PALS Managing Respiratory Emergencies 3 — Questions and Answers
Question 1: A 4-year-old is found unresponsive with agonal respirations and no pulse. After 2 minutes of CPR, the cardiac monitor shows a narrow complex tachycardia at 210 bpm with a palpable pulse. What is this rhythm?
- Sinus tachycardia
- Supraventricular tachycardia (SVT) (Correct answer)
- Ventricular tachycardia
- Junctional rhythm
Correct answer: Supraventricular tachycardia (SVT)
SVT at rates typically >220 bpm in infants or >180 bpm in children, with a narrow complex and sudden onset, is differentiated from sinus tachycardia by its extreme rate and lack of rate variability.
Question 2: A 7-year-old with epiglottitis requires airway management. Which approach is safest?
- Immediate RSI in the ED
- Allow the child to remain calm and transport to OR for controlled intubation (Correct answer)
- Insert an NPA immediately
- Perform blind nasotracheal intubation
Correct answer: Allow the child to remain calm and transport to OR for controlled intubation
Epiglottitis management prioritizes keeping the child calm and performing intubation in a controlled OR setting with ENT backup to avoid sudden complete obstruction.
Question 3: A 10-month-old presents with a 2-day history of cough, wheeze, and low-grade fever. Examination shows prolonged expiration and diffuse crackles. What is the most likely diagnosis?
- Croup
- Pneumonia
- Bronchiolitis (Correct answer)
- Asthma
Correct answer: Bronchiolitis
Bronchiolitis, most commonly caused by RSV, typically affects infants under 2 years with wheeze, prolonged expiration, and crackles following an upper respiratory prodrome.
Question 4: Correct ETT depth (cm at the lip) for oral intubation in a child can be estimated by which formula?
- Age/2 + 12
- Age/4 + 10 (Correct answer)
- Weight (kg)/2 + 12
- Age (years) + 10
Correct answer: Age/4 + 10
The formula (Age/4 + 10) estimates oral ETT insertion depth at the lip in centimeters for pediatric patients.
Question 5: A 5-year-old is intubated for respiratory failure. Post-intubation chest X-ray shows only right lung inflation. What is the most likely cause?
- Right-sided pneumothorax
- Left tension pneumothorax
- Right mainstem intubation (Correct answer)
- Mucus plug in left bronchus
Correct answer: Right mainstem intubation
Right mainstem bronchus intubation is common due to its less acute angle, resulting in right-only lung inflation and absent left breath sounds.
Question 6: In a pediatric patient receiving non-invasive positive pressure ventilation (NIPPV), which parameter directly reduces the work of breathing by counteracting auto-PEEP?
- Inspiratory positive airway pressure (IPAP)
- Expiratory positive airway pressure (EPAP) (Correct answer)
- FiO2 setting
- Backup respiratory rate
Correct answer: Expiratory positive airway pressure (EPAP)
EPAP (similar to PEEP) stents open the small airways, counteracts intrinsic auto-PEEP in obstructive disease, and reduces the inspiratory effort required to trigger a breath.
Question 7: Which clinical scenario represents the 'upper airway obstruction' pattern of respiratory distress?
- Diffuse expiratory wheeze with prolonged expiratory phase
- Inspiratory stridor with suprasternal retractions (Correct answer)
- Bilateral crackles with decreased breath sounds at bases
- Asymmetric breath sounds with tracheal deviation
Correct answer: Inspiratory stridor with suprasternal retractions
Upper airway obstruction produces inspiratory stridor and suprasternal retractions because the obstruction creates turbulent flow during inspiration.
PALS Managing Respiratory Emergencies 3
A 4-year-old is found unresponsive with agonal respirations and no pulse.
After 2 minutes of CPR, the cardiac monitor shows a narrow complex tachycardia at 210 bpm with a palpable pulse.
What is this rhythm?