Mechanical Ventilator Basic

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statistics definitions

Definitions

  • Sensitivity: probability that a test result will be positive when the disease is present (true positive rate).= a / (a+b)
  • Specificity: probability that a test result will be negative when the disease is not present (true negative rate).= d / (c+d)
  • Positive likelihood ratio: ratio between the probability of a positive test result given the presence of the disease and the probability of a positive test result given the absence of the disease, i.e.= True positive rate / False positive rate = Sensitivity / (1-Specificity)
  • Negative likelihood ratio: ratio between the probability of a negative test result given the presence of the disease and the probability of a negative test result given the absence of the disease, i.e.= False negative rate / True negative rate = (1-Sensitivity) / Specificity
  • Positive predictive value: probability that the disease is present when the test is positive.Positive predictive value
  • Negative predictive value: probability that the disease is not present when the test is negative.Negative predictive value
  • Accuracy: overall probability that a patient is correctly classified.= Sensitivity × Prevalence + Specificity × (1 − Prevalence)

Polymerase Chain Reaction (PCR) and Reverse-Transcriptase PCR (RT-PCR)

DR ATIQUR RAHMAN KHAN

Polymerase Chain Reaction (PCR) and Reverse-Transcriptase PCR (RT-PCR)

Our DNA contains loads of information, neatly stacked to insanely small sizes, able to fit within a cell nucleus. A single DNA molecule has two strands, which wrap one around one another to form a double helix. Each single strand of DNA is composed of a sequence of four types of nucleotides – which are the individual letters or building blocks of DNA. Nucleotides of DNA are made up of a sugar – deoxyribose, a phosphate, and one of the four nucleobases – adenine, cytosine, guanine, and thymine – or A, C, G, T for short. The nucleotides on one strand form hydrogen bonds to complementary nucleotides on the other strand; specifically, A bonds with T via two hydrogen bonds, and C bonds with G, via three hydrogen bonds. Additionally, the two DNA strands also have a “direction” – meaning, one of them runs from the 3’ end to the 5’ end, while the other one runs from the 5’ end to the 3’ end. Kinda like two snakes coiled up together, but facing in different directions. Every single protein of our body is encoded through combinations of just four nucleotides. When there are errors in our genetic information, diseases occur. And let’s be honest, we were always interested in knowing what was written in our DNA.

Polymerase chain reaction, or PCR for short, is a technique used in molecular biology to amplify a segment of DNA. Let’s take a step back. A single copy of DNA is not very much DNA. So to work with DNA, we basically make lots and lots of lots of copies of it, so that it’s easier to analyze. For example, if we want to visualize it, we can use a technique called gel electrophoresis. 

PCR is based on DNA replication, a process that our cells normally use to duplicate their genetic material before dividing in two identical daughter cells. So first of all, we’re going to need a machine called a thermal cycler – that’s where the PCR magic happens. You can think of it like a cauldron filled with a solution, where genetic wizards add the ingredients. The ingredients are the DNA that we wish to multiply, an enzyme called Taq polymerase, specific primers, that bind to the DNA, and a mixture of free nucleotides – A, T, C and G. Throw everything in the thermal cycler, wave your magic wand, and the process begins. 

So, let’s say that we have a long, double stranded DNA molecule, and we’re interested in the highlighted part. These two strands would be the template strands.

5’ – T T C A G G T C A C A G T C C T G T A T G C C T A T G T C C- 3’

3’ – A A G T C C A G T G T C A G G A C A T A C G G A T A C A G G- 5’

The first step of PCR is denaturation – meaning that we heat up our ingredients to exactly 96 degrees Celsius – almost as hot as boiling water. This breaks open all bonds between the two strands of DNA, so that they can separate from one another. 

The second step is called annealing. Here’s where we need primers, and for our highlighted sequence, the primers would look like this:

 <—-3’-  C G G A T A C– 5’

    5’ –  A G G T C A C – 3’ —>

During the annealing step, we cool everything down to around 55 degrees Celsius, and this allows the primers to bind to their complementary sequences on the single stranded DNA.

The third step is called extension – we want to make the environment as optimal as possible for Taq polymerase to do its job. Ok, see, Taq polymerase is actually a really cool enzyme. We get it from a bacteria called Thermus aquaticus that grows in geothermal hot springs. So not only can Taq polymerase withstand the heat during the denaturation step of PCR, but it also functions best at around 72 degrees Celsius. So during extension, we heat everything back up to 72 degrees, and Taq polymerase latches onto the primers, grabs some free nucleotides, and assembles the new DNA strands. 

And that’s pretty much all there is to it! A whole PCR cycle lasts roughly 10 minutes, and at the end we’ve doubled the amount of DNA because each template strand of DNA is now double stranded! So, now, we just continue cycling these three steps a couple of dozen times – after every step, and the quantity of DNA gets doubled each cycle. 2 strands, then 4 strands, then 8, then 16, then 32, then 64, then 128, so and and so forth. So PCR actually multiplies DNA at an exponential rate – after around 6 hours and 40 cycles, we’ll theoretically have 2^40, or 1,099,511,627,776 copies – easier to remember as a whole lotta DNA that we can further analyze. 

There are a lot of variations of PCR, but let’s discuss one that has been used recently for diagnosing a viral infection. Specifically, what if you wanted to diagnose someone with a COVID-19? To do that you would collect a nasopharyngeal swab which is where you take a long Q-tip with only one soft end, and twirl it a few times inside a nostril to get enough secretions on it to be analyzed. Now, getting a good sample is crucial, so make sure you really get in there; if no virus gets on the swab, then PCR can’t detect it! To diagnose Covid-19 what you would look for is a virus called severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2.

Now, SARS-CoV2 is an RNA virus, not DNA, so to detect you would need to use a particular type of PCR called reverse-transcriptase PCR; or RT-PCR for short. This technique is a little different, because it starts with RNA, instead of DNA. If you remember, one difference between RNA and DNA is that RNA doesn’t have thymine; instead, it has uracil. RNA is complementary to DNA, though, so if an RNA strand has a nucleotide sequence, 3’-AAG UCC AGU-5’, then the complementary DNA, or cDNA, strand would be 5’- TTC AGG TCA -3’. 

To perform RT-PCR some of the extracted sample from the nasopharyngeal swab is added to a solution containing an enzyme called reverse transcriptase, nucleotides, and primers that are complementary to a specific SARS-CoV-2 target sequence. If the viral RNA is present, the primers attach to the RNA strand, and then reverse transcriptase synthesizes a cDNA strand. Once we’ve got the cDNA, the steps of RT-PCR are pretty much the same as PCR; Taq polymerase is used to amplify the cDNA through denaturation, annealing, and extension steps. After several rounds, if there was SARS-CoV-2 RNA in the original sample you’ll have amplified DNA from that sample that can be detected.

Alright, as a quick recap. Polymerase chain reaction is a technique used to massively multiply DNA, so that it can be analyzed using other techniques. It requires a thermal cycler, filled with the DNA sample to be multiplied, thermostable Taq polymerase, primers with which we select what gets multiplied, and free nucleotides of all 4 types – A, T, C and G. The first step is denaturation, then there’s annealing, and finally extension. PCR doubles the amount of DNA that we’re interested in looking at in each cycle.

SAVEALIFE PALS QUESTION AND ANSWER

  1. True or False: Medication administration via ET tube is preferred due to its consistency.

Your Answer: False

CORRECT

  1. True or False: Early signs of obstructive shock always resemble distributive shock.

Your Answer: False

CORRECT

  1. True or False: When treating obstructive shock, you should focus on diagnosing and correcting the cause.

Your Answer: True

CORRECT

  1. True or False: Atrial flutter is a very common heart rhythm in children.

Your Answer: False

CORRECT

  1. True or False: Symptomatic bradycardia is defined as bradycardia with signs of shock or respiratory failure or distress.

Your Answer: True

CORRECT

  1. True or False: The management of septic shock is simple and straightforward.

Your Answer: False

CORRECT

  1. True or False: Distended neck veins on physical examination may indicate ineffective cardiac function.

Your Answer: True

CORRECT

  1. True or False: Analgesics and sedatives should only be used on intubated individuals if they are extremely agitated.

Your Answer: False

CORRECT

  1. The initial assessment consists of assessing all of the following EXCEPT:
    •  Breathing
    •  Consciousness
    •  Color
    •  Deformity

CORRECT

  1. All of the following assessments are included in the initial assessment EXCEPT:
    •  Cardiac arrest
    •  Exposure
    •  Breathing
    •  Airway

CORRECT

  1. A normal heart rate in an awake child between the ages of 2 to 10 years old is:
    •  100 to 190 beats per minute
    •  75 to 160 beats per minute
    •  85 to 205 beats per minute
    •  60 to 140 beats per minute

CORRECT

  1. Abnormal breath sounds associated with upper airway obstruction include:
    •  Crackles
    •  Absent breath sounds
    •  Stridor
    •  Decreased breath sounds

CORRECT

  1. Croup medications used for treatment are the following:
    •  Dexamethasone
    •  Nebulized epinephrine
    •  Heliox (Oxygen)
    •  All of the above

CORRECT

  1. Common causes of lower airway obstruction include:
    •  Bronchiolitis and asthma
    •  Pleural effusion and bronchospasm
    •  Pneumonia and pulmonary edema
    •  Foreign body aspiration and croup

CORRECT

  1. Medications that may be used to treat moderate to severe asthma include all of the following EXCEPT:
    •  Antibiotics
    •  Ipratropium bromide
    •  Albuterol
    •  Magnesium sulfate

CORRECT

  1. Acute community-acquired pneumonia causes include:
    •  Streptococcus pneumonia
    •  Mycoplasma pneumonia
    •  Chlamydia pneumonia
    •  All of the above

CORRECT

  1. Which two components make up cardiac output?
    •  Stroke volume and heart rate
    •  Heart rate and SVR
    •  SVR and stroke volume
    •  None of the above

CORRECT

  1. Which type of shock leads to fluid loss due to diarrhea?
    •  Cardiogenic
    •  Hypovolemic
    •  Obstructive
    •  Distributive

CORRECT

  1. The type of shock associated with inadequate tissue perfusion resulting from myocardial dysfunction is:
    •  Distributive shock
    •  Cardiogenic shock
    •  Obstructive shock
    •  Hypovolemic shock

CORRECT

  1. Effectiveness of fluid resuscitation and medication therapy should be frequently monitored by which of the following?
    •  Heart rate
    •  Blood pressure
    •  Mental status
    •  All of the above

CORRECT

  1. For fluid resuscitation in hemorrhagic shock, give about _____ of crystalloid for every _____ of blood lost.
    •  2 mL, 3 mL
    •  3 mL, 1 mL
    •  3 mL, 2 mL
    •  1 mL, 3 mL

CORRECT

  1. The consensus definition of hypoglycemia in children and infants is:
    •  Less than or equal to 60 mg/dL
    •  Less than or equal to 40 mg/dL
    •  Less than or equal to 80 mg/dL
    •  Less than or equal to 50 mg/dL

INCORRECT – RIGHT ANSWER: LESS THAN OR EQUAL TO 60 MG/DL

  1. What is the vasoactive agent of choice for the child with fluid-refractory septic shock who presents in vasodilated (warm) shock with poor perfusion or hypotension?
    •  Dopamine
    •  Epinephrine
    •  Norepinephrine
    •  Dobutamine

CORRECT

  1. The first energy dose recommended for synchronized cardioversion for unstable SVT or VT with a pulse that causes cardiovascular instability is:
    •  0.5 to 1 Joules per kg
    •  3 to 5 Joules per kg
    •  0.1 to 0.5 Joules per kg
    •  1 to 2 Joules per kg

CORRECT

  1. What is the initial drug of choice for SVT treatment?
    •  Adenosine
    •  Amiodarone
    •  Procainamide
    •  Atropine

CORRECT

  1. Any organized electrical activity observed on an ECG or cardiac monitor in a individual with no palpable pulse is referred to as:
    •  PEA (pulseless electrical activity)
    •  Ventricular tachycardia without pulses
    •  Ventricular fibrillation
    •  Asystole

CORRECT

  1. What is the preferred priority for drug delivery routes?
    •  IV route, IO route, ET route
    •  IV route, ET route, IO route
    •  ET route, IV route, IO route
    •  IO route, ET route, IV route

CORRECT

  1. Drugs that can be administered down the endotracheal (ET) tube include all of the following EXCEPT:
    •  Adenosine
    •  Lidocaine
    •  Epinephrine
    •  Atropine

CORRECT

  1. When should a child be transferred to tertiary care?
    •  If the child remains comatose post resuscitation
    •  After the first phase of resuscitation management
    •  As soon as possible
    •  Immediately

CORRECT

  1. Which statement is correct concerning pharmacological support during post-resuscitation management?
    •  Dobutamine generally decreases myocardial contractility.
    •  Treat hypotension with vasopressors if needed, titrated to BP.
    •  Milrinone and inamrinone always increase heart rate and myocardial demand.
    •  In infants, with significant circulatory instability and hypotensive shock, do not administer epinephrine.

CORRECT

  1. Poor ventilation causes which of the following:
    •  Respiratory acidosis
    •  Hypocarbia
    •  Hyperglycemia
    •  None of the above

CORRECT

  1. Suitable oxygen delivery to body tissue is dependent on all of the following EXCEPT:
    •  Adequate IV access
    •  Adequate hemoglobin
    •  Adequate perfusion
    •  Adequate blood oxygenation

CORRECT

  1. Pulse oximetry is monitored during post-resuscitation care to:
    •  Monitor hypoglycemia
    •  Monitor hypovolemia
    •  Optimize ventilation and circulation
    •  Stabilize blood pressure

CORRECT

  1. It is appropriate to administer one oral dose of ___________ for mild croup.
    •  Dexamethasone
    •  Albuterol
    •  Atropine
    •  Epinephrine

CORRECT

  1. A complete heart block is also known as:
    •  Mobitz type II block
    •  Third degree AV block
    •  First degree AV block
    •  Mobitz type I block

CORRECT

  1. Which statement concerning cardioversion for unstable pediatric indviduals is NOT correct?
    •  Cardioversion is indicated for unstable ventricular tachycardia with a pulse.
    •  Cardioversion should not be done on pediatric indviduals under any circumstances.
    •  Sedate them before cardioversion when possible, but do not delay cardioversion for sedation.
    •  Cardioversion is indicated for wide complex tachycardia with poor perfusion.

CORRECT

  1. Which of the following is a common sign of hypovolemic shock?
    •  Hypoglycemia
    •  High blood pressure
    •  Tachypnea with mildly elevated work of breathing
    •  Normal urine output

CORRECT

  1. Respiratory acidosis is caused by:
    •  Hypoglycemia
    •  Insufficient ventilation
    •  Hyperoxia
    •  Hypocarbia

CORRECT

  1. Which statement regarding distributive shock is NOT true?
    •  Warm shock is characterized by cool, pale extremities.
    •  Distributive shock commonly results in inadequate tissue perfusion and oxygenation.
    •  Distributive shock can be characterized as either warm shock or cold s
    •  Common forms of distributive shock include septic shock, anaphylactic shock, and neurogenic shock.

CORRECT

  1. Children under the age of ten have _________ normal heart rates when awake compared to adults.
    •  Lower
    •  Higher
    •  Roughly equal
    •  Completely unpredictable

CORRECT

  1. Which statement about hydrocortisone is NOT correct?
    •  Hydrocortisone cannot be used for adrenal insufficiency associated with septic shock.
    •  A common side effect is hyperglycemia.
    •  Hydrocortisone is classified as a corticosteroid.
    •  Hydrocortisone inhibits vascular leak due to proinflammatory mediators.

CORRECT

  1. You should immediately begin chest compressions on a bradycardic individual if they:
    •  A. Have heart rate below 60 bpm
    •  B. Show signs of respiratory distress
    •  C. Show signs of poor perfusion
    •  D. Both A and C

CORRECT

  1. The purpose of post-resuscitation care of a PALS individual is to:
    •  Optimize ventilation
    •  Optimize circulation
    •  Preserve organ and tissue function
    •  All of the above

CORRECT

  1. Which statement about albumin is NOT correct?
    •  Albumin should be used by mouth only.
    •  Albumin is used in hypovolemia.
    •  Albumin is a plasma volume expander.
    •  Albumin is indicated for shock, trauma, and burns.

CORRECT

  1. All of the following are signs of cardiorespiratory distress EXCEPT:
    •  Tachypnea
    •  Irregular heart rhythm
    •  Fatigue
    •  Jaundice

CORRECT

  1. When can post-resuscitation management be necessary?
    •  After cardiac arrest
    •  After severe shock
    •  After respiratory failure
    •  All of the above

CORRECT

  1. All of the following are examples of upper airway obstruction EXCEPT:
    •  Laryngitis
    •  Anaphylaxis
    •  Croup
    •  Asthma

CORRECT

  1. Exposure in PALS evaluations refers to an assessment for:
    •  Trauma
    •  Burns
    •  Fractures
    •  Any of the signs of a problem above

CORRECT

  1. Which of the following is NOT a sign of poor end-organ perfusion?
    •  Irritability
    •  Hypertension
    •  Skin color
    •  Inadequate urine production

CORRECT

  1. Which statement about fluid therapy for shock is NOT correct?
    •  Fluid therapy is never indicated for cardiogenic shock.
    •  Fluid therapy with small boluses is commonly indicated for cardiogenic shock.
    •  Increased urine output often indicates improved condition.
    •  None of the above

CORRECT

SAVEALIFE PALS QUESTION AND ANSWERS

VF and pulseless VT are shockable rhythms and treated in similar fashion. Asystole and PEA are also included in the cardiac arrest algorithm but are non-shockable rhythms.

  1. True or False: Albuterol is a common recommendation for treatment of wheezing in a child with infectious pneumonia.Your Answer: TrueCORRECT
  2. True or False: Full neurological recovery is never a challenge after cardiac arrest.Your Answer: FalseCORRECT
  3. True or False: When treating obstructive shock, you should focus on diagnosing and correcting the cause.Your Answer: TrueCORRECT
  4. True or False: Atrial flutter is a very common heart rhythm in children.Your Answer: FalseCORRECT
  5. True or False: Cardiopulmonary arrest is a common result of respiratory failure and shock.Your Answer: TrueCORRECT
  6. True or False: Symptomatic bradycardia is defined as bradycardia with signs of shock or respiratory failure or distress.Your Answer: TrueCORRECT
  7. The initial assessment consists of assessing all of the following EXCEPT:
    •  Color
    •  Consciousness
    •  Breathing
    •  Deformity
    CORRECT
  8. Restoring the upper airway patency in a child does NOT include:
    •  Using the head-tilt-chin-lift maneuver to open the airway
    •  Use airway adjuncts (e.g., nasopharyngeal or oropharyngeal airways)
    •  Performing foreign body airway-obstruction-relief techniques
    •  Cricothyrotomy
    INCORRECT – RIGHT ANSWER: CRICOTHYROTOMY
  9. Stridor is a sign of _______________.
    •  Upper airway obstruction
    •  Pneumonia
    •  Pulmonary edema
    •  Bronchoconstriction
    CORRECT
  10. What response is NOT scored by the GCS (Glasgow Coma Scale)?
    •  Minute ventilation
    •  Motor response
    •  Verbal response
    •  Eye opening
    CORRECT
  11. Abnormal breath sounds associated with upper airway obstruction include:
    •  Stridor
    •  Absent breath sounds
    •  Crackles
    •  Decreased breath sounds
    CORRECT
  12. Croup medications used for treatment are the following:
    •  Dexamethasone
    •  Nebulized epinephrine
    •  Heliox (Oxygen)
    •  All of the above
    CORRECT
  13. Acute community-acquired pneumonia causes include:
    •  Streptococcus pneumonia
    •  Mycoplasma pneumonia
    •  Chlamydia pneumonia
    •  All of the above
    CORRECT
  14. Types of shock include all of the following EXCEPT:
    •  Distributive shock
    •  Cardiogenic shock
    •  Hypovolemic shock
    •  Hypothermic shock
    CORRECT
  15. The type of shock associated with inadequate tissue perfusion resulting from myocardial dysfunction is:
    •  Cardiogenic shock
    •  Hypovolemic shock
    •  Obstructive shock
    •  Distributive shock
    CORRECT
  16. The acute treatment of shock consists of all of the following EXCEPT:
    •  Correcting metabolic imbalances
    •  Optimizing oxygen content of the blood
    •  Improving volume and distribution of cardiac output
    •  Increasing O2 demand
    INCORRECT – RIGHT ANSWER: INCREASING O2 DEMAND
  17. What is caused by an accumulation of blood in the pericardial space that results in impaired systemic venous return, impaired ventricular filling, and reduced cardiac output?
    •  Cardiac tamponade
    •  Tension pneumothorax
    •  Ductal-dependent congenital heart lesions
    •  Massive pulmonary embolism
    CORRECT
  18. Supraventricular tachycardia (SVT) can be caused by all of the following EXCEPT:
    •  Accessory pathway reentry
    •  AV nodal reentry
    •  Long QT syndromes
    •  Ectopic atrial focus
    CORRECT
  19. The first energy dose recommended for synchronized cardioversion for unstable SVT or VT with a pulse that causes cardiovascular instability is:
    •  0.1 to 0.5 Joules per kg
    •  3 to 5 Joules per kg
    •  1 to 2 Joules per kg
    •  0.5 to 1 Joules per kg
    CORRECT
  20. What is the best vasoactive agent for cold septic shock?
    •  Norepinephrine
    •  Milrinone
    •  Dopamine
    •  Epinephrine
    CORRECT
  21. If at any time you determine that an individual is experiencing a life-threatening emergency, you should support breathing and cardiovascular function immediately by:
    •  Treating respiratory failure
    •  Evaluating for airway obstruction
    •  Providing high-quality CPR
    •  Giving medications for respiratory distress
    CORRECT
  22. All of the following are signs of cardiogenic shock EXCEPT:
    •  Signs of increased respiration, often times including extended neck veins
    •  Signs of pulmonary or systemic venous congestion
    •  Declined respiratory function in response to fluid therapy
    •  Improved tissue perfusion in response to fluid therapy
    INCORRECT – RIGHT ANSWER: IMPROVED TISSUE PERFUSION IN RESPONSE TO FLUID THERAPY
  23. Which statement is correct concerning pharmacological support during post-resuscitation management?
    •  Dobutamine generally decreases myocardial contractility.
    •  Treat hypotension with vasopressors if needed, titrated to BP.
    •  Milrinone and inamrinone always increase heart rate and myocardial demand.
    •  In infants, with significant circulatory instability and hypotensive shock, do not administer epinephrine.
    CORRECT
  24. Initial management of respiratory distress or failure include:
    •  Opening and supporting the airway
    •  Assessing oxygenation with a pulse oximeter
    •  Suctioning and providing supplemental oxygen
    •  All of the above
    CORRECT
  25. Which statement best describes cardiogenic shock?
    •  Increased myocardial dysfunction indicates cardiogenic shock and deteriorating condition.
    •  Aggressive fluid therapy is always indicated for cardiogenic shock.
    •  Increased blood pressure with wide pulse pressures always indicates cardiogenic shock.
    •  Individuals in cardiogenic shock have normal peripheral pulses and blood pressure.
    CORRECT
  26. Which conditions do NOT typically produce tachycardia?
    •  Mobitz type I block
    •  Fever
    •  Acute blood loss
    •  Metabolic stress
    CORRECT
  27. Which is a common cause of quiet tachypnea?
    •  High fever
    •  Hypoglycemia
    •  Upper respiratory obstruction
    •  None of the above
    CORRECT
  28. Pulse oximetry is monitored during post-resuscitation care to:
    •  Optimize ventilation and circulation
    •  Monitor hypoglycemia
    •  Stabilize blood pressure
    •  Monitor hypovolemia
    CORRECT
  29. Which statement concerning cardiac arrest is NOT correct?
    •  High-quality CPR always produces good outcomes for pediatric cardiac arrest individuals.
    •  Pediatric individuals in cardiac arrest often have poor outcomes and poor survival rates.
    •  Cell death within the brain often causes irreversible neurological damage.
    •  An individual may display signs of agonal breathing in stages of cardiac arrest.
    CORRECT
  30. It is appropriate to administer one oral dose of ___________ for mild croup.
    •  Epinephrine
    •  Dexamethasone
    •  Albuterol
    •  Atropine
    CORRECT
  31. Which statement about sinus tachycardia is NOT correct?
    •  Sinus tachycardia is a normal, non-dangerous rhythm.
    •  Sinus tachycardia may occur in response to stress.
    •  Sinus tachycardia may occur in response to fever.
    •  Sinus tachycardia often indicates impending arrest.
    CORRECT
  32. When should you use the “pediatric bradycardia with a pulse” algorithm?
    •  Only on bradycardic individuals with signs of shock
    •  Only on bradycardic individuals with signs of respiratory distress or failure
    •  On all bradycardic individuals without a pulse
    •  For individuals with symptomatic bradycardia
    CORRECT
  33. Which statement concerning cardioversion for unstable pediatric indviduals is NOT correct?
    •  Sedate them before cardioversion when possible, but do not delay cardioversion for sedation.
    •  Cardioversion is indicated for unstable ventricular tachycardia with a pulse.
    •  Cardioversion is indicated for wide complex tachycardia with poor perfusion.
    •  Cardioversion should not be done on pediatric indviduals under any circumstances.
    CORRECT
  34. Which of the following is a common sign of hypovolemic shock?
    •  Hypoglycemia
    •  Normal urine output
    •  High blood pressure
    •  Tachypnea with mildly elevated work of breathing
    CORRECT
  35. Which of the following is a wide complex tachycardia?
    •  Supraventricular tachycardia
    •  Ventricular tachycardia
    •  Atrial flutter
    •  Sinus tachycardia
    CORRECT
  36. Common signs of compensated shock include:
    •  Wide pulse pressure
    •  Increased heart rate
    •  Hypertension
    •  Increased urine output
    CORRECT
  37. Cardiac arrest in pediatrics is most commonly caused by ____________.
    •  Exercise
    •  Respiratory problems
    •  Injury
    •  Poor diet
    CORRECT
  38. When should vasopressors be administered during the management of septic shock?
    •  Always indicated as soon as IV access is obtained
    •  Vasopressors are never used for septic shock.
    •  If the individual develops pulmonary edema
    •  If the individual is severely hypotensive despite proper fluid management
    CORRECT
  39. Which statement about sinus bradycardia is correct?
    •  Sinus bradycardia may be an abnormal heart rate resulting from a pathological condition.
    •  Sinus bradycardia is never a normal rhythm.
    •  Sinus bradycardia often is the result of increased metabolic demand.
    •  Sinus bradycardia always originates at the AV node.
    CORRECT
  40. Children under the age of ten have _________ normal heart rates when awake compared to adults.
    •  Lower
    •  Roughly equal
    •  Completely unpredictable
    •  Higher
    CORRECT
  41. Which rhythm should be shocked?
    •  Atrial fibrillation
    •  Pulseless electrical activity (PEA)
    •  Supraventricular tachycardia
    •  Ventricular fibrillation
    CORRECT
  42. Which of the following is NOT part of the primary circulatory assessment?
    •  Arterial blood gas analysis
    •  Pulse
    •  Blood pressure
    •  Capillary refill time
    CORRECT
  43. Epinephrine may be used in managing which of the following conditions:
    •  Anaphylaxis
    •  Asthma
    •  Symptomatic bradycardia
    •  All of the above
    CORRECT
  44. You should immediately begin chest compressions on a bradycardic individual if they:
    •  A. Have heart rate below 60 bpm
    •  B. Show signs of respiratory distress
    •  C. Show signs of poor perfusion
    •  D. Both A and C
    CORRECT
  45. Untreated shock can lead to:
    •  Cardiopulmonary problems
    •  Hypotension
    •  Cardiac arrest
    •  All of the above
    CORRECT
  46. Which statement is correct concerning neurological assessment during post-resuscitation management?
    •  Dilated unresponsive pupils, hypertension, bradycardia, respiratory irregularities, or apnea may indicate cerebral herniation.
    •  Seizures should not be treated.
    •  Prolonged hypoventilation is suggested for imminent cerebral herniation.
    •  Hypothermia should be strictly avoided.
    CORRECT
  47. All of the following are signs of cardiorespiratory distress EXCEPT:
    •  Fatigue
    •  Tachypnea
    •  Irregular heart rhythm
    •  Jaundice
    CORRECT
  48. All of the following are examples of upper airway obstruction EXCEPT:
    •  Croup
    •  Asthma
    •  Laryngitis
    •  Anaphylaxis
    CORRECT
  49. Which of the following is NOT a sign of poor end-organ perfusion?
    •  Hypertension
    •  Skin color
    •  Inadequate urine production
    •  Irritability
    CORRECT
  50. Which statement about fluid therapy for shock is NOT correct?
    •  Fluid therapy is never indicated for cardiogenic shock.
    •  Fluid therapy with small boluses is commonly indicated for cardiogenic shock.
    •  Increased urine output often indicates improved condition.
    •  None of the above
    CORRECT
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