steps of the VF/pVT pathway of the Pediatric Cardiac Arrest Algorithm? - correct answers - Perform CPR
- Deliver ONE shock
- Establish IV/IO access How should appropriate endotracheal tube placement be confirmed? - correct answers End-tidal carbon dioxide or capnography Oxygen should be titrated to maintain a pulse oximetry saturation level between what range? - correct answers 94% to 99% If myocardial function remains poor in a post-cardiac arrest child, what medication(s) should be considered? - correct answers - Milrinone
- Epinephrine
