PALS Managing Respiratory Emergencies 2 — Questions and Answers
Question 1: A 3-year-old presents with sudden onset stridor, drooling, and refusal to lie down. Which condition is most likely?
- Croup (laryngotracheobronchitis)
- Epiglottitis (Correct answer)
- Foreign body aspiration
- Bronchiolitis
Correct answer: Epiglottitis
Epiglottitis classically presents with the 'tripod position,' drooling, high fever, and toxic appearance — lying down worsens airway obstruction.
Question 2: When using a bag-mask device in a child, which ventilation rate is correct for a child with a pulse but absent respirations?
- 8-10 breaths/min
- 12-20 breaths/min (Correct answer)
- 20-30 breaths/min
- 30-40 breaths/min
Correct answer: 12-20 breaths/min
PALS guidelines recommend 12–20 breaths/min for rescue breathing in a child with a perfusing rhythm but no spontaneous respirations.
Question 3: A 6-month-old with RSV bronchiolitis has SpO2 of 88% on room air. What is the most appropriate initial oxygen delivery method?
- Non-rebreather mask at 15 L/min
- High-flow nasal cannula (Correct answer)
- Simple nasal cannula at 0.5-1 L/min
- Venturi mask at 35%
Correct answer: High-flow nasal cannula
High-flow nasal cannula delivers warmed, humidified oxygen at flows exceeding anatomical dead space, improving oxygenation and reducing work of breathing in bronchiolitis.
Question 4: During assessment of a pediatric patient in respiratory distress, which finding indicates impending respiratory failure?
- Respiratory rate of 28/min in a 2-year-old
- Decreased muscle tone and poor respiratory effort (Correct answer)
- Mild subcostal retractions with normal mentation
- Expiratory wheezing with good air entry
Correct answer: Decreased muscle tone and poor respiratory effort
Decreased muscle tone combined with poor respiratory effort signals fatigue and impending arrest, requiring immediate intervention.
Question 5: A child with known asthma arrives with severe wheeze, SpO2 92%, and accessory muscle use. After two doses of albuterol, symptoms persist. What is the next best intervention?
- Administer IV magnesium sulfate (Correct answer)
- Begin heliox therapy
- Increase albuterol frequency only
- Perform immediate intubation
Correct answer: Administer IV magnesium sulfate
IV magnesium sulfate is indicated for severe, refractory asthma after initial bronchodilator therapy has failed, as it causes bronchial smooth muscle relaxation.
Question 6: Which finding best differentiates obstructive shock from respiratory failure as the primary cause of a child's decompensation?
- Tachycardia and pallor
- Absent breath sounds on one side with tracheal deviation (Correct answer)
- SpO2 less than 90% with increased work of breathing
- Bradycardia with hypotension
Correct answer: Absent breath sounds on one side with tracheal deviation
Absent unilateral breath sounds with tracheal deviation indicate tension pneumothorax causing obstructive shock, not primary respiratory failure.
Question 7: When performing nasopharyngeal airway (NPA) placement in a pediatric patient, which situation is an absolute contraindication?
- Clenched jaw (trismus)
- Suspected basilar skull fracture (Correct answer)
- Active nasal bleeding
- Age less than 1 year
Correct answer: Suspected basilar skull fracture
Suspected basilar skull fracture is an absolute contraindication to NPA insertion due to risk of intracranial placement.
PALS Managing Respiratory Emergencies 2
A 3-year-old presents with sudden onset stridor, drooling, and refusal to lie down.
Which condition is most likely?