PALS Megacode: Unstable Pediatric Bradycardia Part 2


11:40 PM.  You have responded to a call from a grandmother who called and said her grandbaby was not “breathing right.”   You found the 12 month old infant unresponsive and with  agonal respirations.  CPR was initiated and positive pressure respirations were being given.  The grandmother suspects that the toddler got into her pill box and took her weekly dose of metoprolol.  You have placed the patient on the monitor and noted her to be in complete heart block.   After 2 minutes of CPR there is no change in the patient’s rhythm.   An IV is attempted without success, so an IO is placed near the proximal tibia.  Preparations are made to transport the toddler.  The patients stated weight is 22 lbs (10kg)

6.  How do you verify proper placement of an IO needle?
a.  The needle will make a “popping” sound as it enters the bone
b.  The needle will stand up on its own
c.  Bone marrow or blood can be aspirated through the needle
d.  The fluids will flow freely into the bone

7.   What are 4 contraindications for using an IO needle?
a. 
b.  
c.  
d.  


8.  What are 4 complications related to the use of an IO needle?
a. 
b. 
c. 
d. 


9.  What is the recommended fluid bolus for a pediatric patient in cardiogenic shock?
a.   5-10ml/kg
b. 10- 15ml/kg
c.  15-20ml/kg
d. 20-25ml/kg

10. What medication would be indicated if ventilations and oxygenation fail to correct the bradydysrhythmia?
a.  Epinephrine 0.01mg IV or IO
b.  Vasopression 40units IV or IO
c   Atropine 0.5mg IV or IO
d.  Dopamine 2-10mcg/kg/min

Answers

6. c. Bone marrow or blood can be aspirated through the needle

7.
a. Fracture of the tibia or long bones
b. Cellulitis overlying the insertion site
c. Inferior vena caval injury
d. Previous attempt on the same leg bone
e. Osteogenesis imperfecta because of a higher likelihood of fractures occurring
f. Osteoporosis


8.
a. Extravasation of fluid
b. Compartment syndrome
c. Infection
d. Cellulitis at the insertion site
e. Hematoma
f. Pain at insertion site
g. Growth plate injuries

9. a. 5-10ml/kg

10. a. Epinephrine 0.01mg IV or IO

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