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You are called to help resuscitate an infant with severe symptomatic Sinus bradycardia associated with hypoxic distress. Sinus bradycardia persists despite establishment of an effective airway, oxygenation, and ventilation. There is no heart block present. Which of the following is the first drug you should administer? |
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| Atropine |
| Dopamine |
| Epinephrine |
| Adenosine |
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The important components and effects of using epinephrine during attempted resuscitation are? |
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| Epinephrine decreases peripheral vascular resistance and reduces myocardial afterload so that ventricular contractions are more effective |
| Epinephrine is contraindicated in ventricular fibrillation because it increases myocardial irritability |
| Epinephrine improves coronary artery perfusion pressure and stimulates spontaneous contractions when asystole is present |
| Epinephrine decreases myocardial oxygen consumption |
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General assessment of a 2-year-old female reveals her to be alert with mild dyspnea during inspiration and pallor skin color. On primary assessment, she has high-pitched inspiratory sounds (mild stridor) when agitated; otherwise her breathing is quiet. Her SpO2 is 92% in room air, and she has mild inspiratory intercostal retractions. Lung auscultation reveals, All lung field are clear. Which of the following is the most appropriate initial therapeutic intervention for this child? |
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| Perform immediate endotracheal intubation |
| Administer an IV dose of dexamethasone |
| Nebulize 2.5 mg of albuterol |
| Administer humidified supplementary oxygen as tolerated and continue evaluation |
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Which of the following most reliably delivers a high (90% or greater) concentration of inspired oxygen in a child who age is > then 9 months? |
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| Nasal cannula with reservoir set at 4 L/min oxygen flow |
| Simple oxygen mask with 15 L/min oxygen flow |
| Nonrebreathing face mask with high flow oxygen set at 12 L/min |
| Face tent with 15 L/min oxygen flow |
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When administering endotracheal drugs which statements are true? |
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| Endotracheal drug administration is the preferred route of drug administration during resuscitation because it results in predictable drug levels and drug effects |
| Endotracheal doses of resuscitation drugs in children have been well established and are supported by evidence from clinical trials |
| Intravenous drug doses for resuscitation drugs should be used whether you give the drugs by the IV, intraosseous (IO), or the endotracheal route |
| Endotracheal drug administration is the least desirable route of administration because this route results in unpredictable drug levels and effects |
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Which statement regarding the use of magnesium sulfate in the treatment of cardiac arrest is most accurate? |
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| Magnesium sulfate is indicated for VF refractory to repeated shocks and amiodarone or lidocaine |
| Routine use of magnesium sulfate is indicated for shock-refractory monomorphic VT |
| Magnesium sulfate is indicated for torsades de pointes and VF/pulseless VT associated with suspected hypomagnesemia |
| Magnesium sulfate is contraindicated in VT associated with an abnormal QT interval during the preceding sinus rhythm |
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You enter a room to perform a general assessment of a previously stable 10-year-old male and find him unresponsive and apneic. A code is called and bag-mask ventilation is performed with 100% oxygen. The 3 lead deliberator monitor shows a regular wide-complex tachycardia. The boy has no detectable pulses so compressions and ventilations are provided. You perform an unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes of CPR reveals VF. You then deliver another unsynchronized shock of 4 J/kg and resume immediate CPR beginning with compressions. A team member had established IO access, so you give a dose of epinephrine, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO when CPR is restarted after the second shock. At the next rhythm check, persistent shock refractory VF is present. You administer a 4 J/kg unsynchronized shock and resume CPR. what are the next drug and dose to administer when CPR is restarted? |
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| Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution) IO |
| Atropine 0.02 mg/kg IO |
| Amiodarone 5 mg/kg IO |
| Magnesium sulfate 25 to 50 mg/kg IO |
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You are assessing an infant, who has obtunded abdomen and irregular breathing, bruises over the abdomen, and cyanosis. Assisted bag-mask ventilation with 100% oxygen is initiated. On primary assessment heart rate is 36/min, peripheral pulses cannot be palpated, and central pulses are barely palpable. 3 lead Cardiac monitor shows sinus bradycardia. Chest compressions are started with a 15:2 compression-to-ventilation ratio. In the emergency department the infant is intubated and ventilated with 100% oxygen, and IV/IO access is established. The heart rate is now up to 150/min but there are weak central pulses and no distal pulses. Systolic blood pressure is 68 mm Hg. Of the following, which would be most useful in management of this infant? |
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| Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV |
| Rapid bolus of 20 mL/kg of isotonic crystalloid |
| Atropine 0.02 mg/kg IV |
| Synchronized cardioversion |
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Which of the following statements about calcium is true? |
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| Routine administration of calcium is not indicated during cardiac arrest. |
| The recommended dose is 1 to 2 mg/kg of calcium chloride |
| Calcium chloride 10% has the same bioavailability of elemental calcium as calcium gluconate in critically ill children |
| Indications for administration of calcium include hypercalcemia, hypokalemia, and hypomagnesemia |
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You are working in the ED, and an infant with a history of vomiting and diarrhea arrives by ambulance. During your primary assessment of the infant reveals that the infant responds only to painful stimulation. The upper airway is patent, the respiratory rate is 40/min, Lungs are Clear to Auscultation, and 100% oxygen is being administered. The infant has cool extremities, weak pulses, and a capillary refill time of more than 5 seconds. The infant?s blood pressure is 80/60 mm Hg and blood sugar (measured by bedside test) is 30 mg/dL (1.65 mmol/L). Which of the following is the most appropriate treatment to provide for this infant? |
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| Establish IV or IO access and administer 20 mL/kg D50.45% sodium chloride bolus over 15 minutes |
| Establish IV or IO access and administer 20 mL/kg Lactated Ringer's solution over 60 minutes |
| Perform endotracheal intubation and administer epinephrine 0.1 mg/kg 1:1,000 via the endotracheal tube |
| Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over 10 to 20 minutes, and simultaneously administer D25W 2 to 4 mL/kg in a separate infusion |
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You are assessing a 9-year-old boy with increased work of breathing reveals the boy to be agitated and leaning forward on the bed with obvious Dyspnea, he as a HX of Reactive Airway Disorder. You administer 100% oxygen by nonrebreathing mask. He has nasal flaring, severe suprasternal and intercostal retractions, and decreased air movement with prolonged expiratory time and wheezing. His SpO2 is 96% (on nonrebreathing mask). What is the next medical therapy to provide to this patient? |
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| Adenosine 0.1 mg/kg |
| Amiodarone 5 mg/kg IV/IO |
| Albuterol by nebulization |
| Procainamide 15 mg/kg IV/IO |
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A 6-month-old infant is brought to the emergency department (ED) with severe diarrhea and dehydration. During assessment the infant becomes unresponsive and pulseless. You shout for help and start CPR at a compression rate of 100/min and a compression-to-ventilation ratio of 30:2. Another provider arrives, at which point you switch to 2-rescuer CPR with a compression-to-ventilation ratio of 15:2. |
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| High-dose epinephrine, 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution), IO |
| Defibrillation 2 J/kg |
| Normal saline 20 mL/kg IV rapidly |
| Amiodarone 5 mg/kg IO |
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