Pediatric CCRN Cardiovascular Flashcards

A 4-year-old post-Fontan procedure has rising lactate and falling mixed venous oxygen saturation. The MOST likely cause is:

Answer: Low cardiac output syndrome

Rising lactate and falling SvO2 are hallmarks of low cardiac output syndrome, indicating tissues are extracting more oxygen due to inadequate delivery.

Which vasoactive agent is MOST appropriate as first-line therapy for a child in septic shock with poor cardiac contractility?

Answer: Dobutamine

Dobutamine is a beta-1 agonist that increases myocardial contractility, making it the preferred agent when septic shock is accompanied by poor cardiac function.

A 10-year-old develops complete heart block after surgical repair of an AV canal defect. What is the immediate intervention?

Answer: Initiate temporary epicardial pacing

Epicardial pacing wires are routinely placed during open-heart surgery; activating temporary epicardial pacing is the immediate treatment for postoperative complete heart block.

In a child with hypoplastic left heart syndrome (HLHS) after stage I Norwood repair, a rising SaO2 to 95% MOST likely indicates:

Answer: Excessive pulmonary blood flow stealing from systemic circulation

In single-ventricle physiology, an SaO2 >85% suggests excessive pulmonary blood flow that is 'stealing' from systemic circulation, threatening vital organ perfusion.

Which hemodynamic parameter BEST reflects preload in a pediatric patient on mechanical ventilation?

Answer: Stroke volume variation (SVV)

Stroke volume variation dynamically assesses fluid responsiveness and preload in mechanically ventilated patients and is more reliable than static pressures like CVP.

A 3-year-old after cardiac surgery has a heart rate of 220 bpm with a narrow QRS and sudden onset. What is the FIRST-LINE treatment?

Answer: Vagal maneuvers

Vagal maneuvers (e.g., ice to face in infants, Valsalva in older children) are the first-line intervention for stable SVT and should be attempted before pharmacologic therapy.