PALS - Pediatric Advanced Life Support Cardiac Arrest Algorithm Questions and Answers — Questions and Answers
Question 1: A 5-year-old child collapses in the hospital playroom. You find them unresponsive, apneic, and pulseless. The monitor shows ventricular fibrillation. High-quality CPR is initiated. According to the PALS Cardiac Arrest Algorithm, what is the correct energy dose for the initial defibrillation attempt?
- 0.5 J/kg
- 2 J/kg (Correct answer)
- 4 J/kg
- 10 J/kg
Correct answer: 2 J/kg
The PALS guidelines recommend an initial energy dose of 2 J/kg for the first defibrillation attempt in a pediatric patient with a shockable rhythm like ventricular fibrillation. Subsequent shocks may be given at higher energy levels, typically starting at 4 J/kg.
Question 2: During a pediatric resuscitation for pulseless ventricular tachycardia (pVT), two shocks have been delivered and 2 minutes of CPR have been completed. The rhythm remains pVT. Which medication should be administered first according to the PALS algorithm?
- Atropine 0.02 mg/kg
- Adenosine 0.1 mg/kg
- Epinephrine 0.01 mg/kg (Correct answer)
- Sodium Bicarbonate 1 mEq/kg
Correct answer: Epinephrine 0.01 mg/kg
In the PALS Cardiac Arrest Algorithm for shockable rhythms (VF/pVT), epinephrine is the first-line medication. It should be administered every 3-5 minutes. Antiarrhythmics like amiodarone or lidocaine are considered after the second shock and administration of epinephrine if VF/pVT persists.
Question 3: You are leading a resuscitation team for an infant in asystole. High-quality CPR is ongoing, and IV access has been established. After a 2-minute cycle of CPR and rhythm check confirms asystole, what is the most appropriate next action?
- Administer a 4 J/kg shock.
- Give amiodarone 5 mg/kg.
- Check for a pulse for 15 seconds.
- Administer epinephrine 0.01 mg/kg and continue CPR. (Correct answer)
Correct answer: Administer epinephrine 0.01 mg/kg and continue CPR.
For non-shockable rhythms like asystole and PEA, the priorities are high-quality CPR and administration of epinephrine 0.01 mg/kg every 3-5 minutes as soon as IV/IO access is available. Defibrillation is not indicated for asystole. Amiodarone is used for refractory shockable rhythms. Pulse checks should be brief (less than 10 seconds) to minimize interruptions in compressions.
Question 4: A resuscitation team is managing a child in pulseless electrical activity (PEA). While continuing high-quality CPR, the team leader asks everyone to consider reversible causes. Which of the following is one of the 'H's in the H's and T's mnemonic?
- Hypertension
- Hyperoxia
- Hypokalemia (Correct answer)
- Hemothorax
Correct answer: Hypokalemia
The H's and T's mnemonic helps recall the potential reversible causes of cardiac arrest. The 'H's include Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypoglycemia, and Hypothermia. Hyperkalemia is also one of the H's, but Hypokalemia is the correct choice among the options provided. Hemothorax would fall under trauma, and Tension pneumothorax is one of the 'T's.
Question 5: Two healthcare providers are performing CPR on a 7-year-old child who does not have an advanced airway in place. To ensure high-quality CPR, what is the correct compression-to-ventilation ratio?
- 30 compressions to 2 ventilations
- 15 compressions to 2 ventilations (Correct answer)
- 30 compressions to 1 ventilation
- Continuous compressions with 1 breath every 6 seconds
Correct answer: 15 compressions to 2 ventilations
For two-rescuer CPR in infants and children (up to the age of puberty), the recommended compression-to-ventilation ratio is 15:2. The 30:2 ratio is used for single-rescuer CPR for all ages. Continuous compressions are only performed once an advanced airway is in place.
Question 6: A 3-year-old child achieves Return of Spontaneous Circulation (ROSC) after a prolonged resuscitation from asystolic cardiac arrest. The child remains comatose. Which of the following is a primary goal of post-cardiac arrest care?
- Inducing hyperventilation to a PaCO2 of 25-30 mmHg.
- Maintaining oxygen saturation at 100% to maximize oxygen delivery.
- Administering a routine bolus of sodium bicarbonate.
- Optimizing ventilation and oxygenation to avoid both hypoxia and hyperoxia. (Correct answer)
Correct answer: Optimizing ventilation and oxygenation to avoid both hypoxia and hyperoxia.
A key goal of post-ROSC care is to optimize ventilation and oxygenation while avoiding extremes. Both hypoxia and hyperoxia can cause secondary organ injury, particularly to the brain. Oxygen saturation should be titrated, often to a target of 94-99%. Hyperventilation is avoided as it can decrease cerebral blood flow.
PALS - Pediatric Advanced Life Support Cardiac Arrest Algorithm Questions and Answers
A 5-year-old child collapses in the hospital playroom.
You find them unresponsive, apneic, and pulseless.
The monitor shows ventricular fibrillation.
High-quality CPR is initiated.
According to the PALS Cardiac Arrest Algorithm, what is the correct energy dose for the initial defibrillation attempt?