PEARS Managing Shock Emergencies 2 — Questions and Answers
Question 1: A 3-year-old presents with HR 160, BP 70/40, cool mottled extremities, and delayed capillary refill after a dog bite. Which type of shock is most likely?
- Cardiogenic shock
- Distributive shock
- Hypovolemic shock (Correct answer)
- Obstructive shock
Correct answer: Hypovolemic shock
Blood loss from trauma causes hypovolemic shock, characterized by tachycardia, hypotension, and poor perfusion.
Question 2: During management of a child in hypovolemic shock, when should you reassess perfusion after an IV fluid bolus?
- Every 30 minutes
- Immediately after the bolus is complete (Correct answer)
- After two full boluses only
- Only if BP does not normalize
Correct answer: Immediately after the bolus is complete
Reassessment should occur immediately after each fluid bolus to determine the child's response and need for additional therapy.
Question 3: A child in septic shock fails to improve after 60 mL/kg of isotonic fluid. What is the most appropriate next intervention?
- Administer a fourth fluid bolus of 20 mL/kg
- Begin vasoactive drug therapy (Correct answer)
- Perform immediate intubation
- Obtain a chest X-ray before proceeding
Correct answer: Begin vasoactive drug therapy
Fluid-refractory septic shock requires vasoactive agents such as dopamine or epinephrine to restore perfusion.
Question 4: Which vasoactive drug is first-line for cold (low cardiac output) septic shock in children?
- Norepinephrine
- Vasopressin
- Epinephrine (Correct answer)
- Dopamine
Correct answer: Epinephrine
Epinephrine is preferred for cold septic shock because it increases cardiac output and has inotropic properties.
Question 5: A 5-year-old with known peanut allergy suddenly develops urticaria, stridor, and hypotension. What is the priority intervention?
- IV diphenhydramine 1 mg/kg
- Intramuscular epinephrine 0.01 mg/kg (Correct answer)
- Nebulized albuterol
- 20 mL/kg IV normal saline bolus
Correct answer: Intramuscular epinephrine 0.01 mg/kg
IM epinephrine is the first-line treatment for anaphylactic shock and must be given immediately.
Question 6: Which finding best differentiates compensated shock from decompensated shock in a pediatric patient?
- Heart rate above 100 bpm
- Presence of hypotension (Correct answer)
- Capillary refill of 3 seconds
- Decreased urine output
Correct answer: Presence of hypotension
Hypotension defines decompensated shock; compensated shock maintains normal blood pressure through compensatory mechanisms.
Question 7: A 7-year-old post-operative cardiac patient has JVD, muffled heart sounds, and hypotension. Which type of shock should you suspect?
- Hypovolemic shock
- Distributive shock
- Obstructive shock (Correct answer)
- Cardiogenic shock
Correct answer: Obstructive shock
Beck's triad (JVD, muffled heart sounds, hypotension) suggests cardiac tamponade, an obstructive cause of shock.
PEARS Managing Shock Emergencies 2
A 3-year-old presents with HR 160, BP 70/40, cool mottled extremities, and delayed capillary refill after a dog bite.
Which type of shock is most likely?