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
Correct Answers: 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
Correct Answers: 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 collide
- Administer repeated fluid boluses of isotonic crystalloid
- Begin immediate dopamine infusion
- Begin immediate dobutamine infusion
Correct Answers: 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
Correct Answers: 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
Correct Answers: 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) Correct Answers: Using a resuscitation bag to
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 no rebreathing 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 intercostal 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
- lntubate and ventilate
Correct Answers: Provide bag-mask ventilation
You are caring for an 8-year-old child who was struck by a car. The child is alert, very anxious, and in
respiratory distress. The child is receiving high-flow oxygen by face mask, has a respiratory rate of
60/min, heart rate of 150/min, systolic blood pressure of 70 mm Hg, and Spot of 86% and falling.
Breath sounds and chest rise are absent over the right chest. Which of the following is the most likely
cause of this child's distress?
- Cardiac tamponade
- Severe hypovolemia
- Tension pneumothorax
- Cardiac asthma
Correct Answers: Tension pneumothorax
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?
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
Correct Answers: 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
Correct Answers: 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 collide
- Administer repeated fluid boluses of isotonic crystalloid
- Begin immediate dopamine infusion
- Begin immediate dobutamine infusion
Correct Answers: 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
Correct Answers: 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
Correct Answers: 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) Correct Answers: Using a resuscitation bag to
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 no rebreathing 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 intercostal 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
- lntubate and ventilate
Correct Answers: Provide bag-mask ventilation
You are caring for an 8-year-old child who was struck by a car. The child is alert, very anxious, and in
respiratory distress. The child is receiving high-flow oxygen by face mask, has a respiratory rate of
60/min, heart rate of 150/min, systolic blood pressure of 70 mm Hg, and Spot of 86% and falling.
Breath sounds and chest rise are absent over the right chest. Which of the following is the most likely
cause of this child's distress?
- Cardiac tamponade
- Severe hypovolemia
- Tension pneumothorax
- Cardiac asthma
Correct Answers: Tension pneumothorax
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?
