Resuscitation and Critical Care
This domain tests the mechanics of pediatric resuscitation: high-quality CPR with appropriate compression depth and rate, early defibrillation for shockable rhythms, and the shock-refractory sequence. Candidates must know the reversible-cause framework, the role of capnography as a compression-quality and return-of-spontaneous-circulation marker, and the difference between shockable (ventricular fibrillation, pulseless ventricular tachycardia) and non-shockable rhythms.
Understand post-arrest care: targeted temperature considerations, avoidance of hyperoxia and hypocapnia, glucose and electrolyte monitoring, and early neurologic prognostication caution. Know rapid sequence intubation principles-preoxygenation, hemodynamic optimization before induction, and confirmation with waveform capnography plus clinical assessment.
Traps: delaying compressions to obtain vascular access; giving stacked doses without rhythm reassessment; assuming a rhythm check should interrupt prolonged compression cycles; and forgetting that hypotension after intubation often reflects loss of sympathetic tone or hypovolemia rather than a new pulmonary problem. Another trap is over-ventilation, which raises intrathoracic pressure and reduces venous return.
Worked example: a child in pulseless ventricular tachycardia receives one shock, then CPR; if the rhythm persists after a second shock, epinephrine is given and an antiarrhythmic is considered, with compressions resumed immediately after each shock. Rule of thumb: minimize interruptions, confirm tube placement with waveform capnography, and treat the cause while continuing high-quality compressions.