PALS MC Pediatric Anaphylaxis with Airway Obstruction

Pediatric Septic Shock

A 4-year-old child presents to the emergency department with fever, tachycardia, lethargy, and mottled skin. The child’s capillary refill time is delayed at 4 seconds, and they appear hypoxic. The child is flushed with signs of systemic infection, and their heart rate is elevated at 160 bpm. The parents report that the child has been feeling unwell for the past 2 days, with decreased appetite and vomiting. There is concern about the child’s ability to maintain circulation and oxygenation.

Focus on restoring perfusion and correcting the signs of shock.

A 4-year-old child presents with fever, tachycardia, lethargy, and mottled skin. Capillary refill time is delayed at 4 seconds. What is your next step?

Perform endotracheal intubation.

Administer a 20 mL/kg fluid bolus of isotonic crystalloid.

Start dopamine infusion for inotropic support.

Administer broad-spectrum antibiotics immediately.

Consider that more fluids may be needed in distributive shock.

After administering the first fluid bolus, the child’s perfusion remains poor, and capillary refill time is still delayed. What is your next step?

Start a norepinephrine infusion.

Provide high-flow oxygen.

Administer an additional 20 mL/kg fluid bolus.

Perform a chest x-ray.

If fluids alone are insufficient, what intervention helps restore vascular tone?

Despite fluid resuscitation, the child remains hypotensive. What is the next appropriate intervention?

Administer hydrocortisone.

Start a norepinephrine infusion.

Provide 100% oxygen via non-rebreather mask.

Administer an additional 20 mL/kg fluid bolus.

Focus on what fluid resuscitation directly improves in septic shock.

What is the primary goal of fluid resuscitation in septic shock?

Reduce pulmonary edema.

Restore tissue perfusion and oxygen delivery.

Stabilize heart rate to normal levels.

Decrease the fever and normalize temperature.

Focus on indicators of end-organ perfusion.

After starting norepinephrine, the child’s blood pressure stabilizes but their urine output is low. What should you assess next?

Administer a diuretic to stimulate urine output.

Increase norepinephrine dosage.

Evaluate lactate levels and capillary refill time.

Start a dopamine infusion to augment renal perfusion.

When should antibiotics be administered in sepsis?

Antibiotics are ready to administer. What is the most important consideration for timing?

Administer only after fluid resuscitation is complete.

Administer when vasopressors are no longer required.

Administer within the first hour of recognizing sepsis.

Wait until blood cultures are drawn.

Think about therapies used in refractory septic shock.

The child’s lactate levels remain elevated despite interventions. What additional therapy might be needed?

Increase norepinephrine dosage further.

Administer a diuretic.

Start hydrocortisone therapy.

Provide a transfusion of packed red blood cells.

Consider strategies to minimize lung injury during mechanical ventilation.

The child progresses to respiratory failure and requires intubation. What ventilation strategy is most appropriate?

Set high tidal volumes to ensure maximum oxygenation.

Avoid PEEP to minimize hemodynamic compromise.

Use high respiratory rates to increase minute ventilation.

Use lung-protective ventilation with low tidal volumes.

What is the focus of care after initial resuscitation in sepsis?

After achieving stability, what is the primary goal of post-resuscitation care in sepsis?

Reduce fluid intake to prevent overload.

Monitor and prevent organ dysfunction.

Wean off all medications quickly.

Initiate physical therapy as soon as possible.

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