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?

Perform a rapid sequence intubation immediately.

Administer 20 mL/kg of isotonic crystalloid fluid.

Provide 100% oxygen via non-rebreather mask.

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?

Insert a nasopharyngeal airway.

Attach an end-tidal CO2 monitor.

Observe for visible chest rise.

Check for bilateral breath sounds using auscultation.

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?

Prepare for endotracheal intubation.

Perform an emergency cricothyrotomy.

Continue bag-mask ventilation indefinitely.

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?

Use end-tidal CO2 monitoring.

Assess chest rise only.

Perform a chest x-ray immediately.

Listen for gastric sounds.

Bradycardia in children is often secondary to hypoxia.

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

Administer atropine immediately.

Perform chest compressions immediately.

Complete the intubation quickly.

Stop intubation and provide bag-mask ventilation.

What is the immediate treatment for a shockable rhythm?

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

Prepare for intubation.

Administer amiodarone.

Begin chest compressions and defibrillate.

Provide synchronized cardioversion.

What medication is first-line for pediatric cardiac arrest?

After defibrillation, what medication should be administered next?

Calcium gluconate 100 mg/kg IV/IO.

Atropine 0.02 mg/kg IV/IO.

Amiodarone 5 mg/kg IV/IO.

Epinephrine 0.01 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?

Worsening ventilation.

A false reading from the monitor.

Incorrect placement of the ET tube.

Return of spontaneous circulation (ROSC).

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.

Start targeted temperature management (TTM).

Optimize oxygenation and ventilation.

Administer a fluid bolus.

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