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PALS Simulator Cases

Title Topic

Case 1 - A 2 year old with a flu-like illness

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

CPR 5 cycles, defib (2 J/kg), CPR 5 cycles, defib (4 J/kg).
 

 

Ventricular fibrillation

Case 2 - A 2 year old becomes unresponsive on the Pediatrics ward

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

As above. Add epinephrine and defib again.

 

Ventricular fibrillation

Case 3 - A 4 year old arrests on the Pediatrics ward

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

After epinephrine, try amiodarone and defib again.

 

Ventricular fibrillation

Case 4 - A 5 year old takes her brothers medicine

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

In addition to the usual treatment for ventricular fibrillation, consider sodium bicarbonate in the treatment of imipramine toxicity.

 

Ventricular fibrillation -
imipramine toxicity

Case 5 - A 2 year old victim of MVA

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

CPR, intubate, intravenous fluid boluses, epinephrine.

 

Pulseless
electrical
activity

Case 6 - A 5 year old with difficulty breathing

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

You must intubate immediately to provide a clear airway. You must administered several large boluses of intravenous fluids, and you must administer epinephrine.

 

Pulseless
electrical
activity -
Anaphylaxis

Case 7 - A 1 month old with respiratory illness

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

In children, hypoxia often results in severe bradycardia. Correct the hypoxia. Administer epinephrine as needed. Atropine may be helpful if a vagal mechanism is present.

 

Bradycardia

Case 8 - A 3 year old takes grandmas medicine

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

This patient was lethargic and hypoxic on initial assessment. Start by reversing hypoxia and add epinephrine. You should consider transcutaneous pacing for this case.

 

Bradycardia

Case 9 - A 3 month old is suddenly unresponsive

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

Since this patient is unstable, use electrical cardioversion.

 

Tachycarrdia - Supraventricular Tachycardia

Case 10 - A fussy baby

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

Since the pulse is strong you can try adenosine if you can quickly establish IV or IO access.
 

 

Tachycardia -
Supraventricular Tachycardia

Case 11 - A 4 year old reacts to her asthma medication

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

Since adenosine may worsen bronchospasm, try amiodarone or procainamide for stable SVT in children with reactive airway disease.
 

 

Tachycardia -
Supraventricular Tachycardia

Case 12 - A 3 year old with a racing heartbeat

Author: Kathleen Ventre, MD, Department of Pediatrics, University of Utah

Adenosine may cause SVT to degenrate to VFib in a child with WPW. Consult a pediatric cardiologist if possible, and prepare for electrical cardioversion. If stable you can try amiodarone or procainamide infusion.
 

 

Tachycardia -
Wolff-Parkinson-White Syndrome

Case 13 - Trouble on the Heme-Onc Ward

Author: Kathleen Ventre, M.D.

Successful resuscitation from septic shock requires prompt application of supplemental oxygen, restoration of intravascular volume, and provision of appropriate antibiotics. In cases where blood pressure does not respond to fluid administration alone, vasoactive medications may be necessary.
 

 

PEARS -
Septic shock

Case 14 - Respiratory Distress in the Emergency Dept

Author: Kathleen Ventre, M.D.

It is essential for pediatric health care providers to be able to recognize and treat shock. This child requires oxygen and cautious fluid administration of 5-10 mL/kg.
 

 

Cardiogenic shock
in the pediatric patient

Case 15 - 2 month old with a respiratory illness

Author: Kathleen Ventre, M.D.

The management of bradycardia in infants and children begins with an assessment of respiratory and circulatory status. This child needed oxygen and intravenous fluid replacement of 10 mL/kg. Clearing secretions from the airway and positive pressure ventilation will also be required for this child in respiratory distress.
 

 

Bradycardia
in the pediatric patient

Case 16 - Sudden illness at school

Author: Kathleen Ventre, M.D.

Anaphylaxis is a severe allergic event causing upper and/or lower airway edema, profound hypotension, and urticaria. Provide a patent airway and supplemental oxygen, epinephrine and intravenous fluids.
 

 

Anaphylaxis

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