PALS 2025 HEART CODE EXAM QUESTIONS AND ANSWER S. The infant is placed on the ambulance stretcher and responds with a groan when stimulated and has a temperature of 36.3 C (97.3 F) Answer --Monitor and support ABCs -Establish IV/IO access -Monitor heart rate, blood pressure, and pulse oximetry -Call for assistance if needed When you evaluate the patient, you find th e lungs are clear, skin is cool and mottled, glucose is 97 mg/dL and capillary refill time is 5 seconds. What are the warning signs that the patient is progressing from compensated shock to hypotensive shock? Answer --Hypotension (late sign) -Increasin g tachycardia The patient still has a blood pressure of 58/38 mm Hg. Her condition would be classified as ___________ shock. Answer -Hypotensive What should be included in the initial treatment for this patient? Answer --Rapid fluid bolus adminis tration -Establishing IV/IO access The mother does not recall the infant's most recent weight. What is the most appropriate way to rapidly determine her weight and calculate correct medication? Answer -
Measure her by using color -coded length -based tap e You measure the infant to be 7 kg and prepare to administer a fluid bolus of what type? Answer -Normal saline 20 mL/kg What is the most appropriate method of delivering rapid fluid boluses to this patient? Answer -A syringe and 3 -way stopcock After the first fluid bolus is administered, the child is reassessed and her vital signs are HR 167, BP 58/44 mm Hg, RR 56/min and SpO2 92%. Her skin is still cool and pale and she is still lethargic and weak. What should be the next intervention? Ans wer -Deliver a second fluid bolus of 20 mL/kg and reassess When should vasoactive therapy be considered be considered in managing distributive shock? Answer -If the child remains hypotensive and poorly perfused despite rapid bolus fluid administration How does the clinical presentation of distributive shock compare with hypovolemic shock? Answer -Distributive shock has more variable presentation than that of hypovolemic shock For general shock management, administer an isotonic crytalloid bolus o f __ mL/kg over __ to __ minutes Answer -For general shock management, administer an isotonic crytalloid bolus of 20 mL/kg over 5 to 20 minutes What signs distinguish anaphylactic shock from other types of shock? Answer --
Angioedema (swelling of t he face, lips and tongue) -Urticaria (hives) -Respiratory distress with stridor, wheezing or both in a child with anaphylactic shock, what is the most appropriate initial treatment? Answer -IM epinephrine How soon after exposure do symptoms typically occur in anaphylactic shock? Answer -Seconds to minutes What should you evaluate to recognize septic shock? Answer --Temp -Heart rate -Systemic perfusion -Blood pressure -Clinical signs of end -organ perfusion When should antibiotics be administe red in septic shock? Answer -Within the first hour What are the initial assessment findings for septic shock? Answer --Fever -Hypothermia -Normal, elevated or decreased WBC For septic shock, how soon should fluid resuscitation begin? Answer -Within 10 to 15 minutes after recognizing shock What is the recommendation for fluid bolus of isotonic crystalloids in cardiogenic shock? Answer -5 to 10 mL/kg over 10 to 20 minu tes What is the focus of the initial management of distributive shock? Answer --
Correcting hypovolemia -Filling expanded dilated vascular space -Expanding intravascular volume What are causes of obstructive shock? Answer --Pulmonary embolus -Tens ion pneumothorax -Congenital heart defects -Cardiac tamponade What signs are present as obstructive shock progresses? Answer --Increased respiratory effort -Cyanosis -Signs of vascular congestion Most patients in cardiogenic shock will need inotropic support with medications. Which of the following could be used? Answer --Milrinone -Epinephrine What is the main objective of managing obstructive shock? Answer --Correct the cause of cardiac output obstruction -Restore tissue perfusion Why is it important to immediately identify obstructive shock? Answer -Obstructive shock can rapidly progress to cardiopulmonary failure and then cardiac arrest What is an assessment finding unique to tension pneumothorax? Answer -Tracheal deviation In whom should you suspect a tension pneumothorax? Answer --Victim of chest trauma -Any intubated child who deteriorates suddenly while receiving in positive -pressure ventialtion -A child who deteriorates suddenly while receiving bag -mas ventialtion How do you know if a needle decompression is successful? Answer -There is gush of air when the needle is placed What is the immediate treatment for tension pneumothorax? Answer -Needle decompression What is the role of the diaphragm contraction du ring normal breathing in infants? Answer -Pulls the ribs slight inward However, forcefully contracting the diaphragm results in a large drop in pressure within the chest, retracting What are common causes cardiogenic shock? Answer --Congenital he art disease -Myocarditis -Drug toxicity -Arrhythmias What are causes of cardiac tamponade in children? Answer --Penetrating trauma
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