PALS Vascular Access and Fluid Management in Pediatric Emergencies

Question 1

When peripheral IV access cannot be established quickly in a critically ill child, what is the recommended alternative route for emergency medication administration?

Accepted Answer

Intraosseous (IO) access

Answer

Central venous catheter

Answer

Endotracheal tube

Answer

Subcutaneous injection

Question 2

Which is the preferred IO insertion site in infants and young children?

Accepted Answer

Proximal tibia, 1–3 cm below the tibial tuberosity

Answer

Distal femur

Answer

Humeral head

Answer

Iliac crest

Question 3

A 10 kg child in septic shock requires a fluid bolus. What is the correct isotonic fluid dose per PALS guidelines?

Accepted Answer

10–20 mL/kg of isotonic crystalloid over 10–20 minutes

Answer

50 mL/kg given as fast as possible

Answer

5 mL/kg of 5% dextrose

Answer

30 mL/kg of colloid

Question 4

After administering 60 mL/kg of isotonic fluid to a child in septic shock with no improvement, what medication should be started?

Accepted Answer

Vasoactive agents such as epinephrine or norepinephrine

Answer

Additional 20 mL/kg fluid bolus

Answer

IV furosemide

Answer

Sodium bicarbonate

Question 5

Which finding best indicates that a fluid bolus has been successful in a child with hypovolemic shock?

Accepted Answer

Improved capillary refill, improved mental status, and normalization of heart rate

Answer

Increase in respiratory rate

Answer

Rise in temperature

Answer

Decrease in urine output

Question 6

Which isotonic crystalloid is most commonly used for initial fluid resuscitation in pediatric shock per PALS?

Accepted Answer

Normal saline (0.9% NaCl) or lactated Ringer's solution

Answer

5% dextrose in water (D5W)

Answer

0.45% NaCl (half-normal saline)

Answer

Albumin 5%