PALS - Pediatric Advanced Life Support Post-Cardiac Arrest Care Questions and Answers

Question 1

An 8-year-old child is intubated and mechanically ventilated after achieving Return of Spontaneous Circulation (ROSC). The initial SpO2 reading is 100% while receiving 100% FiO2. What is the most appropriate next step regarding oxygen therapy?

Accepted Answer

Titrate FiO2 downwards to achieve a target SpO2 between 94% and 99%.

Answer

After ROSC, both hypoxia and hyperoxia can be harmful, with hyperoxia potentially causing reperfusion injury from oxygen-free radicals. [1, 4] The PALS guidelines recommend titrating the fraction of inspired oxygen (FiO2) to the lowest level required to maintain an oxygen saturation (SpO2) between 94% and 99%. [1, 2, 4, 5] While an ABG is useful, the immediate action is to reduce the FiO2 to avoid the harmful effects of 100% oxygen.

Question 2

A 5-year-old child remains comatose after ROSC from an out-of-hospital cardiac arrest. Which of the following is a primary goal of targeted temperature management (TTM) for this patient?

Accepted Answer

Actively preventing or treating fever to maintain normothermia (36°C to 37.5°C).

Answer

Post-cardiac arrest fever is common and is associated with worse neurological outcomes. [1, 6] The PALS guidelines strongly recommend targeted temperature management to actively prevent and treat fever, maintaining a core temperature between 36°C and 37.5°C. [1, 7, 18] While a period of induced hypothermia (32°C-34°C) is also an acceptable strategy, the absolute priority is the prevention of hyperthermia. [1, 7, 12]

Question 3

A 7-year-old child achieves ROSC after a witnessed in-hospital cardiac arrest. The team is now implementing the post-cardiac arrest care plan. What is the minimum systolic blood pressure the team should target to avoid hypotension?

Accepted Answer

At least the 5th percentile for age

Answer

Avoiding hypotension is critical for perfusing vital organs after ROSC. The PALS guidelines recommend maintaining a systolic blood pressure of at least the 5th percentile for the child's age. [1] For a child aged 1-10 years, this can be estimated using the formula: 70 + (2 x age in years). For a 7-year-old, this would be 70 + (14) = 84 mmHg.

Question 4

You are managing a comatose toddler in the PICU following a prolonged resuscitation. Continuous EEG monitoring is initiated. What is the primary rationale for this intervention in post-cardiac arrest care?

Accepted Answer

To detect and guide the treatment of subclinical seizures.

Answer

Seizures, including non-convulsive or subclinical seizures, are common after cardiac arrest and can worsen secondary brain injury by increasing metabolic demand. [3, 9] Continuous EEG monitoring is recommended for comatose patients to detect these seizures so they can be treated promptly with anticonvulsants. [8, 9]

Question 5

Which of the following assessments are considered essential components of the initial evaluation and management in the immediate post-ROSC period?

Accepted Answer

Obtaining a 12-lead ECG and monitoring blood glucose levels.

Answer

In the immediate post-ROSC phase, it is critical to identify and treat underlying causes and prevent secondary injury. [2, 5] A 12-lead ECG is vital for detecting underlying cardiac pathologies or ischemia. [2] Blood glucose monitoring is also crucial, as both hypoglycemia and hyperglycemia are common and associated with poor neurologic outcomes. [2, 5, 10]

PALS - Pediatric Advanced Life Support Practice Test

PALS - Pediatric Advanced Life Support Practice Test

PALS - Pediatric Advanced Life Support Post-Cardiac Arrest Care Questions and Answers