PALS Managing Respiratory Emergencies 4 — Questions and Answers
Question 1: A 2-year-old with croup has moderate stridor at rest and moderate retractions. After racemic epinephrine, the child improves. What is the minimum observation period before discharge?
- 30 minutes
- 1 hour
- 2–4 hours (Correct answer)
- 6 hours
Correct answer: 2–4 hours
Because racemic epinephrine's effect is temporary (rebound phenomenon can occur), children must be observed for 2–4 hours before discharge.
Question 2: During bag-mask ventilation, you notice the child's chest is not rising. After repositioning the head and ensuring a proper mask seal, there is still no rise. What is the next step?
- Increase bag compression force significantly
- Check for and relieve airway obstruction with a jaw thrust (Correct answer)
- Switch to a larger mask immediately
- Proceed directly to intubation
Correct answer: Check for and relieve airway obstruction with a jaw thrust
If repositioning and mask seal fail to produce chest rise, a jaw thrust to open the airway is the next maneuver before escalating to a more invasive airway.
Question 3: A 9-year-old post-drowning victim is intubated and ventilated. ETCO2 reads 55 mmHg. Which action is correct?
- Decrease the respiratory rate to raise ETCO2 further
- Increase the respiratory rate to lower ETCO2 (Correct answer)
- Accept this value as it is within normal range
- Administer sodium bicarbonate immediately
Correct answer: Increase the respiratory rate to lower ETCO2
An ETCO2 of 55 mmHg indicates hypercapnia (hypoventilation); increasing the respiratory rate will blow off more CO2 and correct this.
Question 4: Which of the following is the most reliable indicator of correct ETT placement after intubation?
- Visible chest rise with ventilation
- Mist in the ETT
- Continuous waveform capnography (Correct answer)
- Symmetric breath sounds on auscultation
Correct answer: Continuous waveform capnography
Continuous waveform capnography (ETCO2) is the gold standard for confirming and continuously monitoring ETT placement in a perfusing patient.
Question 5: A 3-month-old with bronchiolitis has apnea lasting 20 seconds. What is the most appropriate immediate intervention?
- Administer albuterol via nebulizer
- Apply stimulation and prepare for bag-mask ventilation (Correct answer)
- Suction the nares and oropharynx only
- Administer dexamethasone IV
Correct answer: Apply stimulation and prepare for bag-mask ventilation
Apnea in an infant with bronchiolitis requires immediate stimulation and readiness for bag-mask ventilation to support oxygenation and ventilation.
Question 6: When preparing for pediatric rapid sequence intubation (RSI), which pre-oxygenation method is preferred for a spontaneously breathing patient?
- 100% O2 via non-rebreather mask for 3–5 minutes (Correct answer)
- Immediate bag-mask ventilation at 20 breaths/min
- Nasal cannula at 2 L/min for 1 minute
- Room air breathing with pulse oximetry monitoring only
Correct answer: 100% O2 via non-rebreather mask for 3–5 minutes
Pre-oxygenating with 100% FiO2 via non-rebreather mask for 3–5 minutes maximizes nitrogen washout and extends the safe apnea period during RSI.
Question 7: A 6-year-old presents with sudden onset respiratory distress, absent breath sounds on the right, and tracheal deviation to the left. After needle decompression of the right second intercostal space, breath sounds return. This confirms which diagnosis?
- Massive hemothorax
- Right tension pneumothorax (Correct answer)
- Left tension pneumothorax
- Right pleural effusion
Correct answer: Right tension pneumothorax
Right tension pneumothorax causes absent right breath sounds, tracheal deviation away from the affected side (to the left), and is relieved by needle decompression on the right.
PALS Managing Respiratory Emergencies 4
A 2-year-old with croup has moderate stridor at rest and moderate retractions.
After racemic epinephrine, the child improves.
What is the minimum observation period before discharge?