PALS 2025 Heart code 2023 with complete solution questions and answers

What is the priority in initially managing arrhythmias? The initial management of both stable and unstable arrhythmias are identical to the treatment for any critically-ill child. Begin with the support of the airway, breathing, and circulation and treating the underlying cause of the arrhythmia. What are the causes of secondary bradycardia? Hypoxia, hypotension, hypothermia, acidosis, drugs. What are the causes of primary bradycardia? Congenital or acquired heart conditions. What are the ECG characteristics of bradycardia? P wave and QRS may be unrelated. Heart rate slow for age. QRS may be narrow or wide. In what patients would asymptomatic bradycardia not be problematic? A well-conditioned athlete. A healthy child who is sleeping. Define bradycardia. A heart rate that is: - slow for normal range - activity - clinical condition What is the leading cause of symptomatic bradycardia? Tissue hypoxia. What is the dose for epinephrine? Epinephrine every 3-5 mins - 0.01 mg/kg IV - 0.1 mg/kg ETT In what conditions is atropine preferred over epinephrine as 1st choice treatment of symptomatic bradycardia? When the bradycardia is due to: - excessive vagal tone - cholinergic drug toxicity, e.g. organophosphates - complete AV block (primary bradycardia) What is the dose for atropine? Atropine 0.02 mg/kg IV What clinical findings may be present in a child with tachyarrhythmia? Syncope, light-headedness, palpitations. If bradycardia persists after initial treatment, and HR 60 /min, what is the next step? Begin CPR. Where can tachyarrhythmias originate? In the atria or ventricles. What sinus tachycardia usually develop? The body needs increased cardiac output. What are the characteristics of atrial flutter? - Atrial rate 300 /min or higher - Venticular rate often slower - Can occur in congenital heart disease - A narrow-complex tachyarrhythmia What is the initial treatment of bradycardia with cardiopulmonary compromise? Provide BVM ventilation, with 100% oxygen. How is tachycardia defined? A heart rate that is fast for the child's age. What are characteristics of ventricular tachycardia? The rapid rate may - deteriorate into pulseless VT or VFib - compromise ventricular filling It is a wide QRS generated within the ventricles What heart rate is consistent with tachycardia? Infant 220 /min Child 180 /min What is a characteristic feature of SVT? Abrupt onset or termination of the tachycardia, with minimal or no variation in heart rate with activity. CHF may be present. How are tachycardia and tachyarrhythmias classified? By the width of the QRS complex. What ECG characteristics are consistent with sinus tachycardia? Beat-to-beat variability with changes in activity. How should sinus tachycardia be treated? Treat the underlying cause. What signs & symptoms are consistent with SVT? Heart rate: - Infant 220 /min - Child 180 /min Absent or abnormal P waves Heart rate does not vary with activity If amiodarone or procainamide does not terminate the rapid rhythm, why should adenosine be considered? A wide-complex tachycardia could be SVT with aberrant ventricular conduction. What signs & symptoms are consistent with sinus tachycardia? Heart rate: - Infant 220 /min - Child 180 /min P waves are present and normal Heart rate varies with activity What is considered an initial management priority in managing tachyarrhythmias? Assess and support the airway, oxygenation and ventilation. Attach continuous ECG monitor, defibrillator and pulse oximeter Obtain 12-lead ECG if practical NOTE: although algorithm states IV access is part of initial management, this is not part of accepted answer! What ECG characteristic is consistent with ventricular tachycardia? Wide QRS complex, 0.09 sec What is the appropriate initial cardioversion dose? 0.5 - 1 J/kg What are the signs of cardiac arrest? No pulse. Unresponsive. Agonal gasps. For stable patients with regular wide-complex, and monomorphic tachycardia, consider adenosine Venticular fibrillation is associated with no organized heart rhythm and no coordinated contractions. What does optimal post-cardiac arrest care include? Identifying and treating organ system dysfunction. What is considered part of post-cardiac arrest care? Ensure adequate analgesia and sedation. Correct acid-base and electrolyte imbalances. Provide adequate oxygenation and ventilation. What are the most common initial rhythms in both in-hospital and out-of-hospital cardiac arrest? PEA Asystole Oxygen should be titrated to maintain a pulse ox saturation of 94-99% What are the initial steps of treating asystole/PEA? CPR IV access Epinephrine Consider advanced airway What can cause secondary brain injury? Hyperthermia Hypotension Hypoglycemia Hypoxia