PALS Test Answers

Chest Compression depth: Infant

Answer:  1.5 inch or 4 cm (1/3 AP Diameter)

Chest Compression depth: Child

Answer:  2 inches or 5 cm (1/3 AP Diameter)

Maximum Compression depth: Infant

Answer:  2.4 in or 6cm

Infant/children/adolescent compression rate

Answer:  100-120 compressions a minute

Ratio for single rescuer

Answer:  30 compressions 2 breaths

Ratio for 2 rescuer

Answer:  15 compressions 2 breaths

Rate of rescue breathing

Answer:  1 breath every 6-8 seconds or 8-10 breaths/min

Isotonic Crystalloids 2 examples

Answer:  NS & Lactated Ringers

Fluid challenge is how much (in hypotension)?

Answer:  20mL/kg (18kg gets 260 mL)

BP parameters for PALS (minimum systolic in 4 age groups)

Answer:  0-1month old= min 60 systolic 1 month-1 year= min 70 systolic 1 year-10 year= min 70+(2xage) systolic over 10 years= min 90 systolic

Atropine dose pre-intubation

Answer:  Atropine 0.02 mg/kg

Med: Shock refractory VF or pulseless Tachycardia

Answer:  Lidocaine or Amiodarone (used in field had better chance of survival but in hospital, either drug has same outcome)

Amiodarone dosage

Answer:  5mg/kg

Epinephrine in Cardiac Arrest Indication

Answer:  all pulseless arrests, hypotensive shock, anaphylaxis, asthma, croup

Targeted Temperature management post cardiac arrest

Answer:  5 days of normothermia (36C-37.5C or 96.8F-99.5F)- NOT HYPOTHERMIA

Inotrope drugs (3)

Answer:  Dopamine, Dobutamine, epinephrine (epi also vasopressor)

Normoxemia is what %?

Answer:  94% or above oxygenation

6 roles in PALS:

Answer:  team leader airway compressor monitor medication recorder

Oxygen saturation level goals

Answer:  94%-99%

Fluid bolus during post cardiac arrest care

Answer:  5-10 mL/kg over 10-20 minutes

Causes of Secondary Brain Injury

Answer:  Hyperthermia Hypotension Hypoglycemia Hypoxia

Defibrillation Joules (initial and refractory)

Answer:  2J and then if refractory 4J

Temp & timing for Permissive hypothermia post-cardiac arrest… how many days of normothermia after?

Answer:  32C-34C (89.6-98.2) for 2 days followed by 3 days of normothermia

4 Spots for IO

Answer:  proximal tibia medial malleolus distal femur ASIS

How to evaluate alert/awake/responsive?

Answer:  Appearance, Breathing, Circulation

What should always follow IO?

Answer:  NS flush 5-10mL

A 12-year-old child being evaluated in the pediatric intensive care unit displays the following ECG waveform. The team interprets this as which arrhythmia?

Answer:  second degree

Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic, tachypneic, lethargic and pale. Which test would the provider use to determine the adequacy of oxygen delivery?

Answer:  Lactate

A 9-year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition?

Answer:  Respiratory failure

A 4-year-old child is brought to the emergency department by the parents. Assessment reveals that the child has only gasping respirations and the pulse rate is 65 beats per minute. Which action would the provider initiate first?

Answer:  Deliver 1 BVM ventilation every 3 to 5 seconds.

A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with Lyme disease 2 months ago. A rhythm strip is obtained as shown below. The provider interprets this rhythm as indicating which arrhythmia?

Answer:  First-degree atrioventricular (AV) block

A child in cardiac arrest experiences return of spontaneous circulation but is exhibiting signs of post-cardiac arrest syndrome (PCAS). The PALS resuscitation team determines that the child is experiencing a systemic response to ischemia/reperfusion. The team bases this determination on which finding(s)?

Answer:  Hypotension

A 2-year-old child arrives at the emergency department with the parents. The child is unresponsive, is not breathing and has no pulse. Two emergency department providers begin high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR?

Answer:  Allowing the chest to recoil fully after each compression

A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate?

Answer:  VF and pVT are shockable cardiac arrest rhythms.

A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock?

Answer:  Hypotension is not a consistent feature of shock;

A provider is caring for a 4-year-old child in the urgent care clinic. Primary assessment reveals difficulty breathing and an oxygen saturation of 91%. The provider administers oxygen by nasal cannula with the goal of improving the child’s oxygen saturation above what percentage?

Answer:  Supplemental oxygen should be administered as needed to maintain an oxygen saturation above 94%.

An 11-year-old soccer player is brought to the emergency department. After a quick assessment, the team realizes this patient is experiencing a severe asthma exacerbation. Which medication would the team administer first?

Answer:  Albuterol plus ipratropium bromid

A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present?

Answer:  Pallor is a circulation finding that may be seen in patients with respiratory distress.

A healthcare provider is performing a primary assessment of a child in respiratory distress. The provider documents increased work of breathing when which findings are observed?

Answer:  Nasal flaring, use of accessory muscles to breathe and intercostal, substernal or suprasternal retractions are all indicators of increased work or effort of breathing. Grunting and inspiratory stridor are abnormal breath sounds.

An 11-year-old child develops unstable wide-complex tachycardia. Assessment reveals signs of significant hemodynamic compromise, but the child has a pulse. The PALS team would prepare the child for which intervention?

Answer:  First-line treatment for unstable wide-complex tachycardias consists of synchronized electrical cardioversion, particularly when signs of hemodynamic compromise are apparent.

A 4-month old infant is brought to the emergency department in cardiac arrest. Which condition would the team identify as the most common cause of cardiac arrest in an infant of this age?

Answer:  Sudden infant death syndrome

A 9-year-old child is brought to the emergency department because the child suddenly collapsed at school. The child’s ECG reveals the following waveform, and primary assessment findings indicate that the child is hemodynamically unstable. Which primary assessment findings indicate this?

Answer:  Difficulty breathing Hypotension Mottling Decreased level of consciousnes

2-year-old child is brought to the pediatric urgent care clinic by the parent who says that the child has had a barking cough for two days. During the rapid assessment of the child, the provider hears audible inspiratory stridor. Which common cause of partial upper airway obstruction in children would the provider most likely suspect?

Answer:  croup

A 6-year-old child is brought to the emergency department. The child has been experiencing extremely watery stools over the past several days. After completing the assessment, the healthcare provider suspects that the child may be experiencing shock. Which type of shock would the provider most likely suspect?

Answer:  hypovolemic

While performing a rapid assessment and formulating an initial impression using the Pediatric Assessment Triangle (PAT), the provider assesses the child’s circulation. Which information would be important to consider?

Answer:  When assessing the adequacy of circulation, consider skin color and visible mucous membranes for pallor (or gray/dusky color), cyanosis, mottling or flushing and evidence of any bleeding, including life-threatening bleeding.

Assessment of a 3-month-old infant admitted with respiratory distress reveals fever, grunting and a wet, “junky” cough. The infant’s parents said the child had a recent respiratory infection with a fever. A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the provider most likely suspect as the cause?

Answer:  bronchiolitis

PALS resuscitation team notes the following ECG waveform and the child does not have a pulse. The team prepares to intervene to address which arrhythmia?

Answer:  torsades

The emergency response team is providing care to a preschooler who is experiencing shock. The primary goal, common to all types of shock, is to restore a favorable balance between tissue perfusion and metabolic demand with a focus on what?

Answer:  The primary goal in shock, regardless of cause, is to restore a favorable balance between tissue perfusion and metabolic demand with a focus on oxygen delivery and oxygen demand.

The PALS resuscitation team is providing care to an intubated child in cardiac arrest. Which result best determines the adequacy of the team’s chest compressions?

Answer:  End-tidal carbon dioxide level between 15 and 20 mmHg

The PALS team leader is conducting a debriefing session with the team. Which topic(s) would the team leader most likely address during the session?

Answer:  Summary of the event, including what actions were taken, Discussion of the pros and cons of the interventions, Identification of ways to improve, Evaluation of the objective data gathered during the event

Assessment of a 7-year-old patient with septic shock reveals capillary refill of 3 seconds, diminished pulses, narrow pulse pressure and cool, mottled extremities. The emergency response team interprets these findings as indicating which type of septic shock?

Answer:  Most children in septic shock present with cold shock (i.e., delayed capillary refill, diminished pulses, peripheral vasoconstriction, narrow pulse pressure, and cool, mottled extremities) instead of warm shock.

Primary assessment of a 10-year-old child reveals septic shock. As part of the secondary assessment, laboratory testing is completed to evaluate the child’s status. Which laboratory tests would be ordered for this child?

Answer:  Laboratory testing for the child in septic shock may include CBC, blood cultures, blood gasses, coagulation panel, renal function tests, liver function panel and lactate level.

A 4-year-old patient presents with tachycardia, tachypnea, cold extremities and weak pulses. Assessment also reveals an enlarged liver and neck vein distension. The provider interprets these assessment findings as suggesting which type of shock?

Answer:  cardio

A 10-year-old child has collapsed in the gym of the elementary school. The school nurse arrives and determines that the child is unresponsive. The school nurse then simultaneously checks for breathing and a central pulse, limiting this assessment to which time frame?

Answer:  5 seconds, but no more than 10.

A child being cared for in the pediatric telemetry unit suddenly displays the following ECG waveform. The provider prepares to intervene because the child is demonstrating which type of arrhythmia?

Answer:  Supraventricular tachycardia

A 6-year-old patient is brought to the emergency department after a bicycle accident. Assessment reveals tracheal deviation to the left side, chest pain on inspiration and decreased breath sounds on the right side. The provider suspects obstructive shock caused by what condition?

Answer:  tension pneumothorax

A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial treatment would the provider administer?

Answer:  vagal

An unresponsive 7-year-old child with no pulse is brought to the pediatric urgent care center by his parents and CPR is initiated. The cardiac monitor reveals ventricular fibrillation. Which action would the PALS team take first?

Answer:  initiate defibrillation with 2 J/kg.

A child who is stable and exhibiting a narrow-complex tachycardia is to receive adenosine. The provider would be alert for which result after administering this medication?

Answer:  Patients may have a brief period of “asystole” following the administration of adenosine. This is normal and typically self-limited.

An 8-year-old child being treated in the emergency department has significant respiratory distress. The child also exhibits hives, wheezing, angioedema, tachycardia and dyspnea. The parents state that the child, who is allergic to peanuts, had eaten some popcorn that had peanuts in it. The team initiates care, preparing to administer which agent first?

Answer:  epi

A 2-year-old child of unknown weight arrives at the emergency department in cardiac arrest. When preparing to administer medications, which action would be appropriate for the team to take?

Answer:  tape

The PALS team is providing post-cardiac arrest care to an 8-year-old child in the pediatric intensive care unit. Which intervention would the team implement to achieve the primary goal of post-cardiac arrest care?

Answer:  ensure MAP

A 12-year-old is being treated in the urgent care clinic. The mother reports that the child came home from school yesterday with a high fever, vomiting and multiple episodes of watery diarrhea. The healthcare provider obtains a rhythm strip and notes the following waveform. The provider interprets this as which type of arrhythmia?

Answer:  sinus tahy

A child requires cardiac monitoring. A three-electrode system is being used. At which location would the provider place the red electrode?

Answer:  On the lower left abdomen

An advanced airway was placed in a 5-year-old child. Which action(s) would be most appropriate for the team to take to confirm correct placement?

Answer:  Auscultate over the lungs and epigastrium for air movement, Observe for bilateral chest rise, Evaluate results of capnography.

A 12-lead ECG is ordered for a child complaining of a “racing heart.” When placing the electrodes on the child, at which location would the lead for V4 be placed?

Answer:  fifth intercostal space at the midclavicular line on the patient’s left side.

A 7-year-old child collapses on the playground at school. The school nurse is called to the scene and determines that the child is unresponsive and is not breathing and has no pulse. The nurse initiates CPR. At what rate and depth would the nurse deliver compressions to this child?

Answer:  100 to 120 compressions per minute at a depth of about 2 inch

Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient?

Answer:  Maintain the head in midline position with 30-degree elevation

child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)?

Answer:  Hypotension, Bradycardia, Diminished central pulses

A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer?

Answer:  Corticosteroids, Racemic epinephrine

After ROSC, a child is experiencing post-cardiac arrest hemodynamic instability. The PALS resuscitation team would administer which element to restore intravascular volume and optimize preload?

Answer:  Isotonic fluid boluses

A 5-year-old child with a history of a chronic neuromuscular disease is experiencing respiratory distress. The child is breathing spontaneously and receiving supplemental oxygen. Which additional intervention is a critical component of airway management for this patient?

Answer:  Airway clearance

A provider is forming an initial impression of a child using the Pediatric Assessment Triangle (PAT). During which step of the PAT may the provider use the mnemonic TICLS to assess the patient?

Answer:  appearance

A child in the pediatric intensive care unit displays the following ECG waveform. The child has no pulse. The resuscitation team interprets this as which arrhythmia

Answer:  Monomorphic pulseless ventricular tachycardia

A child experiencing unstable bradycardia is receiving CPR. Despite efforts with CPR, including assuring oxygenation and ventilation, the child’s status remains unchanged. Which medication would the emergency response team expect to administer next?

Answer:  epi

A 4-year-old child suddenly collapses in the playroom of the facility. A healthcare provider observes the event and hurries over to assess the child. The healthcare provider completes which assessment first?

Answer:  rapid