PALS Vascular Access and Fluid Management in Pediatric Emergencies 2 — Questions and Answers
Question 1: What maximum fluid volume (in mL/kg) should be given before reassessing a child in septic shock and considering vasopressors?
- 40–60 mL/kg (Correct answer)
- 10–20 mL/kg
- 100 mL/kg
- 5 mL/kg
Correct answer: 40–60 mL/kg
PALS guidelines suggest reassessing and considering vasoactive agents after 40–60 mL/kg of fluid if perfusion has not improved.
Question 2: A child with distributive shock is fluid-resuscitated but becomes hypotensive with signs of fluid overload. Which finding suggests fluid overload?
- New crackles on lung auscultation and hepatomegaly (Correct answer)
- Dry mucous membranes
- Sunken fontanelle
- Decreased skin turgor
Correct answer: New crackles on lung auscultation and hepatomegaly
Pulmonary crackles and hepatomegaly indicate excessive fluid accumulation, signaling fluid overload in pediatric patients.
Question 3: Which drug is used as a first-line vasoactive agent for cold septic shock (decreased cardiac output) in children?
- Epinephrine (Correct answer)
- Norepinephrine
- Vasopressin
- Phenylephrine
Correct answer: Epinephrine
Epinephrine is preferred for cold septic shock because its combined alpha and beta effects increase cardiac output and vascular tone.
Question 4: During IO administration of medications, which action must be performed to ensure drug delivery into the circulation?
- Flush with 5–10 mL of normal saline after each drug (Correct answer)
- Aspirate bone marrow to confirm placement before every dose
- Remove the IO needle and reinsert at a different site
- Dilute all medications in 50 mL of D5W
Correct answer: Flush with 5–10 mL of normal saline after each drug
Flushing with saline after IO drug administration ensures the medication reaches the systemic circulation from the bone marrow cavity.
Question 5: Which of the following is a contraindication to IO placement at a specific site?
- Fracture of the bone proximal to the intended site (Correct answer)
- Intact skin over the insertion site
- Age under 1 year
- Use of a manual IO needle
Correct answer: Fracture of the bone proximal to the intended site
A fracture proximal to the IO site is a contraindication because fluids and medications can extravasate through the fracture site into surrounding tissue.
Question 6: In a child with obstructive shock from tension pneumothorax, what is the definitive treatment?
- Needle decompression followed by chest tube thoracostomy (Correct answer)
- IV fluid bolus of 20 mL/kg
- Synchronized cardioversion
- Endotracheal intubation alone
Correct answer: Needle decompression followed by chest tube thoracostomy
Tension pneumothorax causing obstructive shock requires immediate needle decompression followed by chest tube placement to relieve the obstruction.
PALS Vascular Access and Fluid Management in Pediatric Emergencies 2
What maximum fluid volume (in mL/kg) should be given before reassessing a child in septic shock and considering vasopressors?