RQI Pediatric Advanced Life Support (PALS) Practice Test

In pediatric septic shock, the priority is to rapidly restore intravascular volume with isotonic crystalloids to improve tissue perfusion. The practical approach is to start with a 20 mL/kg bolus of isotonic fluid (such as normal saline or lactated Ringer’s) given over a few minutes, then reassess the patient’s perfusion, blood pressure, mental status, urine output, and signs of fluid overload. If perfusion remains inadequate after that initial bolus, additional boluses are appropriate, with a goal of reaching up to about 60 mL/kg total within the first hour, provided the patient tolerates it and shows no signs of fluid overload. The rationale is to maximize hemodynamic support quickly while balancing the risk of edema and respiratory compromise. If adequate perfusion is achieved with fluids alone, additional boluses are not needed; if shock persists despite achieving this fluid target, vasopressor support is considered.