PALS Megacode Scenario 4

The mother states that the boy has had vomiting and diarrhea for the last two days. He quit eating and drinking yesterday. Another team member takes vital signs and notes that the pulse is palpable but weak at a rate of 160 bpm. 

His blood pressure is 100/62 mmHg, and his respiratory rate is 28 breaths per minute. The child’s SpO₂ is 95%. 

You ask the nurse to start an IV. You attach a cardiac monitor and see this rhythm:

You measure the QRS duration and note that it is 0.08 seconds.

1. You recognize this rhythm as:

He is tired but is responsive. His pulse is still weakly palpable at 130 bpm. Capillary refill is delayed, and the boy’s skin is pale, cool, and mottled.

2. You determine that the child is displaying signs of:

3. You know that all of the following are signs of hypovolemic shock EXCEPT:

4. You suspect that the child’s shock is:

He is maintaining an open airway and adequate respiratory effort. His SpO₂ is 96%. His blood pressure is 90/62 mmHg. The nurse’s third attempt at starting an IV has failed. 

5. The most appropriate next intervention is to:

6. Appropriate sites for an IO catheter include all the following EXCEPT:

7. The preferred initial fluid recommended for this child is:

8. For hypovolemic shock, the correct amount of isotonic fluid for a child is:

9. For this 35 kg child, the correct amount of isotonic fluid as an initial bolus is:

10. Your next intervention is to: