A newborn male is evaluated one minute after birth. He was born at 38 weeks gestation to a 28-year-old gravida 3 via vaginal delivery. The patient’s mother received sporadic prenatal care, and the pregnancy was complicated by gestational diabetes. The amniotic fluid was clear. The patient’s pulse is 70/min, and his breathing is irregular with a slow, weak cry. He whimpers in response to a soft pinch on the thigh, and he has moderate muscle tone with some flexion of his extremities. His body is pink and his extremities are blue. The patient is dried with a warm towel and then placed on his back on a flat warmer bed. His mouth and nose are suctioned with a bulb syringe. Which of the following is the best next step in management?

Positive pressure ventilation and reassessment of Apgar score at 5 minutes

Supplemental oxygen via nasal cannula and reassessment of Apgar score at 5 minutes

Chest compressions and bag-mask ventilation

Endotracheal intubation and mechanical ventilation

Intravenous epinephrine and reassessment of Apgar score at 5 minutes

A first time mother of a healthy, full term, newborn girl is anxious about sudden infant death syndrome. Which of the following pieces of advice can reduce the risk of SIDS?

Sleep supine in a crib without bumpers, use a pacifier after 1 month of age, and avoid smoking

Sleep supine in a crib with bumpers, head propped up on a pillow, and wrapped in a warm blanket

Sleep supine in a crib with bumpers, head propped up on a pillow, and wrapped in an infant sleeper

Sleep supine in the parent's bed and use a pacifier after 1 month of age

Sleep supine in a crib without bumpers, use a pacifier after 1 month of age, and use a home apnea monitor

A 57-year-old man is admitted to the burn unit after he was brought to the emergency room following an accidental fire in his house. His past medical history is unknown due to his current clinical condition. Currently, his blood pressure is 75/40 mmHg, pulse rate is 140/min, and respiratory rate is 17/min. The patient is subsequently intubated and started on aggressive fluid resuscitation. A Swan-Ganz catheter is inserted to clarify his volume status. Which of the following hemodynamic parameters would you expect to see in this patient?

Cardiac output: ↓, systemic vascular resistance: ↑, pulmonary artery wedge pressure: ↓

Cardiac output: ↓, systemic vascular resistance: ↔, pulmonary artery wedge pressure: ↔

Cardiac output: ↑, systemic vascular resistance: ↑, pulmonary artery wedge pressure: ↔

Cardiac output: ↑, systemic vascular resistance: ↓, pulmonary artery wedge pressure: ↔

Cardiac output: ↔, systemic vascular resistance: ↔, pulmonary artery wedge pressure: ↔

A 6-month-old male presents to the emergency department with his parents after his three-year-old brother hit him on the arm with a toy truck. His parents are concerned that the minor trauma caused an unusual amount of bruising. The patient has otherwise been developing well and meeting all his milestones. His parents report that he sleeps throughout the night and has just started to experiment with solid food. The patient’s older brother is in good health, but the patient’s mother reports that some members of her family have an unknown blood disorder. On physical exam, the patient is agitated and difficult to soothe. He has 2-3 inches of ecchymoses and swelling on the lateral aspect of the left forearm. The patient has a neurological exam within normal limits and pale skin with blue irises. An ophthalmologic evaluation is deferred. Which of the following is the best initial step?

Complete blood count and coagulation panel

Ensure the child's safety and alert the police

A 3-year-old girl with no significant past medical history presents to the clinic with a 4-day history of acute onset cough. Her parents have recently started to introduce several new foods into her diet. Her vital signs are all within normal limits. Physical exam is significant for decreased breath sounds on the right. What is the most appropriate definitive management in this patient?

Inhaled bronchodilators and oral corticosteroids

A 2-year-old girl is brought to the emergency department after swallowing a button battery that was lying on the table 1 hour ago. She has no shortness of breath or chest discomfort. Her pulse is 112/min and respirations are 30/min. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows no abnormalities. An x-ray of the chest shows the battery lodged in the esophagus at the level of T2. Which of the following is the most appropriate next step in management?

Endoscopic removal of the battery

Removal of the battery with magnet and nasogastric tube

A previously healthy 5-year-old boy is brought to the emergency department because of a 1-day history of high fever. His temperature prior to arrival was 40.0°C (104°F). There is no family history of serious illness. Development has been appropriate for his age. He is administered rectal acetaminophen. While in the waiting room, he becomes unresponsive and starts jerking his arms and legs back and forth. A fingerstick blood glucose concentration is 86 mg/dL. After 5 minutes, he continues having jerky movements and is unresponsive to verbal and painful stimuli. Which of the following is the most appropriate next step in management?

Intravenous administration of lorazepam

Intravenous administration of phenobarbital

Intravenous administration of valproate

Intravenous administration of fosphenytoin

A 5-year-old boy is brought to the emergency department by his grandmother because of difficulty breathing. Over the past two hours, the grandmother has noticed his voice getting progressively hoarser and occasionally muffled, with persistent drooling. He has not had a cough. The child recently immigrated from Africa, and the grandmother is unsure if his immunizations are up-to-date. He appears uncomfortable and is sitting up and leaning forward with his chin hyperextended. His temperature is 39.5°C (103.1°F), pulse is 110/min, and blood pressure is 90/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Pulmonary examination shows inspiratory stridor and scattered rhonchi throughout both lung fields, along with poor air movement. Which of the following is the most appropriate next step in management?

Prepare for emergency airway management in the operating room with anesthesia and ENT backup

Direct laryngoscopy and pharyngoscopy

Immediate nasotracheal intubation in the emergency department

Intravenous administration of antibiotics

Pediatric basic life support for USMLE Step 1: High-Yield Pediatrics Lessons

PBLS Intro - Scene, Safety, Stimulate

1. Scene Safety: First, ensure the environment is safe for you and the child. Check for hazards like traffic, fire, or electrical wires before approaching.
2. Check for Response (Stimulate):
- Child: Tap shoulders firmly and shout, "Are you alright?"
- Infant: Tap the soles of the feet.
3. Shout for Help: If unresponsive, shout for help. Activate the emergency response system / call for a code blue.

⭐ For an infant, the correct technique to check for responsiveness is to tap the soles of the feet. Shaking can cause injury.

The BLS Algorithm - Rescue Rhythm

After initial assessment, simultaneously check for breathing and a central pulse (brachial/femoral) for no more than 10 seconds.

Rescue Breathing (Pulse present, breathing absent/inadequate):
- Give 1 breath every 2-3 seconds (20-30 breaths/min).
- Ensure visible chest rise with each breath.
- Re-check pulse every 2 minutes. If it drops below 60/min with poor perfusion, start full CPR.

⭐ The most common cause of bradycardia and cardiac arrest in children is progressive hypoxia and respiratory failure, not a primary cardiac event.

Pediatric bag-mask ventilation technique

CPR (No pulse or pulse < 60/min with poor perfusion):
- Immediately begin cycles of chest compressions and ventilations.
- Ratio: 30:2 for a single rescuer, 15:2 for two rescuers.

CPR Technique - The Right Moves

Compressions: Push Hard, Push Fast
- Rate: 100-120/min.
- Depth: At least ⅓ of chest AP diameter.
  - Infants: ~4 cm (1.5 inches).
  - Children: ~5 cm (2 inches).
- Action: Allow complete chest recoil after each compression.
Hand Position
- Infants (<1 yr):
  - 1 Rescuer: Two-finger technique below the nipple line.
  - 2 Rescuers: Two thumb-encircling hands technique (preferred).
- Children (1 yr to puberty):
  - Use one or two hands on the lower half of the sternum.

Compression:Ventilation (C:V) Ratio
- Single Rescuer: 30:2
- Two Rescuers: 15:2

⭐ The two thumb-encircling hands technique for infant CPR is superior as it generates better blood flow and coronary perfusion pressure.

Choking (FBAO) - Unblock the Airway

Goal: Relieve obstruction & restore airflow. Technique varies by age and consciousness.

Choking First Aid: Back Blows & Abdominal Thrusts

⭐ Never perform a blind finger sweep. Only attempt to remove a foreign body if it is clearly visible, to avoid pushing it further into the airway.

High-Yield Points - ⚡ Biggest Takeaways

Follow the C-A-B sequence (Chest Compressions, Airway, Breathing) for resuscitation.

The compression-ventilation ratio is 30:2 for a single rescuer and 15:2 for two rescuers.

Maintain a compression rate of 100-120/min.

Compress to a depth of at least one-third the AP diameter of the chest.

Check the brachial artery pulse in infants and the carotid/femoral artery in children.

Start compressions if the pulse is <60/min with poor perfusion.

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