PALS Vascular Access and Fluid Management in Pediatric Emergencies 1 — Questions and Answers
Question 1: When peripheral IV access cannot be established quickly in a critically ill child, what is the recommended alternative route for emergency medication administration?
- Intraosseous (IO) access (Correct answer)
- Central venous catheter
- Endotracheal tube
- Subcutaneous injection
Correct answer: Intraosseous (IO) access
IO access is recommended by PALS guidelines when IV access cannot be established rapidly, as it provides reliable vascular access in emergencies.
Question 2: Which is the preferred IO insertion site in infants and young children?
- Proximal tibia, 1–3 cm below the tibial tuberosity (Correct answer)
- Distal femur
- Humeral head
- Iliac crest
Correct answer: Proximal tibia, 1–3 cm below the tibial tuberosity
The proximal tibia is the preferred IO site in young children due to its flat, easily identifiable surface and large medullary cavity.
Question 3: A 10 kg child in septic shock requires a fluid bolus. What is the correct isotonic fluid dose per PALS guidelines?
- 10–20 mL/kg of isotonic crystalloid over 10–20 minutes (Correct answer)
- 50 mL/kg given as fast as possible
- 5 mL/kg of 5% dextrose
- 30 mL/kg of colloid
Correct answer: 10–20 mL/kg of isotonic crystalloid over 10–20 minutes
PALS recommends 10–20 mL/kg boluses of isotonic crystalloid (normal saline or lactated Ringer's) for pediatric shock, reassessing after each bolus.
Question 4: After administering 60 mL/kg of isotonic fluid to a child in septic shock with no improvement, what medication should be started?
- Vasoactive agents such as epinephrine or norepinephrine (Correct answer)
- Additional 20 mL/kg fluid bolus
- IV furosemide
- Sodium bicarbonate
Correct answer: Vasoactive agents such as epinephrine or norepinephrine
If a child remains in shock after 40–60 mL/kg of fluid resuscitation, vasoactive/inotropic support should be initiated.
Question 5: Which finding best indicates that a fluid bolus has been successful in a child with hypovolemic shock?
- Improved capillary refill, improved mental status, and normalization of heart rate (Correct answer)
- Increase in respiratory rate
- Rise in temperature
- Decrease in urine output
Correct answer: Improved capillary refill, improved mental status, and normalization of heart rate
Successful fluid resuscitation is indicated by improved perfusion signs: better capillary refill, improved mentation, and normalization of heart rate.
Question 6: Which isotonic crystalloid is most commonly used for initial fluid resuscitation in pediatric shock per PALS?
- Normal saline (0.9% NaCl) or lactated Ringer's solution (Correct answer)
- 5% dextrose in water (D5W)
- 0.45% NaCl (half-normal saline)
- Albumin 5%
Correct answer: Normal saline (0.9% NaCl) or lactated Ringer's solution
Normal saline and lactated Ringer's are recommended isotonic crystalloids for initial fluid resuscitation in pediatric emergencies.
PALS Vascular Access and Fluid Management in Pediatric Emergencies 1
When peripheral IV access cannot be established quickly in a critically ill child, what is the recommended alternative route for emergency medication administration?