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Pediatric Advanced Life Support/124 Questions and Answers
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Pediatric Advanced Life Support/124Questions and Answers
Recognize *supraventricular tachycardia* - -
-Recognize *wide-complex tachycardia* - -
-Recognize *SVT converting to sinus rhythm after adenosine administration*
- -
-What oxygen delivery system most reliably delivers a high (90% of greater)
concentration of inspired oxygen to a 7-year-old child? - -Nonrebreathing
face mask
-You are called to help treat an infant with severe symptomatic bradycardia
(heart rate 66/min) associated with respiratory distress. Bradycardia persists
despite establishment of an effective airway, oxygenation, and ventilation.
There is no heart block present. What first drug should you administer? - -
*Epinephrine*
-You are part of a team attempting to resuscitate a child with ventricular
fibrillation cardiac arrest. You deliver 2 unsynchronized shocks. A team
member established IO access, so you give a dose of epinephrine, 0.01
mg/kg IO. At next rhythm check, persistent ventricular fibrillation is present.
You administer a 4-J/kg shock and resume CPR. What drug and dose should
be administered next? - -*Amiodarone 5 mg/kg IO*
- can be used for shock-refractory VF or pVT
-Initial impression of a 2-year-old girl shows her to be alert with mild
breathing difficulty during inspiration and pale skin color. On primary
assessment, she makes high-pitched inspiratory sounds (mild stridor) when
agitated; otherwise, her breathing is quiet. Her SpO2 is 92% on room air, and
she has mild inspiratory intercostal retractions. Lung auscultation reveals
transmitted upper airway sounds with adequate distal breath sounds
bilaterally. Most appropriate initial intervention for this child? - -*Humidified
oxygen as tolerated*
-7-year-old boy found unresponsive, apneic, and pulseless. CPR is ongoing.
Child is intubated, and vascular access is established. ECG monitor shows
organized rhythm with heart rate of 45/min, but a pulse check reveals no
palpable pulses. High-quality CPR is resumed, and an initial IV dose of
epinephrine is administered. What intervention should you perform next? - -
*Identify and treat reversible causes*
, -You are caring for a 6-year-old patient who is receiving positive-pressure
mechanical ventilation via an endotracheal tube. Child begins to move his
head and suddenly becomes cyanotic, and his heart rate decreases. His
SpO2 is 65%. You remove child from mechanical ventilator and begin to
provide manual ventilation with a bag via endotracheal tube. During manual
ventilation with 100% oxygen, child's color and heart rate improve slightly
and his BP remains adequate. Breath sounds and chest expansion are
present and adequate on right side and are present but consistently
diminished on left side. Trachea not deviated, and neck veins are not
distended. Suction catheter passes easily beyond tip of the endotracheal
tube. Most likely cause of this child's acute deterioration? - -*Tracheal tube
displacement into right main bronchus*
-You are giving chest compressions for a child in cardiac arrest. What is the
proper depth of compressions for a child? - -*Compress the chest at least
one third the depth of the chest, about 2 inches (5 cm)*
-During PALS, you and another rescuers begin CPR. Your colleague begins
compressions, and you noticed that the compression rate is too slow. What
should you say to offer constructive feedback? - -*You need to compress at
a rate of 100 to 120 per minute*
-You are preparing to use a manual defibrillator in the pediatric setting.
What best describes when it is appropriate to use the smaller pediatric-sized
paddles? - -*If the child weighs less than 10 kg or is less than 1 year old*
-You need to provide rescue breaths to a child victim with a pulse. What is
the appropriate rate for delivering breaths? - -*1 breath every 3 to 5
seconds*
-You find an infant who is unresponsive, is not breathing, and does not have
a pulse. You shout for nearby help, but no one arrives. What action should
you take next? - -*Provide CPR for about 2 minutes before leaving to
activate the emergency response system*
-3 yo boy presents with multiple-system trauma. Child was an unrestrained
passenger in a high-speed MVC. On primary assessment, he is unresponsive
to voice or painful stimulation. His RR is 5/min, HR and pulses are 170/min,
systolic BC is 60 mmHg, capillary refill is 5 seconds, and SpO2 is 75% on
room air. What action should you take first? - -*While a colleague provides
spinal motion restriction, open the airway with a jaw thrust and provide bag-
mask ventilation*
-You are assisting in the elective intubation of an average-sized 4 yo child
with respiratory failure. Colleague is retrieving the color-coded length-based
, tape from the resuscitation chart. What is likely to be the estimated size of
the uncuffed endotracheal tube for this child? - -*5-mm tube*
-You find a 10 yo boy to be unresponsive. You shout for help, and after
finding that he is not breathing and has no pulse, you and a colleague begin
CPR. Another colleague activates the emergency response system, brings
the emergency equipment, and places the child on a cardiac
monitor/defibrillator, which reveals ventricular tachycardia. You attempt
defib at 2 J/kg and give 2 minutes of CPR. The rhythm persists at the second
rhythm check, at which point you attempt defibrillation with 4 J/kg. A fourth
colleague arrives, starts an IV, and administers 1 dose of epinephrine 0.01
mg/kg. If v fib or pulseless ventricular tachycardia persists after 2 minutes of
CPR, you will administer another shock. What drug and dose should be
administered? - -*Lidocaine 1 mg/kg IV*
-During bag-mask ventilation, how should you hold the mask to make an
effective seal between the child's face and the mask? - -*Position your
fingers using the E-C clamp technique*
-Age of infants - -<1 yo (excluding the newly born)
-Age of children - -from 1 year of age to puberty
-To perform a pulse check in an infant, palpate a - -brachial pulse
- if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning
with chest compressions
-To perform a pulse check in a child, palpate a - -carotid or femoral pulse
- if you don't definitely feel a pulse within 10 seconds, starts CPR, beginning
with chest compressions
-Compression depth in infants - -at least 1/3 the AP diameter of the chest or
about 1 1/2 inches (4 cm)
-If a head or neck injury is suspected, use what to open the airway? - -jaw-
thrust maneuver
- if jaw thrust does not open the airway, use the head tilt-chin lift
-The primary assessment (primary survey) uses a hands-on ABCDE
approach and includes assessment of the patient's vital signs .. what does
ABCDE stand for? - -Airway
Breathing
Circulation
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