PALS Shock Management 4 — Questions and Answers
Question 1: A newborn with ductal-dependent congenital heart disease develops cardiogenic shock at day 3 of life. Which medication is critical to administer?
- Furosemide IV push
- Prostaglandin E1 (alprostadil) (Correct answer)
- Adenosine IV
- Amiodarone IV
Correct answer: Prostaglandin E1 (alprostadil)
Prostaglandin E1 keeps the ductus arteriosus open in ductal-dependent lesions, maintaining pulmonary or systemic blood flow.
Question 2: During resuscitation of a child in shock, which lab value most directly assesses tissue oxygen delivery and adequacy of perfusion?
- Serum sodium
- Lactate level (Correct answer)
- Serum creatinine
- White blood cell count
Correct answer: Lactate level
Elevated serum lactate indicates anaerobic metabolism from inadequate oxygen delivery to tissues, reflecting shock severity.
Question 3: A 7-year-old with acute myocarditis develops cardiogenic shock with severe hypotension despite dobutamine. Which therapy should be added next?
- Additional fluid boluses of 20 mL/kg
- Norepinephrine to support blood pressure (Correct answer)
- Immediate cardioversion
- High-dose furosemide infusion
Correct answer: Norepinephrine to support blood pressure
Norepinephrine provides vasopressor support to maintain perfusion pressure when cardiogenic shock is severe and inotropes alone are insufficient.
Question 4: Which parameter best indicates ADEQUATE fluid resuscitation response in a child with hypovolemic shock?
- Decrease in heart rate toward normal range (Correct answer)
- Rise in blood pressure above 140/90
- Increase in respiratory rate
- Widening of pulse pressure beyond 60 mmHg
Correct answer: Decrease in heart rate toward normal range
Return of heart rate toward age-appropriate normal is a key clinical indicator that perfusion and volume status are improving.
Question 5: A child with hemorrhagic shock due to trauma requires packed red blood cells. What is the recommended initial PRBC dose in pediatric patients?
- 5 mL/kg over 4 hours
- 10 mL/kg over 30–60 minutes (Correct answer)
- 20 mL/kg bolus
- 1 unit (250 mL) regardless of weight
Correct answer: 10 mL/kg over 30–60 minutes
10 mL/kg of PRBC over 30–60 minutes is the standard pediatric transfusion dose for hemorrhagic or anemia-related shock.
Question 6: In neurogenic shock following spinal cord injury, which hemodynamic pattern is expected?
- Tachycardia and high SVR
- Bradycardia and low SVR (Correct answer)
- Tachycardia and low SVR
- Bradycardia and high SVR
Correct answer: Bradycardia and low SVR
Loss of sympathetic tone in neurogenic shock causes bradycardia and vasodilation (low SVR), distinguishing it from other shock types.
Question 7: A child receiving epinephrine infusion for fluid-refractory cold septic shock develops worsening extremity ischemia. Which action is most appropriate?
- Increase the epinephrine dose
- Add vasopressin and reduce epinephrine (Correct answer)
- Switch to phenylephrine
- Discontinue all vasoactives immediately
Correct answer: Add vasopressin and reduce epinephrine
Vasopressin can be added as a catecholamine-sparing agent, allowing reduction of epinephrine and decreasing peripheral vasoconstriction.
PALS Shock Management 4
A newborn with ductal-dependent congenital heart disease develops cardiogenic shock at day 3 of life.
Which medication is critical to administer?