1. Parents of a 1-year-old female phoned EMS when they picked up their
daughter from the babysitter. Paramedics perform an initial impression revealing an obtunded infant with irregular breathing, bruises over the ab-
...
1. Parents of a 1-year-old female phoned EMS when they picked up their
daughter from the babysitter. Paramedics perform an initial impression revealing an obtunded infant with irregular breathing, bruises over the ab- domen,
abdominal distension, and cyanosis. Assisted bag-mask ventilationwith 100%
oxygen is initiated. On primary assessment heart rate is 36/min, peripheral
pulses cannot be palpated, and central pulses are barely palpable.Cardiac monitor
shows sinus bradycardia. Chest compressions are startedat 15:2. In the ED the
infant is intubated and ventilated, and IV access is established. The heart rate is
now up to 150/min, but there are weak centralpulses and no distal pulses.
Systolic BP is 74. Of the following, which wouldbe most useful in management of
this infant?
A. Synchronized cardioversion
B. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV
C. Rapid bolus of 20 mL/kg of isotonic crystalloid
D. Atropine 0.02 mg/kg IV
2. You enter a room to perform an initial impression of a previously stable 10-
year-old male and find him unresponsive and apneic. A code is called andbagmask ventilation is performed with 100% oxygen. The cardiac monitor shows a
wide-complex tachycardia. The boy has no detectable pulses so compressions
and ventilations are provided. As soon as the defibrillator arrives you deliver an
unsynchronized shock with 2 J/kg. The rhythm checkafter 2 minutes of CPR
reveals VF. You then deliver a shock of 4 J/kg and resume immediate CPR
beginning with compressions. A team member hasestablished IO access, so you
give a dose of epi, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO after second
shock. At the next rhythm check, persistentVF is present.You administer another
4 J/kg shock and resume CPR. Basedon the PALS Pulseless Arrest Algorithm,
what is the next drug and dose to administer when CPR is restarted?
A. Magnesium sulfate 25-50 mg/kg IO
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