PALS - Pediatric Advanced Life Support Pediatric Shock Management Questions and Answers

Question 1

A 4-year-old child presents with a two-day history of fever, vomiting, and diarrhea.
On examination, the child is lethargic with cool extremities, a capillary refill time of 4 seconds, and a heart rate of 160/min.
The blood pressure is 80/50 mmHg.
What is the most appropriate initial fluid resuscitation for this child in suspected hypovolemic shock?

Accepted Answer

Administer a 20 mL/kg bolus of 0.9% normal saline over 5-20 minutes.

Answer

Administer a 5 mL/kg bolus of 5% dextrose over 60 minutes.

Answer

Administer a 10 mL/kg bolus of packed red blood cells immediately.

Answer

Administer a 20 mL/kg bolus of 0.45% saline over 30 minutes.

Question 2

A 6-year-old is brought to the emergency department with suspected septic shock. The child is febrile, tachycardic, and has a prolonged capillary refill. After administering three 20 mL/kg boluses of isotonic crystalloid, the child remains hypotensive with poor perfusion. Which of the following is the most appropriate next step in management?

Accepted Answer

Initiate an epinephrine or norepinephrine infusion.

Answer

Administer another 20 mL/kg fluid bolus.

Answer

Administer a dose of furosemide to prevent fluid overload.

Answer

Start a dopamine infusion.

Question 3

You are managing a 2-year-old with cardiogenic shock secondary to myocarditis. The child has tachypnea, increased work of breathing, and crackles on lung auscultation. Blood pressure is low for age. Which fluid management strategy is most appropriate for this patient?

Accepted Answer

Cautious 5-10 mL/kg bolus of isotonic crystalloid over 10-20 minutes.

Answer

Rapid 20 mL/kg bolus of normal saline.

Answer

No fluids should be given; start diuretics immediately.

Answer

Administer 20 mL/kg of albumin over one hour.

Question 4

Which of the following is considered a late and ominous sign of shock in a pediatric patient?

Accepted Answer

Hypotension

Answer

Tachycardia

Answer

Delayed capillary refill

Answer

Cool extremities

Question 5

A 5-year-old boy with a known severe peanut allergy accidentally ingested a cookie containing peanuts. He is now anxious, has diffuse urticaria, wheezing, and a blood pressure of 70/40 mmHg. What is the immediate, first-line medication for managing his condition?

Accepted Answer

Intramuscular epinephrine

Answer

Intravenous diphenhydramine

Answer

A rapid 20 mL/kg bolus of normal saline

Answer

Intravenous hydrocortisone

Question 6

A 10-year-old presents with signs of shock, including tachycardia, cool skin, and altered mental status, but their systolic blood pressure is 95 mmHg, which is within the normal range for their age. This clinical state is best described as:

Accepted Answer

Compensated shock

Answer

Septic shock

Answer

Decompensated shock

Answer

Irreversible shock