PALS Post-Cardiac Arrest Care 4 — Questions and Answers
Question 1: A post-arrest child on TTM develops shivering. Why is shivering problematic in this setting?
- It raises core temperature and counteracts cooling (Correct answer)
- It indicates return of neurological function and should be encouraged
- It only increases discomfort but has no physiological effect
- It causes bradycardia requiring atropine
Correct answer: It raises core temperature and counteracts cooling
Shivering generates heat, which raises core temperature and undermines the cooling goals of TTM.
Question 2: Which of the following is an appropriate management target for post-arrest oxygen delivery in pediatric patients?
- SpO2 of 100% with high-flow oxygen
- PaO2 of 60–80 mmHg
- SpO2 of 94–99% (Correct answer)
- SpO2 below 90% to reduce reperfusion injury
Correct answer: SpO2 of 94–99%
Targeting SpO2 94–99% avoids both hypoxia and hyperoxia, both of which worsen outcomes after cardiac arrest.
Question 3: What is the primary concern when giving high-dose IV fluids immediately after ROSC in a child?
- Fluid causes hypothermia
- Myocardial dysfunction may worsen with volume overload (Correct answer)
- Fluids increase blood glucose dangerously
- IV fluids alkalinize the blood inappropriately
Correct answer: Myocardial dysfunction may worsen with volume overload
Post-arrest myocardial dysfunction is common; excessive fluid boluses can worsen cardiac output in a stunned heart.
Question 4: A child 48 hours post-cardiac arrest has a fixed, dilated pupil. How should this finding be interpreted in the context of TTM?
- It is a definitive sign of brain death and withdrawal should be discussed immediately
- Pupillary findings during TTM are unreliable and must be interpreted cautiously (Correct answer)
- It confirms brainstem herniation and indicates immediate surgical decompression
- It indicates the TTM target temperature is too low
Correct answer: Pupillary findings during TTM are unreliable and must be interpreted cautiously
TTM and sedating medications can alter pupillary responses, making neurological prognostication unreliable until at least 72 hours after rewarming.
Question 5: Which ECG finding post-ROSC should prompt urgent evaluation for a reversible cardiac cause of arrest?
- Sinus tachycardia
- ST-segment elevation (Correct answer)
- Respiratory sinus arrhythmia
- Isolated PR interval prolongation
Correct answer: ST-segment elevation
ST-segment elevation post-ROSC may indicate acute coronary syndrome or myocarditis requiring immediate cardiac evaluation and possible intervention.
Question 6: When is the earliest appropriate time to begin neurological prognostication in a post-cardiac arrest child managed with TTM?
- Immediately after ROSC
- Within the first 24 hours
- At least 72 hours after rewarming is complete (Correct answer)
- Only after the child is extubated
Correct answer: At least 72 hours after rewarming is complete
Reliable neurological prognostication should not occur until at least 72 hours after completing rewarming to allow drug clearance and recovery.
Question 7: What is the recommended approach to ventilation rate in an intubated post-arrest pediatric patient?
- Hyperventilate at 20–30 breaths/min to reduce ICP
- Ventilate to achieve normocapnia (PaCO2 35–45 mmHg) (Correct answer)
- Hypoventilate to maintain PaCO2 > 55 mmHg
- Use spontaneous ventilation only to avoid ventilator-induced injury
Correct answer: Ventilate to achieve normocapnia (PaCO2 35–45 mmHg)
Normocapnic ventilation prevents cerebrovascular changes from both hypocapnia and hypercapnia during the post-arrest period.
PALS Post-Cardiac Arrest Care 4
A post-arrest child on TTM develops shivering.
Why is shivering problematic in this setting?