PALS Post-Cardiac Arrest Care 5 — Questions and Answers
Question 1: A 5-year-old resuscitated from VF arrest is now post-ROSC. Which underlying condition should be considered and investigated?
- Febrile seizure disorder
- Structural heart disease or inherited channelopathy (Correct answer)
- Viral upper respiratory infection
- Idiopathic hypertension
Correct answer: Structural heart disease or inherited channelopathy
VF in a child is uncommon and warrants evaluation for structural heart disease, cardiomyopathy, or inherited ion channelopathies such as long QT syndrome.
Question 2: Which of the following best describes the role of echocardiography in post-cardiac arrest pediatric care?
- It is used exclusively to diagnose brain death
- It evaluates myocardial function and guides fluid and vasopressor management (Correct answer)
- It replaces the need for blood pressure monitoring
- It is contraindicated during TTM
Correct answer: It evaluates myocardial function and guides fluid and vasopressor management
Echocardiography assesses post-arrest myocardial dysfunction and helps titrate hemodynamic support including fluids and vasoactive medications.
Question 3: During post-arrest care, a child develops refractory shock despite epinephrine infusion. What should be considered next?
- Discontinue all vasoactive medications
- Evaluate for tension pneumothorax, tamponade, or other reversible causes (Correct answer)
- Increase the TTM cooling temperature
- Administer adenosine to stabilize rhythm
Correct answer: Evaluate for tension pneumothorax, tamponade, or other reversible causes
Refractory shock post-arrest should prompt reassessment for treatable causes such as tension pneumothorax, cardiac tamponade, or metabolic abnormalities.
Question 4: What is the purpose of continuous capnography monitoring in the post-arrest pediatric patient?
- To detect hypoglycemia early
- To confirm endotracheal tube position and monitor ventilation adequacy (Correct answer)
- To replace pulse oximetry for oxygenation monitoring
- To measure cardiac output directly
Correct answer: To confirm endotracheal tube position and monitor ventilation adequacy
Continuous capnography confirms ongoing ETT placement and helps titrate ventilation to normocapnia during the post-arrest period.
Question 5: A child post-ROSC has lactic acidosis with a pH of 7.15. What is the MOST appropriate initial management?
- Administer sodium bicarbonate immediately
- Optimize ventilation, oxygenation, and perfusion to clear the lactate (Correct answer)
- Restrict all IV fluids to prevent acidosis worsening
- Begin hemodialysis for metabolic correction
Correct answer: Optimize ventilation, oxygenation, and perfusion to clear the lactate
Post-arrest lactic acidosis usually resolves with optimizing perfusion; sodium bicarbonate is not routinely recommended and does not improve outcomes.
Question 6: Which family communication practice is recommended during post-cardiac arrest pediatric care?
- Withhold all prognostic information until 30 days post-arrest
- Provide regular, honest, compassionate updates with prognostic uncertainty acknowledged (Correct answer)
- Limit family contact to prevent emotional interference with care
- Defer all discussions to discharge
Correct answer: Provide regular, honest, compassionate updates with prognostic uncertainty acknowledged
PALS emphasizes clear, compassionate, and ongoing family communication including honest acknowledgment of prognostic uncertainty.
Question 7: In post-cardiac arrest care, which intervention has the strongest evidence for improving neurological outcomes in pediatric patients?
- High-dose corticosteroids
- Magnesium sulfate infusion
- Targeted temperature management (TTM) (Correct answer)
- Early tracheostomy
Correct answer: Targeted temperature management (TTM)
TTM (targeting 32–34°C or preventing fever at 36–37.5°C) has the strongest evidence base for neuroprotection in comatose post-arrest pediatric patients.
PALS Post-Cardiac Arrest Care 5
A 5-year-old resuscitated from VF arrest is now post-ROSC.
Which underlying condition should be considered and investigated?