PEARS Managing Shock Emergencies 3 — Questions and Answers
Question 1: In pediatric cardiogenic shock, which physical finding is most characteristic compared to hypovolemic shock?
- Tachycardia
- Hepatomegaly and crackles on lung auscultation (Correct answer)
- Dry mucous membranes
- Decreased skin turgor
Correct answer: Hepatomegaly and crackles on lung auscultation
Hepatomegaly and pulmonary crackles indicate fluid overload and heart failure, hallmarks of cardiogenic shock.
Question 2: When establishing IV access is delayed in a child in shock, what is the preferred alternative vascular access route?
- Central venous catheter
- Intraosseous access (Correct answer)
- Subcutaneous fluids
- Rectal fluids
Correct answer: Intraosseous access
Intraosseous (IO) access provides rapid, reliable vascular access when IV access cannot be quickly established.
Question 3: A 10-year-old with spinal cord injury has bradycardia, hypotension, and warm flushed skin. Which type of shock is this?
- Hypovolemic shock
- Neurogenic shock (Correct answer)
- Cardiogenic shock
- Obstructive shock
Correct answer: Neurogenic shock
Neurogenic shock presents with bradycardia and warm skin due to loss of sympathetic tone after spinal cord injury.
Question 4: What is the maximum recommended total volume of isotonic fluid boluses in pediatric septic shock resuscitation within the first hour?
- 20 mL/kg
- 40 mL/kg
- 60 mL/kg (Correct answer)
- 100 mL/kg
Correct answer: 60 mL/kg
Current PEARS guidelines recommend up to 60 mL/kg (three 20 mL/kg boluses) before initiating vasoactive therapy.
Question 5: Which laboratory finding would MOST support a diagnosis of septic shock over hypovolemic shock?
- Elevated lactate with leukocytosis and bandemia (Correct answer)
- Low hematocrit
- Elevated BUN and creatinine
- Hyponatremia
Correct answer: Elevated lactate with leukocytosis and bandemia
Elevated lactate combined with white blood cell abnormalities strongly suggests an infectious etiology with systemic infection.
Question 6: A child in shock receives supplemental oxygen. What SpO2 target should guide therapy?
- Greater than 94% (Correct answer)
- Greater than 88%
- Greater than 80%
- Exactly 100%
Correct answer: Greater than 94%
Maintaining SpO2 greater than 94% ensures adequate oxygen delivery to tissues during shock resuscitation.
Question 7: Which clinical sign indicates that a child in shock is responding adequately to fluid resuscitation?
- Persistent tachycardia
- Capillary refill improving to less than 2 seconds (Correct answer)
- Ongoing cool extremities
- Unchanged mental status
Correct answer: Capillary refill improving to less than 2 seconds
Capillary refill time normalizing to under 2 seconds reflects improved peripheral perfusion and treatment response.
PEARS Managing Shock Emergencies 3
In pediatric cardiogenic shock, which physical finding is most characteristic compared to hypovolemic shock?