Question

have been posting the same questions and not getting an answers for so please answer all the questions :

PALS Q’s

If bradycardia (heart rate less than 60 beats per minute) with a pulse is associated with cardiopulmonary compromise despite effective oxygenation and ventilation, what is the next step in management?

  Administer atropine.

  Administer epinephrine.

  Consider cardiac pacing.

  Perform CPR.

When should you use the “pediatric bradycardia with a pulse” algorithm?

  Only on bradycardic individuals with signs of shock

  Only on bradycardic individuals with signs of respiratory distress or failure

  On all bradycardic individuals without a pulse

  For individuals with symptomatic bradycardia

When should cardiac pacing be administered to an individual with symptomatic bradycardia with a pulse?

  If the individual does not respond to CPR

  If the individual does not respond to CPR and pharmacological support

  None of the above

  If the bradycardia is the result of a complete heart block or an abnormal sinus node function

When should vasopressors be administered during the management of septic shock?

  If the individual develops pulmonary edema

  Always indicated as soon as IV access is obtained

  Vasopressors are never used for septic shock.

  If the individual is severely hypotensive despite proper fluid management

Which statement about shock is NOT correct?

  Secondary conditions such as fever, infection, respiratory distress, and pain also contribute to shock.

  Children in shock can progress to cardiac failure.

  Children in shock may become disorientated.

  Decreased urine output is not a symptom of shock.

Which statement about hydrocortisone is NOT correct?

  A common side effect is hyperglycemia.

  Hydrocortisone is classified as a corticosteroid.

  Hydrocortisone inhibits vascular leak due to proinflammatory mediators.

  Hydrocortisone cannot be used for adrenal insufficiency associated with septic shock. The purpose of post-resuscitation care of a PALS individual is to:

  Optimize ventilation

  Optimize circulation

  Preserve organ and tissue function

  All of the above

Which statement about post-resuscitation management is correct?

  Post-resuscitation management should not start until organ systems are functioning normally.

  It is important to prevent hypothermia after cerebral insult.

  Analgesics and sedatives should never be used due to potential respiratory problems.

  Acid-base and electrolyte imbalances may need to be corrected.

Which statement is correct concerning neurological assessment during post-resuscitation management?

  Prolonged hypoventilation is suggested for imminent cerebral herniation.

  Seizures should not be treated.

  Hypothermia should be strictly avoided.

  Dilated unresponsive pupils, hypertension, bradycardia, respiratory irregularities, or apnea may indicate cerebral herniation.

All of the following are signs of cardiorespiratory distress EXCEPT:

  Fatigue

  Irregular heart rhythm

  Tachypnea

  Jaundice

When can post-resuscitation management be necessary?

  After cardiac arrest

  After severe shock

  After respiratory failure

  All of the above

Exposure in PALS evaluations refers to an assessment for:

  Trauma

  Burns

  Fractures

  Any of the signs of a problem above

Answer 1

1.If bradycardia (heart rate less than 60 beats per minute) with a pulse is associated with cardiopulmonary compromise despite effective oxygenation and ventilation, what is the next step in management?

ANS:Perform CPR.(perform chest compression for profound sustained bradycardia, especially for infants with a weak pulse, if heart rate does not quickly improve with attempts at ventilation and oxygenation)

Administer atrophine( epinephrine is considered before atropine in symptomatic bradycardia that is unresponsive to adequate airway and ventilation management)

Administer epinephrine ( if profound, sustained bradycardia persists despite good ventilation and oxygenation, and perfusion is compromised, then drug therapy is indicated: • epinephrine IV/IO = 0.01 mg/kg (1:10,000 solution)https://www.mc.vanderbilt.edu/root/pdfs/CPR/PALS/pals_studypack.pdf

Consider cardiac pacing(The most common indications for permanent pacemaker implantation in children are third-degree atrioventricular (AV) block, either congenital or post-surgical, and rarely symptomatic sinus node dysfunction.)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634247/#sec1-2title

2.When should you use the “pediatric bradycardia with a pulse” algorithm?

ANS: Only on bradycardic individuals with signs of respiratory distress or failure

  Only on bradycardic individuals with signs of shock-If shock is present tachycardia may be present

  On all bradycardic individuals without a pulse- CPR should begin

  For individuals with symptomatic bradycardia-Pacing is recommended for these individuals

3.When should cardiac pacing be administered to an individual with symptomatic bradycardia with a pulse?

ANS: If the bradycardia is the result of a complete heart block or an abnormal sinus node function(The most common indications for permanent pacemaker implantation in children are third-degree atrioventricular (AV) block, either congenital or post-surgical, and rarely symptomatic sinus node dysfunction.)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3634247/#sec1-2title

  If the individual does not respond to CPR-Provide drug therapy

  If the individual does not respond to CPR and pharmacological support- Defibrilation can be given

  None of the above

4.When should vasopressors be administered during the management of septic shock?

ANS:If the individual is severely hypotensive despite proper fluid management.(Septic shock is a consequence of a systemic infection that is characterized by hypotension unresponsive to fluid resuscitation. Patients who fail to respond to aggressive fluid resuscitation are candidates for vasopressor or inotropic therapy in order to maintain hemodynamic parameters.)

Vasopressor and Inotropic Management Of Patients With Septic Shock-Sacha Pollard, PharmD, BCPS, Stephanie B. Edwin, PharmD, BCPS, and Cesar Alaniz, PharmD(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495871/)

5.Which statement about shock is NOT correct?

ANS:Decreased urine output is not a symptom of shock.Urine output is always decreased in patients with shock as they will be dehydrated.

6.Which statement about hydrocortisone is NOT correct?

ANS:Hydrocortisone cannot be used for adrenal insufficiency associated with septic shock(Adrenal insufficiency is noted in children having septic shock . In patients with septic shock presenting adrenal insufficiency, either suspected or confirmed, the administration of hydrocortisone in shock or stress doses can be vital for a favorable clinical outcomehttps://www.ncbi.nlm.nih.gov/pubmed/14647713)

7.The purpose of post-resuscitation care of a PALS individual is to:

ANS:All of the above(Post-Resuscitation Care is meant to optimize ventilation and circulation, preserve organ/tissue function, and maintain recommended blood glucose levels.https://nhcps.com/lesson/pals-post-resuscitation-care/)

8.Which statement about post-resuscitation management is correct?

ANS:Acid-base and electrolyte imbalances may need to be corrected.Correct metabolic abnormalities (chemistry panel)https://nhcps.com/lesson/pals-post-resuscitation-care

If a patient has a Return of Spontaneous Circulation (ROSC), start Post-Resuscitation Care immediately. Avoid hyperthermia and treat fever aggressively.Control pain with analgesics and anxiety with sedatives (e.g. benzodiazepines)

9.Which statement is correct concerning neurological assessment during post-resuscitation management?

ANS:Dilated unresponsive pupils, hypertension, bradycardia, respiratory irregularities, or apneamay indicate cerebral herniation(https://nhcps.com/lesson/pals-post-resuscitation-care/)

Monitor and treat seizures.Do not re-warm hypothermic cardiac arrest patient unless hypothermia is interfering with cardiovascular function.Hyperthermia should be strictly avoided.Normoventilation unless temporizing due to intracranial swelling.

10.All of the following are signs of cardiorespiratory distress EXCEPT:

ANS:Jaundice.

Fatigue, irregular heart rhythm and tachynea are signs of cardiorespiratory distress

11.When can post-resuscitation management be necessary?

ANS:All of the above.Successful return of spontaneous circulation (ROSC) is the first step towards the goal of complete recovery from cardiac arrest. The complex pathophysiological processes that occur following whole body ischaemia during cardiac arrest and the subsequent reperfusion response during CPR and following successful resuscitation have been termed the post-cardiac arrest syndrome. https://www.resus.org.uk/resuscitation-guidelines/post-resuscitation-care/

12.Exposure in PALS evaluations refers to an assessment for:

ANS:Any of the signs above . Exposure reminds the provider to look for signs of trauma, burns, fractures, and any other obvious sign that might provide a clue as to the cause of the current problem. https://nhcps.com/lesson/pals-initial-assessment-diagnose-treat/