Cardiac Arrest Flashcard 1

C. Rationale: The patient is in cardiac arrest demonstrated by the absence of a pulse and the absence of breathing. Thus, the interpretation of this ECG finding is pulseless electrical activity (PEA). PEA has an organized rhythm on ECG but with no palpable pulse. It can present as a slow, normal, or fast rhythm. Agonal PEA has a very slow rate. PEA can also show low or high amplitude T waves, prolonged PR and QT intervals, atrioventricular dissociation, complete heart block, or ventricular complexes without P waves.

B. Rationale: If anaphylaxis causes cardiac arrest, the provider prioritizes high-quality CPR with attention to maintaining a patent airway and administering fluid therapy. Epinephrine is the drug of choice for treating anaphylaxis. The goal of high-quality CPR is to maintain adequate oxygen delivery until the anaphylactic reaction resolves. Steroid therapy can be of value in the management of anaphylaxis upon resolution of the cardiac arrest. If return of spontaneous circulation has been achieved, methylprednisolone can be given at a dose of 1 to 2 mg/kg IV or IO as part of post-cardiac arrest care.

C. Rationale: When a pediatric patient goes into cardiac arrest, the PALS resuscitation team’s primary goal is to achieve an organized and perfusing cardiac rhythm evidenced by a return of a palpable pulse and spontaneous breathing. This is termed return of spontaneous circulation. Clinically, the patient’s color and breathing returns to normal. The treatment of cardiac arrest with PALS involves establishing intravascular access, rhythm assessment for shockable and non shockable rhythms, early defibrillation if indicated, medical therapy, and advanced airway management.

A. Rationale: A rhythm that does not record any electrical activity from the heart is known as asystole. Asystole is a non shockable rhythm. In this case, following the American Heart Association pediatric cardiac arrest guidelines, the next step is to immediately perform high-quality CPR for 5 cycles, administer epinephrine IV every 3 to 5 minutes, and perform another rhythm check.

B. Rationale: To prevent interruptions in chest compressions, rhythm and pulse checks must be performed within 10 seconds. If the team is unsure or the arrhythmia persists after the 10-second check, CPR must resume at once.

B. Rationale: If after the rhythm check, the VF or pVT persists, then a higher dose of 4 J/kg or 100 J may be given in this case. If the arrhythmia persists in the next rhythm check, a much higher dose between 5 and 10 J/kg should then be delivered. The maximum adult dose for a pediatric patient should not be exceeded.

D. Rationale: Respiratory failure and shock are the most common causes of cardiac arrest in pediatric patients.

A. Rationale: The first shock dose for infants must be calculated at 2 J per kg. Therefore, the rescuer must administer 20 J for the first shock in this case. The second dose is calculated at 4 J per kg.

B. Rationale: The most common cause of cardiac arrest in infants and children is respiratory failure and shock, also described as a hypoxic arrest. Hypoxic arrest in infants and children may be due to an underlying disease. It is vital for healthcare providers to reverse respiratory failure and shock so that it does not progress into cardiac arrest.

D. Rationale: Intraosseous canalization provides non collapsible vascular access for intravenous medications and fluid resuscitation. However, in PALS, it is a priority to use the IV route for all medical therapies and fluid resuscitation techniques. If the intravenous route is not possible, the next recommended route is intraosseous.