NPS NPS Emergency and Critical Care 1 — Questions and Answers
Question 1: During neonatal resuscitation, chest compressions are indicated when the heart rate remains below what threshold after 30 seconds of effective positive pressure ventilation?
- 40 bpm
- 60 bpm (Correct answer)
- 80 bpm
- 100 bpm
Correct answer: 60 bpm
NRP guidelines specify initiating chest compressions when HR remains <60 bpm after 30 seconds of effective PPV with 100% oxygen.
Question 2: The correct compression-to-ventilation ratio during neonatal CPR is:
- 15:2
- 30:2
- 3:1 (Correct answer)
- 5:1
Correct answer: 3:1
NRP recommends a 3:1 compression-to-ventilation ratio (90 compressions + 30 breaths per minute) for neonatal CPR to prioritize ventilation in asphyxia-driven cardiac arrest.
Question 3: A 6-week-old infant presents with apnea, bradycardia, and poor perfusion. Heart rate is 40 bpm. After initiating CPR, which vascular access is the fastest to establish?
- Peripheral IV in antecubital vein
- Umbilical venous catheter
- Intraosseous access (IO) (Correct answer)
- Central venous catheter
Correct answer: Intraosseous access (IO)
Intraosseous access is the fastest vascular access in pediatric emergencies when peripheral IV fails, allowing immediate delivery of resuscitative medications.
Question 4: What is the initial fluid bolus volume and type for a pediatric patient in septic shock?
- 5 mL/kg normal saline
- 10 mL/kg albumin
- 20 mL/kg isotonic crystalloid (Correct answer)
- 40 mL/kg D5 0.45NS
Correct answer: 20 mL/kg isotonic crystalloid
Current PALS guidelines recommend 20 mL/kg isotonic crystalloid (normal saline or LR) as the initial fluid bolus for pediatric septic shock, reassessing after each bolus.
Question 5: A 3-year-old child has an anaphylactic reaction at a peanut-free facility. What is the first-line treatment?
- Diphenhydramine IV
- Methylprednisolone IV
- Epinephrine IM (0.01 mg/kg) into the anterolateral thigh (Correct answer)
- Albuterol nebulization
Correct answer: Epinephrine IM (0.01 mg/kg) into the anterolateral thigh
Intramuscular epinephrine 0.01 mg/kg (max 0.5 mg) into the anterolateral thigh is the first-line treatment for anaphylaxis in children — antihistamines and steroids are adjuncts.
Question 6: Which is the most common cause of cardiac arrest in the pediatric population outside of the neonatal period?
- Primary ventricular fibrillation
- Respiratory failure leading to hypoxic cardiac arrest (Correct answer)
- Congenital heart defects
- Electrolyte imbalances
Correct answer: Respiratory failure leading to hypoxic cardiac arrest
Unlike adults, pediatric cardiac arrest is predominantly caused by respiratory failure (asphyxia) rather than primary cardiac arrhythmia, making airway management the priority.
NPS NPS Emergency and Critical Care 1
During neonatal resuscitation, chest compressions are indicated when the heart rate remains below what threshold after 30 seconds of effective positive pressure ventilation?