PALS Shock Management 5 — Questions and Answers
Question 1: A 2-year-old is brought in with vomiting and diarrhea for 3 days. HR is 175, CRT is 5 sec, skin turgor is poor, and mucous membranes are dry. What is the primary shock type?
- Distributive shock
- Cardiogenic shock
- Hypovolemic shock (Correct answer)
- Obstructive shock
Correct answer: Hypovolemic shock
Prolonged vomiting and diarrhea cause volume depletion leading to hypovolemic shock, the most common type of shock in children.
Question 2: Which PALS endpoint of resuscitation indicates that shock has been adequately treated?
- CVP > 12 mmHg
- Heart rate, CRT, mental status, and urine output normalized (Correct answer)
- Systolic BP > 100 mmHg in all ages
- Absence of fever for 1 hour
Correct answer: Heart rate, CRT, mental status, and urine output normalized
PALS targets normalization of clinical perfusion markers — heart rate, CRT < 2 sec, mental status, and urine output ≥ 1 mL/kg/hr.
Question 3: During a trauma resuscitation, massive hemothorax is identified. After chest tube placement drains 500 mL of blood, the child remains in shock. What is the next intervention?
- Repeat fluid bolus only and observe
- Administer blood products and prepare for operative intervention (Correct answer)
- Increase vasopressor infusion without surgery
- Perform pericardiocentesis
Correct answer: Administer blood products and prepare for operative intervention
Persistent hemorrhagic shock after initial chest tube output requires blood product resuscitation and surgical hemorrhage control.
Question 4: A 5-year-old post-cardiac surgery develops Beck's triad (hypotension, muffled heart sounds, JVD). Which diagnosis and treatment are correct?
- Tension pneumothorax — needle decompression
- Cardiac tamponade — pericardiocentesis (Correct answer)
- Myocarditis — dobutamine infusion
- Pulmonary embolism — anticoagulation
Correct answer: Cardiac tamponade — pericardiocentesis
Beck's triad is pathognomonic for cardiac tamponade, which causes obstructive shock relieved by pericardiocentesis.
Question 5: In a pediatric patient with distributive shock from anaphylaxis, what is the FIRST drug to administer?
- IV diphenhydramine
- IV methylprednisolone
- IM epinephrine 0.01 mg/kg (max 0.5 mg) (Correct answer)
- IV ranitidine
Correct answer: IM epinephrine 0.01 mg/kg (max 0.5 mg)
IM epinephrine is the first-line treatment for anaphylaxis, reversing bronchospasm and vasodilation before antihistamines or steroids.
Question 6: When titrating dopamine for a child in cold septic shock, which dose range provides predominantly beta-1 inotropic effects?
- 1–3 mcg/kg/min (dopaminergic)
- 5–10 mcg/kg/min (beta-1 predominant) (Correct answer)
- 15–20 mcg/kg/min (alpha predominant)
- 20–25 mcg/kg/min (vasopressin-like)
Correct answer: 5–10 mcg/kg/min (beta-1 predominant)
At 5–10 mcg/kg/min, dopamine primarily stimulates beta-1 receptors, increasing heart rate and contractility.
Question 7: A child in shock has ScvO2 of 52% despite normal BP and heart rate after fluid resuscitation. What does this indicate and what should be done?
- Adequate resuscitation — no further action needed
- Inadequate oxygen delivery — consider transfusion or inotrope (Correct answer)
- Hyperoxia — reduce FiO2
- Fluid overload — administer furosemide
Correct answer: Inadequate oxygen delivery — consider transfusion or inotrope
ScvO2 < 70% indicates increased oxygen extraction due to inadequate delivery; hemoglobin optimization or inotropic support is needed.
PALS Shock Management 5
A 2-year-old is brought in with vomiting and diarrhea for 3 days.
HR is 175, CRT is 5 sec, skin turgor is poor, and mucous membranes are dry.
What is the primary shock type?