PALS Managing Respiratory Emergencies 5 — Questions and Answers
Question 1: A 4-year-old is in respiratory failure from severe pneumonia. Tidal volume during bag-mask ventilation should be targeted at which amount?
- 3–4 mL/kg
- 5–8 mL/kg (Correct answer)
- 10–12 mL/kg
- 15 mL/kg
Correct answer: 5–8 mL/kg
PALS recommends tidal volumes of 5–8 mL/kg for pediatric bag-mask ventilation to provide adequate ventilation while avoiding barotrauma.
Question 2: Which of the following is a sign of 'compensated' respiratory distress rather than 'decompensated' respiratory failure?
- Bradycardia and hypotension
- Altered mental status and cyanosis
- Tachycardia with maintained SpO2 ≥94% (Correct answer)
- Absent respiratory effort
Correct answer: Tachycardia with maintained SpO2 ≥94%
In compensated respiratory distress the child works harder to breathe but maintains oxygenation; decompensation occurs when compensatory mechanisms fail.
Question 3: A child receives succinylcholine for RSI. Which contraindication should have been ruled out before administration?
- Suspected foreign body aspiration
- Known or suspected hyperkalemia or crush injury (Correct answer)
- Active bronchospasm
- Age under 2 years
Correct answer: Known or suspected hyperkalemia or crush injury
Succinylcholine can cause fatal hyperkalemia in patients with crush injuries, burns, denervation injuries, or pre-existing hyperkalemia — it must be avoided in these cases.
Question 4: A 1-year-old with a history of prematurity presents with wheeze and respiratory distress. The parents report this is the first episode. What additional history finding would support reactive airway disease over bronchiolitis?
- URI prodrome over the past 3 days
- Family history of atopy and asthma (Correct answer)
- Fever of 38.5°C
- Exposure to a sibling with RSV
Correct answer: Family history of atopy and asthma
A strong family history of atopy or asthma in a first-episode wheeze shifts the diagnosis toward reactive airway disease, although this age group often has overlapping presentations.
Question 5: Which initial action is most appropriate when a 2-year-old with suspected partial foreign body airway obstruction presents with stridor, coughing, and a weak cry but is still moving air?
- Perform back blows and chest thrusts immediately
- Perform blind finger sweeps of the oropharynx
- Encourage the child to continue coughing and monitor closely (Correct answer)
- Perform abdominal thrusts (Heimlich maneuver)
Correct answer: Encourage the child to continue coughing and monitor closely
In partial airway obstruction with an effective cough, allowing the child to clear the obstruction spontaneously by coughing is preferred over blind maneuvers that could worsen the obstruction.
Question 6: A child with status asthmaticus is intubated. Shortly after intubation, SpO2 drops and peak airway pressures increase. After ruling out ETT malposition and pneumothorax, which ventilator-related cause is most likely?
- Auto-PEEP from insufficient expiratory time (Correct answer)
- Excessive tidal volume causing volutrauma
- Low FiO2 setting
- Inadequate PEEP causing atelectasis
Correct answer: Auto-PEEP from insufficient expiratory time
Air trapping (auto-PEEP) is a critical concern when ventilating status asthmaticus patients; insufficient expiratory time causes progressive hyperinflation and hemodynamic compromise.
Question 7: Which medication is the first-line treatment for anaphylaxis-related upper airway angioedema in a child?
- Diphenhydramine IV
- Methylprednisolone IV
- Epinephrine IM (anterolateral thigh) (Correct answer)
- Racemic epinephrine nebulized
Correct answer: Epinephrine IM (anterolateral thigh)
Intramuscular epinephrine to the anterolateral thigh is the first-line and life-saving treatment for anaphylaxis, including anaphylactic airway angioedema.
PALS Managing Respiratory Emergencies 5
A 4-year-old is in respiratory failure from severe pneumonia.
Tidal volume during bag-mask ventilation should be targeted at which amount?