PALS Megacode: Unstable Pediatric Bradycardia Part 4

12:00 AM. You have responded to a call regarding a 12 month old female pediatric patient (10kg) with suspected metoprolol overdose. CPR is in progress with positive pressure ventilations. An IO needle has been placed in the proximal right tibia and two fluid boluses at 10ml/kg have been given as well as one round of epinephrine. The toddler’s heart rhythm remained unchanged so transcutaneous pacing has been initiated. You are in the process of adjusting the milliamps downward and the following rhythm is observed.

16.  What are your observations regarding this rhythm

a.  The rhythm show good electrical capture so the milliamps can continue to be adjusted downward until the pacing threshold is reached.

b.  The rhythm strip show that the milliamps have been decreased below the pacing threshold.

c.  Based upon the patients weight, the above milliamp settings are correct for this patient.

d.  The pacing spikes indicate a loss of electrical capture so the pacing rate should be increased to 120 beats per minute.

17.  What are your observations regarding this rhythm.   

a.  The rhythm show good electrical capture and is above the patient’s pacing threshold

b.  The pacing spikes show failure to sense

c.  The pacing spikes indicate failure to capture

d.  The pacing spikes indicate inadequate mechanical capture

18.  What is the recommended dose of atropine for a pediatric patient?

a.  0.01mg/kg IV or IO

b. 0.1mg/kg, up to 3mg/kg

c.  0.02mg/kg IV or IO

d.  0.5mg IV or IO

19.  You only have on hand the standard adult concentration of atropine (1mg in 10ml).  Calculate the correct ml to administer based upon the patient’s stated weight of 10 kg.

a. 0.1 ml

b. 0.2 ml

c. 2.0 ml

d. 1.0 ml

20.  Pediatric pacing electrodes are recommended for a pediatric patient weighing less than

a.  10 kg

b. 15kg

c. 20 kg

d. 25 kg

Answers

16. b. The rhythm strip show that the milliamps have been decreased below the pacing threshold.

17. a. The rhythm show good electrical capture and is above the patient’s pacing threshold

18. c. 0.02mg/kg IV or IO

19. b. 0.2 ml

20. b. 15kg