PALS Megacode - Severe Respiratory Distress

A seven-year-old with a history of asthma presents to the emergency department in severe respiratory distress.

Initial vitals:

R: 40, O₂: 85%, P: 160, BP: 90/60, T: 37.6

On exam, The patient is sitting upright, airway is patent but patient is tachypneic, with intercostal retractions and tracheal tugging. You hear wheezing in all lung fields. No stridor.
1. Which describes best initial course of treatment?*
- Nebulized albuterol and ipratropium bromide, IV steroids, subcutaneous epinephrine and prepare to intubate
- Humidified oxygen, IVF’s and preparation for tracheostomy
- IVF’s and supplemental oxygen
- Racemic epinephrine and preparation for intubatio

While you are administering medications and preparing for intubation, the patient becomes unresponsive.

The monitor demonstrates the following
2. What is your first step in management?*
- Initiate CPR
- Synchronized cardioversion
- Defibrillate
- Check a pulse

Despite being unresponsive, the patient has a pulse and is intubated for definitive airway management.

Subsequent to intubation, the blood pressure is markedly decreased and on reevaluation, the patient has become pulseless, although telemetry monitor remains unchanged.
3. What is your next step in management?*
- Initiate CPR and give epinephrine
- Administer amiodarone
- Defibrillate
- Synchronized cardioversion

You initiate CPR for this PEA arrest.
4. What is the appropriate concentration and dose of epinephrine to be administered?*
- 0.1 mg/kg of 1: 10,000 IV every 3-5 minutes
- 0.01 mg/kg of 1: 1,000 IV every 3-5 minutes
- 0.01 mg/kg of 1:10,000 IV every 3-5 minutes
- 0.02 mg/kg of 1: 1,000 IV every 2-5 minutes

Severe Respiratory Distress