Multiple Choice Questions

A 3yo unresponsive, apneic child is brought to the emergency department. EMS personnel report that the child became unresponsive as they arrived at the hospital. The child is receiving CPR with bag-mask ventilation. The rhythm shown here is on the cardiac monitor. A biphasic manual defibrillator is present. You quickly use the length from head to of the child on a color-coded length-based resuscitation tape to estimate the approximate weight as 15kg. Which therapy is most appropriate for this child at this time?
  • Open the airway with a head tilt-chin lift maneuver and give 2 breaths
  • While a colleague provides spinal motion restriction, open the airway with a jaw thrust and provide bag-mask ventilation
  • Attempt defibrillation at 30 J, and then resume CPR, beginning with compressions
  • Open the airway and provide positive-pressure ventilation using 100% oxygen and a bag-mask device
Paramedics are called to the home of a 1yo child. Their initial assessment reveals a child who responds only to painful stimuli and has irregular breathing, faint central pulses, bruises over the abdomen, abdominal distention, and cyanosis
  • Rapid bolus of 20ml/kg of isotonic crystalloid
  • Position your fingers using the E-C clamp technique
  • You need to compress at a rate of 100-120 per minute."
  • Perform needle decompression of the right chest
An 8mo infant is brought to the emergency department for evaluation of severe diarrhea and dehydration. On arrival to the emergency department, the infant becomes unresponsive, apneic, and pulseless. You shout for help and start CPR. Another provider arrives, at which point you switch to 2-rescuer CPR. The rhythm shown here is seen on the cardiac monitor. The infant is intubated and ventilated with with 100% oxygen. An IO line is established, and a dose of epinephrine is given. While continuing high-quality CPR, what do you do next?
  • Give normal saline 20 ml/kg IO rapidly
  • Perform needle decompression of the right chest
  • Epinephrine 0.01 mg/kg IV/IO
  • Humidified oxygen as tolerated
Which statement is correct about endotracheal drug administration during resuscitative efforts for pediatric patients?
  • It is the least desirable route of administration
  • Position your fingers using the E-C clamp technique
  • Epinephrine stimulates spontaneous contractions when asystole is present
  • Routine administration is not indicated during cardiac arrest
Initial impression of a 2yo girl shows her to be alert with mild breathing difficulty during inspiration and pale skin color. On primary assessment, she makes high-pitched inspiratory sounds (mild stridor) when agitated; otherwise, her breathing is quiet. Her spO2 is 92% on room air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Which is the most appropriate initial intervention for this child?
  • Give normal saline 20 ml/kg IO rapidly
  • Amiodarone 5 mg/kg IO
  • Humidified oxygen as tolerated
  • Magnesium sulfate 25-50 mg/kg IV
You are caring for a 3yo with vomiting and diarrhea. You have established IV access. The child's pulses are palpable but faint, and the child is now lethargic
  • Epinephrine 0.01 mg/kg IV/IO
  • Epinephrine
  • Amiodarone 5 mg/kg IO
  • Atropine 0.02 mg/kg IV
You need to provide rescue breaths to a child victim with a pulse. What is the appropriate rate for delivering breaths?
  • 1 breath every 3-5 seconds
  • Start high-quality CPR
  • Atropine 0.02 mg/kg IV
  • Epinephrine 0.01 mg/kg IV/IO
A 9yo boy is agitated and leaning forward on the bed in obvious respiratory distress.
  • Albuterol
  • Identify and treat reversible causes
  • Administer adenosine 0.1 mg/kg IV rapid push
  • Magnesium sulfate 25-50 mg/kg IV
You find an infant who is unresponsive, is not breathing, and does not have a pulse. You shout for nearby help, but no one arrives. What action should you take next?
  • Provide CPR for about 2 minutes before leaving to activate the emergency response system
  • Fluids can be administered freely without local soft tissue swelling."
  • Compress the chest at least one third the depth of the chest, about 2 inches (5 cm)
  • You need to compress at a rate of 100-120 per minute."
You are supervising a student who is inserting an IO needle into an infant's tibia. The student asks you what she should look for to know that she successfully inserted the needle into the bone marrow cavity. What do you tell her?
  • Provide CPR for about 2 minutes before leaving to activate the emergency response system
  • Nonrebreathing face mask
  • If the child weighs less than 10kg or is less than 1 year old
  • Fluids can be administered freely without local soft tissue swelling."
A child becomes unresponsive in the emergency department and is not breathing. You are uncertain if a faint pulse is present
  • Atropine 0.02 mg/kg IV
  • 1 breath every 3-5 seconds
  • Start high-quality CPR
  • Epinephrine 0.01 mg/kg IV/IO
You find a 10yo boy to be unresponsive. You shout for help, and after finding that he is not breathing and has no pulse, you and a colleague begin CPR. Another colleague activates the emergency response system.brings the emergency equipment, and places the child on a cardiac monitor/defibrillator, which reveals the rhythm shown here. You attempt defibrillation at 2 J/kg and give 2 minutes of CPR. The rhythm persists at the second rhythm check, at which point you attempt defibrillation with 4 J/kg. A fourth colleague arrives, starts an IV, and administers 1 dose of epinephrine 0.01 mg/kg. If ventricular fibrillation or pulseless ventricular tachycardia persists after 2 minutes of CPR, you will administer another shock. Which drug and dose should be administered next?
  • Atropine 0.02 mg/kg IV
  • Lidocaine 1 mg/kg IV
  • Tracheal tube displacement into the right main bronchus
  • Amiodarone 5 mg/kg IO
A 3yo boy presents with multiple-system trauma. The child was an unrestrained passenger in a high-speed MVC. On primary assessment, he is unresponsive to voice or painful stimulation. His respiratory rate is 5/min, heart rate and pulses are 170/min, systolic BP is 60 mmHg, capillary refill is 5 seconds, and spO2 is 75% on room air. Which action should you take first?
  • Magnesium sulfate 25-50 mg/kg IV
  • Attempt defibrillation at 30 J, and then resume CPR, beginning with compressions
  • Open the airway and provide positive-pressure ventilation using 100% oxygen and a bag-mask device
  • While a colleague provides spinal motion restriction, open the airway with a jaw thrust and provide bag-mask ventilation
A 7yo boy is found unresponsive, apneic, and pulseless. CPR is ongoing
  • Magnesium sulfate 25-50 mg/kg IV
  • Identify and treat reversible causes
  • Albuterol
  • Administer adenosine 0.1 mg/kg IV rapid push
A 1yo boy is brought to the emergency department for evaluation of poor feeding, irritability, and sweating
  • Administer adenosine 0.1 mg/kg IV rapid push
  • Albuterol
  • Administer a bolus of 20 ml/kg isotonic crystalloid
  • Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and also give D25W 2-4 ml/kg IV
You are alone and witness a child suddenly collapse. There is no suspected head or neck injury. A colleague responded to your shout for help and is activating the emergency response system and is retrieving the resuscitation equipment, including a defibrillator. After delivering 30 compressions, what would be your next action?
  • Compress the chest at least one third the depth of the chest, about 2 inches (5 cm)
  • Open the airway with a head tilt-chin lift maneuver and give 2 breaths
  • If the child weighs less than 10kg or is less than 1 year old
  • Epinephrine
A pale and very sleepy but arousable 3yo child with a hx of diarrhea is brought to the hospital. Primary assessment reveals a respiratory rate of 45/min with good breath sounds bilaterally
  • Administer a bolus of 20 ml/kg isotonic crystalloid
  • Rapid bolus of 20ml/kg of isotonic crystalloid
  • Administer adenosine 0.1 mg/kg IV rapid push
  • Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and also give D25W 2-4 ml/kg IV
A previously healthy infant with a history of vomiting and diarrhea is brought to the emergency department by her parents. During your assessment, you find that the infant responds only to painful stimulation.
  • Administer a bolus of 20 ml/kg isotonic crystalloid
  • Administer adenosine 0.1 mg/kg IV rapid push
  • Open the airway and provide positive-pressure ventilation using 100% oxygen and a bag-mask device
  • Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and also give D25W 2-4 ml/kg IV
An 18mo child has a 1 week hx of cough and runny nose. The child has diffuse cyanosis and is responsive only to painful stimulation with slow respirations and rapid central pulses. The child's respiratory rate has decreased from 65/min to 10/min, severe inspiratory intercostal retractions are present, heart rate is 160/min, spO2 is 65% on room air, and capillary refill is less than 2 seconds. Which are the most immediate interventions for this toddler
  • Open the airway and provide positive-pressure ventilation using 100% oxygen and a bag-mask device
  • Perform needle decompression of the right chest
  • Attempt defibrillation at 30 J, and then resume CPR, beginning with compressions
  • Give normal saline 20 ml/kg IO rapidly
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Multiple Choice Questions
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