PALS Megacode 2 Out-of-HospitalHurry, don’t let time run out!Sorry, time is up!0 Hours 0 mins 0 secsStep 1 of 911%You are a healthcare provider working on an ALS ambulance. You are dispatched to the home of a 3-year-old female who has been experiencing trouble breathing. You are advised by dispatch that the mother reports the patient may have ingested glass cleaner, likely mistaking it for candy or a fruit drink, and that the patient's breathing is worsening progressively. Your response time to the scene is 6 minutes. A rapid initial impression (ABCs) reveals the following:Appearance: Awake, alert, anxiousBreathing: Increased work of breathing, tachypneic, grunting, intercostal retractionsCirculation: Skin is pink1. What type and severity of respiratory emergency is occurring in the given scenario?* Upper airway obstruction leading to respiratory distress Disordered control of breathing leading to respiratory failure Lower airway obstruction leading to respiratory distress Lung tissue disease leading to respiratory distressYou have evaluated the patient and identified that they are experiencing respiratory distress caused by a lung tissue disease.2. What are your initial actions?* Establish IV access Suction the airway Support the airway and provide humidified oxygen via NRB Support the airway and provide oxygen via NCYou have evaluated the patient and identified that they are experiencing respiratory distress caused by a lung tissue disease.3. What are your initial actions?* Support the airway and provide humidified oxygen via NRB Support the airway and provide oxygen via NC Establish IV access Suction the airwayYour ALS partner is supporting the airway and has started providing regular oxygen via NRB. The patient is attached to a cardiac monitor and pulse oximeter. You conduct a rapid, hands-on primary assessment using the ABCDE approach which reveals the following:Airway: Clear, maintainableBreathing: RR 50/min, SpO2 84%, labored, grunting, coarse respirations, cracklesCirculation: HR 140/min, BP 110/59, normal CRTDisability: Moving extremities x4, irritableExposure: Pink, afebrile, perioral erythema4. A primary assessment reveals persistent respiratory distress. You are suspecting hydrocarbon poisoning via aspiration. What are your next actions?* Prioritize the airway and prepare to intubate Establish IV access and administer corticosteroids Establish IV access and administer a nebulized bronchodilator Continue providing humidified oxygen via NRB and repeat primary assessmentA primary assessment revealed low oxygen saturation, labored breathing, crackles bilaterally, and tachycardia.5. Which of these findings is the primary indicator of impending respiratory failure?* Labored breathing Crackles bilaterally Tachycardia Low oxygen saturationThe patient has a low oxygen saturate despite being provided with supplemental oxygen. You have decided to implement additional measures to assist with respiratory support.6. What are your next actions?* Intubate with an ETT Attempt non-invasive ventilation via BiPAP Attempt non-invasive ventilation via CPAP Place an oropharyngeal airway and begin supported ventilation via BVMYour ALS partner prepares to intubate the patient. You conduct a rapid secondary assessment using the SAMPLE approach which reveals the following:Signs/Symptoms: Identical to those noted in the primary assessmentAllergies: NKA, NKDAMedications: nonePast medical history: Unremarkable, IUTDLast meal 2 hours agoEvents: Approx. 20 minutes has gone by since the incident occurred7. A secondary assessment reveals that there is a high risk of regurgitation of gastric contents, which currently contain hydrocarbon-based chemicals. If regurgitation occurs and these contents are aspirated into the lungs, chemical pneumonitis can occur. Based on these findings, what are your next actions?* Intubate with a cuffed ETT and consider nasogastric tube placement Intubate with a standard ETT and consider ET drug therapy Apply cricoid pressure for 5-10 seconds after intubating Intubate with a standard ETTA paralytic is administered, and you perform an unremarkable ET intubation. The patient is now being mechanically ventilated. A nasogastric tube is placed. The patient is now being transported to the hospital.8. What are your next actions?* Consider hyperventilation Provide mechanical ventilation and monitor Repeat primary assessment Consider ET drug therapyA repeated primary assessment reveals an improvement in oxygenation from 84 to 97% and normal chest expansion with continuous mechanical ventilation. Coarse respirations and moist crackles are still present. Vitals are stable and the patient arrives at the hospital without any additional respiratory events.9. What three diagnostic tests are likely to be performed on the patient in the emergency department?* Central venous oxygen saturation, complete blood count, chest x-ray Arterial blood gas, complete blood count, complete metabolic panel Chest x-ray, arterial blood gas, central venous oxygen saturation Complete metabolic panel, chest x-ray, arterial blood gas
