PALS Megacode 4 In-HospitalHurry, don’t let time run out!Sorry, time is up!0 Hours 0 mins 0 secsStep 1 of 812%You are a healthcare provider working in a pediatric intensive care unit. You are called to the bedside of a 5-month-old female infant with copious amounts of purulent nasal secretions and increased lethargy after being admitted two days ago for bronchiolitis. Cardiac monitoring, IV maintenance fluids, and supplemental oxygen at 4 L/min via NC are being provided. The infant is receiving nebulized albuterol treatments every 4 hrs with no change in condition; the last treatment was 2 hrs ago. A recent chest x-ray revealed extensive pulmonary hyperinflation with no infiltrates or consolidation. You enter the room and conduct a rapid initial impression (ABCs) which reveals the following:Appearance: IrritableBreathing: Tachypneic, increased effort, wheezingCirculation: Pink1. ALS algorithms allow healthcare providers to systematically evaluate and subsequently treat critically ill patients. What is the name of the primary algorithm used in PALS?* Pediatric Cardiac Arrest Management of Respiratory Emergencies Recognition of Respiratory Problems Systematic ApproachThe initial impression is the first step of the PALS Systematic Approach algorithm and provides a rapid visual and auditory observation of the patient.2. What is the purpose of this observation?* Determine if stat diagnostic tests are needed Identify if a life-threatening problem is present Intervene with approach actions to treat the problem Recognize possible environmental hazards3. What is the type and severity of the respiratory emergency occurring in the given scenario?* Upper airway obstruction leading to respiratory distress Lower airway obstruction leading to respiratory distress Disordered control of breathing leading to respiratory failure Lung tissue diseases leading to respiratory distressAn initial impression tells you that the infant is in acute respiratory distress. A rapid, hands-on primary assessment using the ABCDE approach reveals the following:Airway: Maintainable, but worseningBreathing: RR 81/min, SpO2 85%, labored, retractions, nasal flaring, wheezingCirculation: HR 196/min, BP 90/60, normal CRT, pink skinDisability: Moving extremities x4, not interactiveExposure: Subfebrile (37.6 °C), no rashes, no trauma4. A primary assessment reveals persistent respiratory distress. What are your initial actions?* Respiratory failure is imminent; secure an advanced airway without delay Administer nebulized albuterol, suction nose, and place an advanced airway Suction the nose and provide oxygen via NRB Suction the nose and place an advanced airwayYou have suctioned the nose and are providing oxygen via NRB. A repeated primary assessment reveals HR 188/min, RR 73, SpO2 94%, BP 95/45, and CRT 2 sec. The patient remains irritable and lethargic while showing continued signs of labored breathing, moderate retractions, and decreased air movement.5. What are your next actions?* Administer a higher dose of nebulized albuterol Administer nebulized racemic epinephrine Start CPR Prepare for ET intubationNebulized racemic epinephrine has been administered and you begin non-invasive ventilatory support via BVM. A repeated primary assessment reveals HR 205/min, RR 48, SpO2 90%, BP 80/45, and CRT 2 sec. Hypoxia is becoming a concern.6. What are your next actions?* Administer 20 ml/kg IV fluid bolus Continue providing supported ventilation via BVM Administer additional bronchodilators Intubate immediately and begin providing mechanical ventilationThe patient is successfully intubated, and mechanical ventilation is provided. Confirmation of correct ETT placement is confirmed using waveform capnography. Auscultation reveals good air movement bilaterally and an improvement in vital signs is noted.7. What are your next actions?* Obtain a peripheral venous blood gas Obtain an arterial blood gas Obtain a complete metabolic panel Monitor for hypotensionThe infant has been provided with mechanical ventilation for several minutes. A repeated primary assessment reveals a continued improvement in oxygenation and further stabilization.8. If there was a sudden deterioration in the infant’s condition shortly after intubating, what reasons would you consider in explaining the sudden change in status?* Displacement of the ETT or pneumothorax Obstruction of the ETT or shock Shock of equipment failure Pneumothorax or myocardial infarction
