A 2-year-old, 12 kg child requires CPR.
Which of the following steps is most appropriate for this patient?
Correct Answer: B
PALS program provides a structured approach to the assessment and treatment of the critically ill pediatric patient. While there are similarities between the PALS and adult algorithms, important differences also exist. Compression depth for adults is a minimum of 5 cm/2 in. Compression depth for a child is at least one-third the depth of the chest size, or 5 cm for a child and 4 cm for an infant.
For pediatric patients noted to be in ventricular fibrillation or pulseless ventricular tachycardia, an unsynchronized shock should be administered starting at 2 J/kg. The PALS algorithm continues with subsequent shocks of 4 J/kg administered if needed.
Whereas adults receive 1 mg of epinephrine during ACLS, pediatric patients receive a weight-based dose at 0.01 mg/kg.
As in adults, amiodarone is recommended in pediatric patients for the management of ventricular fibrillation or pulseless ventricular tachycardia with the pediatric dosage of 5 mg/kg IV/IO/bolus dose.
A 23-year-old man is brought to the ED after sustaining a gunshot wound to the leg. When emergency medical services (EMS) arrived at the scene with pulsatile bleeding from the leg, they placed a tourniquet with good effect. Upon initial evaluation of the patient, he is arousable to pain but confused. His vital signs are:
Laboratory data reveal
What class of hemorrhagic shock is most consistent with the patient’s clinical examination and laboratory findings?
Correct Answer: C
Hemorrhagic shock can be rapidly fatal. The primary goal is to stop the bleeding. Resuscitation may well depend on estimated severity of hemorrhage. The severity of hemorrhagic shock is commonly subdivided into four classes based on alterations in vital signs, urine output, GCS, and base deficit (see table tbelow).
The patient has tachycardia, mild hypotension with narrowed pulse pressure, a reduced GCS, and a base deficit most consistent with class III hemorrhagic shock.
A patient’s age, severity of injury, time between injury and resuscitation, prehospital resuscitation efforts, and the patient’s medical history (including medications) will all impact the patient’s clinical presentation. Given this, it is essential that volume and blood resuscitation happen promptly and appropriately. The clinician should not wait until the patient fits a certain class of shock before initiating resuscitation.
A 25-year-old patient is hypotensive (BP 87/54) and tachycardic (HR 110) after sustaining a stab wound to the right thigh. Based on his vital signs, he would be expected to have lost approximately what percentage of his total circulating blood volume?
Correct Answer: D
Predicting blood loss is important to determine treatments of patients with traumatic injury, which can cause death by hypovolemic hemorrhagic shock. Hemorrhagic deaths typically occur very early, usually within the first 6 hours of admission, and early hypoperfusion or shock has been demonstrated to promote coagulopathy The ATLS guidelines suggest four classes of hypovolemic shock based on the percentage of estimated blood loss and include recommendations for appropriate treatment according to the classes. The importance of diagnosing hemorrhage at initial patient contact by first responders has been greatly emphasized, as more accurate diagnosis of hemorrhage severity and shock has been shown to lead to better treatment for these patients.
Based on the presence of tachycardia and hypotension, this patient would be expected to have lost more than 30% of his circulating blood volume.
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