PALS MC Pediatric Respiratory Failure with Cardiac Arrest

Pediatric Respiratory Failure with Cardiac Arrest

A 3-year-old child is rushed to the emergency department in severe respiratory distress. They are gasping for air, with retractions and nasal flaring. Stridor and wheezing are audible, with oxygen saturation falling rapidly despite non-invasive support. The child becomes unresponsive, with agonal breathing before progressing to respiratory failure and cardiac arrest.

Assess the child's respiratory effort and intervene to provide ventilation.

A 3-year-old presents with severe respiratory distress, tachypnea, nasal flaring, and retractions. The child becomes lethargic, and their respiratory rate slows. What is your next step?

Provide 100% oxygen via non-rebreather mask.

Perform a rapid sequence intubation immediately.

Administer 20 mL/kg of isotonic crystalloid fluid.

Begin bag-mask ventilation immediately.

Consider how you immediately confirm ventilation success.

After initiating bag-mask ventilation, what is the most appropriate next step to assess effectiveness?

Check for bilateral breath sounds using auscultation.

Insert a nasopharyngeal airway.

Observe for visible chest rise.

Attach an end-tidal CO2 monitor.

Consider when bag-mask ventilation might be inadequate for ongoing care.

Despite effective bag-mask ventilation, the child remains hypoxic. What is the next step?

Perform an emergency cricothyrotomy.

Continue bag-mask ventilation indefinitely.

Prepare for endotracheal intubation.

Switch to high-flow nasal cannula.

Think of a reliable and immediate confirmation method.

After successful intubation, how do you confirm correct endotracheal tube placement?

Perform a chest x-ray immediately.

Listen for gastric sounds.

Assess chest rise only.

Use end-tidal CO2 monitoring.

Bradycardia in children is often secondary to hypoxia.

The child develops bradycardia during intubation. What is the first action?

Administer atropine immediately.

Stop intubation and provide bag-mask ventilation.

Complete the intubation quickly.

Perform chest compressions immediately.

What is the immediate treatment for a shockable rhythm?

The child’s rhythm changes to pulseless ventricular tachycardia (pVT). What is your next action?

Administer amiodarone.

Provide synchronized cardioversion.

Begin chest compressions and defibrillate.

Prepare for intubation.

What medication is first-line for pediatric cardiac arrest?

After defibrillation, what medication should be administered next?

Calcium gluconate 100 mg/kg IV/IO.

Epinephrine 0.01 mg/kg IV/IO.

Amiodarone 5 mg/kg IV/IO.

Atropine 0.02 mg/kg IV/IO.

Think about what a rise in perfusion might indicate.

During CPR, the team notices a sudden spike in end-tidal CO2. What does this indicate?

A false reading from the monitor.

Incorrect placement of the ET tube.

Return of spontaneous circulation (ROSC).

Worsening ventilation.

Consider the primary goals immediately following ROSC.

After achieving ROSC, what is the most important next step in post-resuscitation care?

Wean the child off mechanical ventilation.

Administer a fluid bolus.

Optimize oxygenation and ventilation.

Start targeted temperature management (TTM).

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