PALS Shock Management 2 — Questions and Answers
Question 1: A 3-year-old presents with HR 170, BP 60/40, cool mottled extremities, and altered mental status after a bee sting. Which type of shock is most likely?
- Hypovolemic shock
- Distributive (anaphylactic) shock (Correct answer)
- Cardiogenic shock
- Obstructive shock
Correct answer: Distributive (anaphylactic) shock
Anaphylactic shock is a form of distributive shock triggered by allergen exposure, causing massive vasodilation and hypotension.
Question 2: In a pediatric patient with septic shock, what is the recommended initial fluid bolus dose per PALS guidelines?
- 5 mL/kg isotonic crystalloid
- 10 mL/kg isotonic crystalloid
- 20 mL/kg isotonic crystalloid (Correct answer)
- 40 mL/kg isotonic crystalloid
Correct answer: 20 mL/kg isotonic crystalloid
PALS recommends 20 mL/kg of isotonic crystalloid as the initial fluid bolus for septic shock, repeated as needed up to 60 mL/kg.
Question 3: A child in distributive shock remains hypotensive after 60 mL/kg of IV fluids. Which vasoactive agent is the FIRST-LINE choice for warm (vasodilatory) septic shock?
- Dopamine
- Epinephrine
- Norepinephrine (Correct answer)
- Dobutamine
Correct answer: Norepinephrine
Norepinephrine is preferred for warm distributive shock because its alpha-adrenergic vasoconstriction counteracts pathologic vasodilation.
Question 4: Which finding is the MOST reliable early indicator of shock in a pediatric patient?
- Hypotension
- Tachycardia (Correct answer)
- Decreased urine output
- Altered mental status
Correct answer: Tachycardia
Tachycardia is typically the earliest compensatory response to shock in children; hypotension is a late and ominous sign.
Question 5: A 6-month-old has HR 210, CRT 4 sec, cool extremities, and normal BP. This presentation is best classified as:
- Decompensated shock
- Compensated shock (Correct answer)
- Neurogenic shock
- Irreversible shock
Correct answer: Compensated shock
Compensated shock maintains normal blood pressure through physiologic compensation; decompensated shock is defined by hypotension.
Question 6: Which crystalloid solution is preferred for initial fluid resuscitation in pediatric shock per current PALS guidelines?
- 0.45% NaCl (half-normal saline)
- 5% dextrose in water
- Lactated Ringer's or normal saline (Correct answer)
- 3% NaCl (hypertonic saline)
Correct answer: Lactated Ringer's or normal saline
Isotonic solutions such as normal saline or lactated Ringer's are recommended to restore intravascular volume without causing hyponatremia.
Question 7: In obstructive shock due to tension pneumothorax, what is the definitive emergency intervention?
- IV fluid bolus of 20 mL/kg
- Needle decompression of the affected side (Correct answer)
- Epinephrine 0.01 mg/kg IV
- Emergent pericardiocentesis
Correct answer: Needle decompression of the affected side
Needle decompression releases the trapped air causing mediastinal shift, immediately relieving the obstruction to cardiac output.
PALS Shock Management 2
A 3-year-old presents with HR 170, BP 60/40, cool mottled extremities, and altered mental status after a bee sting.
Which type of shock is most likely?