PALS - Pediatric Advanced Life Support PALS Pharmacology Questions and Answers — Questions and Answers
Question 1: A 5-year-old child is in ventricular fibrillation. Two defibrillation attempts and 2 minutes of high-quality CPR have been performed. IV access is established. According to the PALS Cardiac Arrest Algorithm, which medication should be administered FIRST?
- Amiodarone
- Epinephrine (Correct answer)
- Lidocaine
- Atropine
Correct answer: Epinephrine
In the PALS Cardiac Arrest Algorithm for a shockable rhythm (VF/pVT), epinephrine is the first drug to be administered after the second shock. It should be given every 3 to 5 minutes. Amiodarone or lidocaine are antiarrhythmics considered only after the third shock if the rhythm remains refractory. Atropine has no role in the management of VF/pVT.
Question 2: An 8-year-old child presents with a regular, monomorphic wide-complex tachycardia and is hemodynamically stable. After consulting with a pediatric cardiologist, which medication is most appropriate to administer?
- Amiodarone 5 mg/kg IV infused over 20-60 minutes (Correct answer)
- Adenosine 0.1 mg/kg rapid IV push
- Synchronized cardioversion at 0.5 J/kg
- Amiodarone 5 mg/kg as a rapid IV bolus over 1-2 minutes
Correct answer: Amiodarone 5 mg/kg IV infused over 20-60 minutes
For stable wide-complex tachycardia, an antiarrhythmic such as amiodarone is indicated. The correct dose is 5 mg/kg, and it must be infused slowly over 20 to 60 minutes to avoid hypotension. A rapid bolus can cause a significant drop in blood pressure. Adenosine is used for narrow-complex SVT. Synchronized cardioversion is reserved for unstable tachycardia.
Question 3: A 6-year-old with suspected sepsis has received 60 mL/kg of isotonic crystalloid but remains hypotensive with cool extremities and delayed capillary refill. According to PALS guidelines for fluid-refractory septic shock, which vasoactive infusion is the preferred first-line agent?
- Dopamine
- Dobutamine
- Norepinephrine
- Epinephrine (Correct answer)
Correct answer: Epinephrine
For fluid-refractory pediatric septic shock, particularly 'cold shock' (characterized by poor perfusion and cool extremities), epinephrine is the recommended first-line vasoactive agent due to its potent inotropic and vasopressor effects. While norepinephrine is used for 'warm shock' (vasodilated), epinephrine is preferred here. Dopamine is no longer a first-line agent. Dobutamine is an inotrope used for myocardial dysfunction, but epinephrine provides broader support in this scenario.
Question 4: During a cardiac arrest, the team suspects hyperkalemia is the underlying cause. Which medication should be administered with the primary goal of stabilizing the cardiac membrane?
- Sodium bicarbonate
- Insulin and glucose
- Calcium chloride (Correct answer)
- Albuterol
Correct answer: Calcium chloride
In hyperkalemia, calcium chloride (or calcium gluconate) is administered to stabilize the myocardial cell membrane, antagonizing the arrhythmogenic effects of high potassium levels. While sodium bicarbonate, insulin/glucose, and albuterol are also used to treat hyperkalemia, their mechanism is to shift potassium into the cells, rather than directly protecting the heart muscle.
Question 5: A 15 kg child is in asystolic cardiac arrest. You are preparing the first dose of epinephrine. What is the correct volume of epinephrine to administer IV/IO, using the standard 1:10,000 concentration?
- 0.15 mL
- 15 mL
- 0.75 mL
- 1.5 mL (Correct answer)
Correct answer: 1.5 mL
The PALS dose for IV/IO epinephrine in cardiac arrest is 0.01 mg/kg. For a 15 kg child, this is 0.15 mg (15 kg x 0.01 mg/kg). The standard 1:10,000 concentration contains 1 mg in 10 mL, which is equivalent to 0.1 mg per mL. Therefore, the correct volume is 0.15 mg divided by 0.1 mg/mL, which equals 1.5 mL.
Question 6: A 9-year-old achieves Return of Spontaneous Circulation (ROSC) but remains hypotensive despite an initial fluid bolus. Which of the following is an appropriate initial choice for a continuous infusion to manage post-arrest hypotension?
- Adenosine
- Epinephrine (Correct answer)
- Amiodarone
- Lidocaine
Correct answer: Epinephrine
For post-cardiac arrest hypotension that is unresponsive to fluid boluses, a continuous infusion of a vasoactive agent is required. Epinephrine is a preferred agent in pediatric post-arrest care due to its combined inotropic and vasopressor effects, which help improve cardiac output and blood pressure. Adenosine, amiodarone, and lidocaine are antiarrhythmics and not indicated for the primary management of hypotension.
PALS - Pediatric Advanced Life Support PALS Pharmacology Questions and Answers
A 5-year-old child is in ventricular fibrillation.
Two defibrillation attempts and 2 minutes of high-quality CPR have been performed.
IV access is established.
According to the PALS Cardiac Arrest Algorithm, which medication should be administered FIRST?