PALS Post-Cardiac Arrest Care 2 — Questions and Answers
Question 1: What is the recommended target PaCO2 range during post-cardiac arrest care in pediatric patients?
- 25–30 mmHg
- 35–45 mmHg (Correct answer)
- 50–55 mmHg
- 20–25 mmHg
Correct answer: 35–45 mmHg
Normocapnia (PaCO2 35–45 mmHg) is targeted to avoid cerebral vasoconstriction from hypocapnia or vasodilation and increased ICP from hypercapnia.
Question 2: A post-cardiac arrest child has a blood glucose of 240 mg/dL. What is the recommended action?
- Administer insulin immediately
- Avoid treatment; hyperglycemia is protective
- Treat hyperglycemia while avoiding hypoglycemia (Correct answer)
- Restrict all fluids to reduce glucose
Correct answer: Treat hyperglycemia while avoiding hypoglycemia
Both hyperglycemia and hypoglycemia worsen neurological outcomes, so glucose should be managed to normoglycemia.
Question 3: Which intervention is MOST appropriate to assess neurological recovery after pediatric cardiac arrest?
- CT scan within 1 hour of ROSC
- Continuous EEG monitoring (Correct answer)
- Lumbar puncture at 24 hours
- Immediate MRI in the resuscitation bay
Correct answer: Continuous EEG monitoring
Continuous EEG monitoring is recommended post-arrest to detect seizures, which are common and may be non-convulsive.
Question 4: Post-ROSC, a child's SpO2 is 98% on FiO2 1.0. What adjustment should be made?
- Maintain 100% FiO2 to ensure oxygenation
- Titrate FiO2 down to maintain SpO2 94–99% (Correct answer)
- Increase FiO2 if SpO2 drops below 100%
- Switch to room air immediately
Correct answer: Titrate FiO2 down to maintain SpO2 94–99%
Hyperoxia worsens reperfusion injury; FiO2 should be titrated to maintain SpO2 94–99% after ROSC.
Question 5: Which temperature range is recommended for targeted temperature management (TTM) in comatose pediatric survivors of cardiac arrest?
- 32–34°C for all patients
- 36–37.5°C for neonates, 32–34°C for children
- 32–34°C or 36–37.5°C depending on protocol (Correct answer)
- 38–39°C to prevent shivering
Correct answer: 32–34°C or 36–37.5°C depending on protocol
Current PALS guidelines support either 32–34°C or 36–37.5°C as acceptable TTM targets for comatose pediatric patients after cardiac arrest.
Question 6: A 7-year-old is post-cardiac arrest with a MAP of 45 mmHg. Which agent is MOST appropriate as first-line vasopressor support?
- Epinephrine or dopamine (Correct answer)
- Nitroglycerin
- Atropine
- Adenosine
Correct answer: Epinephrine or dopamine
Epinephrine or dopamine are first-line vasopressors to maintain adequate blood pressure and end-organ perfusion post-ROSC.
Question 7: How long should active fever prevention be maintained after cardiac arrest in a child managed with TTM?
- 12 hours only
- Until the child wakes up
- At least 72 hours post-arrest (Correct answer)
- Only during ICU admission
Correct answer: At least 72 hours post-arrest
Fever prevention should continue for at least 72 hours post-arrest because hyperthermia worsens neurological injury during the recovery period.
PALS Post-Cardiac Arrest Care 2
What is the recommended target PaCO2 range during post-cardiac arrest care in pediatric patients?