TYK101

You are in the operating room beginning an ENT case. The patient is a 6-week-old with Pierre-Robin Sequence and you are attempting endotracheal intubation with the surgeon present. After sedation and paralysis a direct laryngoscopy is attempted with a grade IV view. The patient is now difficult to mask ventilate following your attempt at endotracheal tube placement. First the infant desaturates and then becomes bradycardic to 42 with a pulse. You appropriately begin chest compressions. What drug should be administered at this time?

a) Epinephrine 1:10,000 dilution 10 mcg/kg

b) Epinephrine 1:1,000 dilution 10 mcg/kg

c) Atropine 0.02 mg/kg

d) Epinephrine 1:10,000 dilution 100 mcg/kg

e) Atropine 0.04 mg/kg

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Answer

Answer A.

The best drug for treatment of bradycardia with a pulse is epinephrine (1:10,000 dilution or 0.1 mg/mL) 10 mcg/kg. An equivalent dose of epinephrine may be achieved with a higher concentration (1:1000 or 1 mg/mL) and lower volume. High-dose epinephrine (100 mcg/kg) is no longer recommended as part of the PALS management guidelines. Atropine can be considered if the suspected etiology is increased vagal tone or AV block, but in this case life-threatening hypoxemia is the suspected cause.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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