ENPC ENPC Cardiovascular Emergencies 2 — Questions and Answers
Question 1: What is the correct IV/IO epinephrine dose for pediatric cardiac arrest?
- 0.01 mg/kg using 1:10,000 (0.1 mg/mL) solution (Correct answer)
- 0.1 mg/kg using 1:1,000 (1 mg/mL) solution
- 1 mg fixed dose for all children
- 0.001 mg/kg using 1:1,000 solution
Correct answer: 0.01 mg/kg using 1:10,000 (0.1 mg/mL) solution
The standard IV/IO epinephrine dose in pediatric cardiac arrest is 0.01 mg/kg using the 1:10,000 concentration.
Question 2: A child presents with muffled heart sounds, hypotension, and JVD following blunt chest trauma. Which condition is suspected?
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Traumatic aortic rupture
- Pulmonary contusion
Correct answer: Cardiac tamponade
Beck's triad (muffled heart sounds, hypotension, JVD) following chest trauma is the classic presentation of cardiac tamponade.
Question 3: A 6-year-old with Tetralogy of Fallot develops sudden cyanosis and hyperpnea. Which intervention is FIRST?
- Administer IV morphine sulfate
- Place the child in knee-chest position and give supplemental oxygen (Correct answer)
- Prepare for immediate cardiac catheterization
- Administer IV propranolol bolus
Correct answer: Place the child in knee-chest position and give supplemental oxygen
Knee-chest position increases systemic vascular resistance to reduce right-to-left shunting, and supplemental oxygen helps manage hypercyanotic spells.
Question 4: Which ECG finding in a pediatric patient requires IMMEDIATE intervention?
- Sinus arrhythmia with HR of 80 bpm
- Complete heart block with ventricular rate of 30 bpm (Correct answer)
- Occasional premature atrial contractions
- First-degree AV block with PR of 220 ms
Correct answer: Complete heart block with ventricular rate of 30 bpm
Complete heart block with a ventricular rate of 30 bpm causes severe hemodynamic compromise and requires urgent pacing or pharmacological support.
Question 5: In pediatric septic shock, what is the recommended initial fluid resuscitation volume per bolus?
- 10 mL/kg of normal saline
- 20 mL/kg of isotonic crystalloid, reassessing after each bolus (Correct answer)
- 40 mL/kg as a single rapid infusion
- 5% dextrose at twice the maintenance rate
Correct answer: 20 mL/kg of isotonic crystalloid, reassessing after each bolus
Current PALS guidelines recommend 20 mL/kg isotonic fluid boluses with clinical reassessment after each bolus to avoid fluid overload.
Question 6: A 4-year-old presents with fever, pleuritic chest pain, and diffuse ST elevation across multiple ECG leads. What condition is suspected?
- Supraventricular tachycardia
- Myocarditis
- Kawasaki disease
- Pericarditis (Correct answer)
Correct answer: Pericarditis
Diffuse ST elevation (across multiple leads) with fever and pleuritic chest pain is characteristic of pericarditis, often of viral etiology.
ENPC ENPC Cardiovascular Emergencies 2
What is the correct IV/IO epinephrine dose for pediatric cardiac arrest?