PALS Scenarios

Question 1

the most common cause of bradycardia in kids

Answer 1

hypoxia

Question 2

if there is bradycardia what is the priority over everything else?

Answer 2

effective ventilation

Question 3

when are chest compressions indicated in children?

Answer 3

HR below 60

Question 4

primary bradycardia

Answer 4

result of congenital or acquired heart conditions that slow depolarization in the electrical conducting system

Question 5

secondary bradycardia

Answer 5

any non cardiac condition that slows HR
hypoxia
acidosis
hypothermia
drugs

Question 6

when is atropine prioritized before epi?

Answer 6

there is an increase in vagal tone or vagal response is suspected
cholinergic drug toxicity

Question 7

should you use atropine as a premediation?

Answer 7

no evidence to support routine use of it as premed

Question 8

PALS algorithm for bradycardia

Answer 8

monitors iv o2
open and assist airway
start CPR if HR <60
Other options: epo/atropine/transcut pacing/Hs&Ts

Question 9

SVT rate infants

Answer 9

> 220

Question 10

SVT rate children

Answer 10

> 180

Question 11

algorithm for sinus tachy stable or unstable

Answer 11

monitors iv o2

search for cause and treat

Question 12

algorithm for stable SVT

Answer 12

monitors iv o2
vagal maneuvers
adenosine up to 2 doses
consult
consider amiodarone or procainamide
consider synch cardiovert
consider reverse causes

Question 13

first dose adenosine

Answer 13

100mcg/kg max 6mg

Question 14

second dose adenosine

Answer 14

200mcg/kg max 12mg

Question 15

algorithm for unstable SVT

Answer 15

same but cardiovert is #1

Question 16

algorithm for vtach with pulse adequate perfusion

Answer 16

amiodarone or procainamide NOT BOTH
consider adenosine only if monomorphic 
consult
search and treat reversible cause
consider sync cardiovert

Question 17

algorithm for vtach with pulse poor perfusion

Answer 17

prompt sync cardiovert
amiodarone or procainamide
consider adenosine
consult
search and treat reversible cause

Question 18

algorithm for vfib/pulseless vtach

Answer 18

shock 2J/kg
CPR 2 min
reanalyze
shock 4J/kg
cpr 2 min 
consider epi 10mcg/kg after 2 shock
consider antiarrhythmic after 3 shock

Question 19

torsades special therapy

Answer 19

magnesium after 3 shock

Question 20

algorithm for asystole/PEA

Answer 20

CPR 2 min
epi
consider advanced airway/HsTs

Question 21

what are the 4 types of airway scenarios

Answer 21

lower airway obst
upper airway obst
lung tissue disease
disordered control breathing

Question 22

treatment for lower airway obstruction

Answer 22

supplemental o2
nebulized bronchodilator
airway suctioning
consider labs and diagnostics

Question 23

asthma mild to moderate treatment

Answer 23

nebulized bronchodilator
corticosteriods
consider humidified o2

Question 24

asthma moderate to severe treatment

Answer 24

subcut epi
subq terbutaline
consider magnesium, bipap, intubation

Question 25

croup treatment

Answer 25

steroids
nebulized epi
humidified o2 and heliox
consider intubation

Question 26

anaphylaxis treatment

Answer 26

same as asthma and add:
20mL/kg crystalloid
histamine blocker (benadryl or zantac)

Question 27

if a choking pt becomes unconscious what should you do?

Answer 27

immediately start CPR even if they have pulse

Question 28

treatment for infectious, chemical, and aspiration pneumonia

Answer 28

diagnostic test
administer o2 and abx
obtain consult
support ventilation (PEEP,Cpap, intub?)
treat wheezing with nebulizer
reduce metabolic demand by normalizing temp

Question 29

cardiogenic pulmonary edema treatment

Answer 29

ventilatory support
consider diuretics/inotropes
consider abx if fever
reduce met demand by treating fever

Question 30

non cardiogenic pulmonary edema (ARDS)

Answer 30

bilateral infiltrates due to alveolar capillary membrane injury

Question 31

protocol for lung tissue disease

Answer 31

o2
suctioning and breathing treatment
assist airway
abx for pneumonia
diuretics for pulm edema

Question 32

treatment for disordered control of breathing caused by poisoning or OD

Answer 32

o2, support and assist airway
give antidote or poison control
(not if was used to treat seizure)
IF bradycardia present that therapy is prioritized

Question 33

treatment for disordered control of breathing caused by increased ICP

Answer 33

avoid hypoxemia, hypercardia, hyperthermia
-mild hyperventilation
osmotic agents
neuro consult

Question 34

treatment for disordered control of breathing caused by neuromuscular disease

Answer 34

support and assist airway with bag mask or intubation

Question 35

therapeutic endpoints for shock management

Answer 35

normal vital signs
good signs of perfusion
normal labs

Question 36

treatment for hypovolemic shock

Answer 36

o2, fluid bolus, consider blood transfusion and control hemorrhage
start pressors and consider aline/central line

Question 37

treatment of obstructive shock intubated pt

Answer 37

DOPE pneumonic then other treatment

Question 38

treatment of obstructive shock tension pneumo

Answer 38

needle decomp.

chest tube placement

Question 39

treatment of obstructive shock cardiac tamponade

Answer 39

pericardiocentesis

fluid bolus

Question 40

treatment of obstructive shock pulmonary embolism

Answer 40

fluid bolus
consider thrombolytics and anticoags
expert consult

Question 41

treatment of obstructive shock ductal dependent lesion

Answer 41

prostaglandin E1

expert consult

Question 42

treatment of septic (distributive) shock

Answer 42

o2 monitors ive, labs and identify type of shock in 10-15min
fluid boluses/vasopressors/abx (in first hr)
correct hypoglycemia and hypocalcemia, start invasive lines, consider stress dose steriods and intubation

Question 43

cardiogenic shock treatment

Answer 43

o2 monitors
slower fluid bolus (5-10mL/kg)
consider inotropes/diuretic
expert consilt