PALS Shock Management 3 — Questions and Answers
Question 1: A child with known congenital heart disease develops cardiogenic shock. Which vasoactive agent is most appropriate to improve cardiac contractility?
- Norepinephrine
- Vasopressin
- Dobutamine (Correct answer)
- Phenylephrine
Correct answer: Dobutamine
Dobutamine is a beta-1 agonist that increases myocardial contractility and is first-line for cardiogenic shock with preserved blood pressure.
Question 2: A 4-year-old with purpuric rash, fever, and hypotension most likely has which type of shock?
- Hypovolemic shock
- Cardiogenic shock
- Septic (distributive) shock (Correct answer)
- Obstructive shock
Correct answer: Septic (distributive) shock
Purpuric rash with fever and hemodynamic instability suggests meningococcemia causing septic shock, a form of distributive shock.
Question 3: Which hemodynamic pattern is characteristic of hypovolemic shock?
- High CO, low SVR
- Low CO, high SVR (Correct answer)
- High CO, high SVR
- Low CO, low SVR
Correct answer: Low CO, high SVR
Hypovolemic shock causes reduced preload, leading to low cardiac output and compensatory increased systemic vascular resistance.
Question 4: A child in septic shock with fluid-refractory hypotension and suspected adrenal insufficiency should receive which additional treatment?
- IV calcium gluconate
- Hydrocortisone stress dosing (Correct answer)
- Sodium bicarbonate bolus
- Fresh frozen plasma
Correct answer: Hydrocortisone stress dosing
Hydrocortisone is indicated for catecholamine-resistant septic shock when adrenal insufficiency is suspected to restore vascular responsiveness.
Question 5: What is the target mean arterial pressure (MAP) goal when managing pediatric septic shock?
- Greater than 45 mmHg for all ages
- Age-appropriate normal MAP (Correct answer)
- MAP > 65 mmHg regardless of age
- MAP > 80 mmHg to ensure perfusion
Correct answer: Age-appropriate normal MAP
MAP goals in pediatric septic shock should be age-appropriate, as normal MAP varies significantly from infants to adolescents.
Question 6: Which of the following best describes 'cold shock' in a septic pediatric patient?
- Hypotension with warm, flushed extremities and bounding pulses
- Hypotension with cool extremities, prolonged CRT, and weak pulses (Correct answer)
- Hypertension with cool extremities and normal CRT
- Normal blood pressure with fever and tachycardia only
Correct answer: Hypotension with cool extremities, prolonged CRT, and weak pulses
Cold septic shock is characterized by low cardiac output with compensatory vasoconstriction, producing cool extremities and weak pulses.
Question 7: A 10-year-old trauma victim has HR 130, BP 80/50, and estimated 30% blood loss. What is the best initial vascular access strategy?
- Wait for central venous access before fluids
- Establish intraosseous access immediately if peripheral IV fails (Correct answer)
- Begin oral rehydration therapy
- Apply MAST trousers and transport without fluids
Correct answer: Establish intraosseous access immediately if peripheral IV fails
Intraosseous access provides rapid, reliable vascular access when peripheral IV cannot be established quickly in a critically ill child.
PALS Shock Management 3
A child with known congenital heart disease develops cardiogenic shock.
Which vasoactive agent is most appropriate to improve cardiac contractility?