PALS Post-Cardiac Arrest Care 3 — Questions and Answers
Question 1: What hemodynamic goal is targeted for systolic blood pressure in post-cardiac arrest pediatric patients?
- Below the 5th percentile for age
- At or above the 5th percentile for age (Correct answer)
- Greater than 120 mmHg regardless of age
- 50% of normal for age
Correct answer: At or above the 5th percentile for age
Post-arrest resuscitation targets systolic BP at or above the 5th percentile for age to ensure adequate organ perfusion.
Question 2: Which of the following best describes 'post-cardiac arrest syndrome'?
- Only neurological dysfunction following ROSC
- Systemic ischemia-reperfusion response affecting brain, heart, and other organs (Correct answer)
- Cardiac arrhythmia occurring within 1 hour of ROSC
- Pulmonary edema caused exclusively by fluid overload
Correct answer: Systemic ischemia-reperfusion response affecting brain, heart, and other organs
Post-cardiac arrest syndrome is a global ischemia-reperfusion injury affecting the brain, myocardium, and systemic vasculature after ROSC.
Question 3: Which imaging modality is most useful for prognostication of neurological outcome days after pediatric cardiac arrest?
- Chest X-ray
- Brain MRI (Correct answer)
- CT angiography of the chest
- Renal ultrasound
Correct answer: Brain MRI
Brain MRI performed 2–7 days post-arrest provides the most accurate prognostic information about neurological outcome.
Question 4: A child develops recurrent seizures 6 hours after ROSC despite one dose of lorazepam. What is the next appropriate step?
- Repeat lorazepam at double the dose
- Administer fosphenytoin or levetiracetam (Correct answer)
- Perform immediate neurosurgery consult
- Increase the TTM cooling target
Correct answer: Administer fosphenytoin or levetiracetam
Benzodiazepine-refractory seizures should be treated with a second-line anticonvulsant such as fosphenytoin or levetiracetam per PALS protocols.
Question 5: During TTM rewarming, what rate of temperature increase is recommended to minimize secondary injury?
- 2–4°C per hour
- 0.1–0.5°C per hour (Correct answer)
- 1°C per hour
- Rapid rewarming over 30 minutes
Correct answer: 0.1–0.5°C per hour
Slow controlled rewarming at 0.1–0.5°C per hour prevents rebound fever and secondary neurological injury.
Question 6: Which laboratory value is most important to monitor frequently in the first 24 hours after pediatric ROSC?
- Serum sodium
- Blood glucose (Correct answer)
- Serum creatinine
- Hemoglobin A1c
Correct answer: Blood glucose
Blood glucose must be monitored frequently because both hypoglycemia and hyperglycemia after ROSC worsen neurological outcomes.
Question 7: What is the rationale for avoiding hypotension in post-cardiac arrest pediatric patients?
- Hypotension triggers arrhythmias
- Low MAP impairs cerebral perfusion pressure and worsens brain injury (Correct answer)
- Hypotension causes pulmonary edema
- Low BP increases the risk of TTM failure
Correct answer: Low MAP impairs cerebral perfusion pressure and worsens brain injury
Hypotension reduces cerebral perfusion pressure, worsening ischemic brain injury in the vulnerable post-arrest period.
PALS Post-Cardiac Arrest Care 3
What hemodynamic goal is targeted for systolic blood pressure in post-cardiac arrest pediatric patients?