PEARS - Pediatric Emergency Assessment, Recognition, and Stabilization Pediatric Cardiac Arrest Care Questions and Answers 1 — Questions and Answers
Question 1: An 8-month-old infant is found unresponsive, pale, and limp. You assess for a brachial pulse and cannot definitively feel one within 10 seconds. A cardiac monitor shows a heart rate of 45 beats per minute. What is the most appropriate immediate action?
- Provide rescue breaths only at a rate of 1 every 3-5 seconds.
- Administer a rapid fluid bolus of isotonic crystalloid.
- Continue to assess for a pulse for another 15 seconds.
- Begin high-quality chest compressions and ventilations. (Correct answer)
Correct answer: Begin high-quality chest compressions and ventilations.
According to American Heart Association guidelines, if an infant or child has a pulse rate less than 60 beats per minute with signs of poor perfusion (e.g., unresponsiveness, pallor) despite adequate oxygenation and ventilation, the provider should start CPR. The heart rate of 45 bpm is below this threshold, warranting immediate chest compressions and ventilations.
Question 2: You and a colleague are performing high-quality, two-rescuer CPR on a 4-year-old child. What is the correct compression-to-ventilation ratio that should be used?
- 15 compressions to 2 breaths (Correct answer)
- 30 compressions to 2 breaths
- 15 compressions to 1 breath
- 30 compressions to 1 breath
Correct answer: 15 compressions to 2 breaths
For two-rescuer CPR on an infant or child, the recommended compression-to-ventilation ratio is 15:2. This ratio provides more frequent ventilations compared to the 30:2 ratio used for single-rescuer CPR, which is critical as pediatric cardiac arrest is often secondary to respiratory issues.
Question 3: Which of the following is a critical component of high-quality chest compressions in a pediatric patient that directly contributes to better outcomes?
- Compressing at a rate of 80-90 per minute to allow for more effective ventilations.
- Pausing compressions every minute for a 10-second rhythm check.
- Allowing for full chest recoil between each compression. (Correct answer)
- Delivering shallow compressions to prevent rib fractures.
Correct answer: Allowing for full chest recoil between each compression.
Allowing the chest to fully recoil after each compression is essential for high-quality CPR. Full recoil creates negative intrathoracic pressure, which helps the heart's chambers refill with blood, improving coronary and cerebral perfusion on the next compression. The correct rate is 100-120/min, interruptions should be minimized, and compressions must be of adequate depth (at least 1/3 the AP chest diameter).
Question 4: A 6-year-old child weighing 22 kg (48 lbs) collapses and is found to be in pulseless cardiac arrest. An AED with both adult and pediatric pads arrives. What is the most appropriate action regarding the AED?
- Use the adult pads in an anterior-posterior placement.
- Apply the pediatric pads and use a dose attenuator if available. (Correct answer)
- Do not use the AED until an advanced life support team arrives.
- Wait to see if CPR alone restores a pulse before applying pads.
Correct answer: Apply the pediatric pads and use a dose attenuator if available.
For children under 8 years of age or weighing less than 25 kg (55 lbs), pediatric-specific pads with a dose attenuator are recommended. These pads deliver a reduced energy dose more appropriate for a child's size. An AED should be applied and used as soon as it becomes available. If pediatric pads were not available, using adult pads would be the next best option.
Question 5: Unlike cardiac arrest in adults, which is typically caused by primary cardiac events, pediatric cardiac arrest is most often a secondary event resulting from which underlying condition?
- Sudden arrhythmic death syndrome (SADS).
- Congenital heart disease.
- Severe electrolyte abnormalities.
- Progressive respiratory failure or shock. (Correct answer)
Correct answer: Progressive respiratory failure or shock.
The most common pathway to cardiac arrest in infants and children is progressive respiratory failure, shock, or a combination of both. These conditions lead to hypoxia and acidosis, which ultimately cause the heart to stop. Recognizing and treating respiratory distress and shock early is key to preventing cardiac arrest in this population.
Question 6: Following a successful resuscitation, a 5-year-old child has a return of spontaneous circulation (ROSC). The child is being supported with high-flow oxygen. What is the recommended target range for oxygen saturation (SpO2) during the post-cardiac arrest care phase?
- Titrate oxygen to maintain SpO2 between 94% and 99%. (Correct answer)
- Maintain SpO2 at 100% to maximize oxygen delivery.
- Keep SpO2 between 88% and 92% to avoid oxygen toxicity.
- Discontinue supplemental oxygen immediately to promote spontaneous breathing.
Correct answer: Titrate oxygen to maintain SpO2 between 94% and 99%.
In the post-cardiac arrest phase, both hypoxia and hyperoxia can be harmful to the recovering brain and other organs. The current American Heart Association guidelines recommend titrating inspired oxygen to achieve an oxygen saturation between 94% and 99% to avoid these extremes.
PEARS - Pediatric Emergency Assessment, Recognition, and Stabilization Pediatric Cardiac Arrest Care Questions and Answers 1
An 8-month-old infant is found unresponsive, pale, and limp.
You assess for a brachial pulse and cannot definitively feel one within 10 seconds.
A cardiac monitor shows a heart rate of 45 beats per minute.
What is the most appropriate immediate action?