PALS 1
A child in cardiac arrest has persistent VF after multiple shocks. Which medication is recommended after Epinephrine?
A. Adenosine
B. Amiodarone
C. Atropine
D. Dopamine
B — Amiodarone
Used for refractory VF/pVT after defibrillation attempts.
An 8-year-old in cardiac arrest receives IV access. What medication should be administered every 3–5 minutes?
A. Amiodarone
B. Epinephrine
C. Atropine
D. Adenosine
B — Epinephrine
Epinephrine 0.01 mg/kg IV/IO every 3–5 minutes during cardiac arrest.
During pediatric CPR with two providers, what compression-ventilation ratio should be used?
A. 30:2
B. 15:2
C. 10:1
D. Continuous compressions only
B — 15:2
Two-rescuer pediatric CPR ratio is 15 compressions to 2 breaths.
A 4-year-old with respiratory distress becomes bradycardic with HR 50/min despite oxygen and ventilation. What should you do next?
A. Administer atropine
B. Start CPR
C. Give adenosine
D. Observe
B — Start CPR
If HR <60/min with poor perfusion despite oxygenation and ventilation, start CPR.
A 6-year-old develops tachycardia due to dehydration. The rhythm is sinus tachycardia. What is the appropriate treatment?
A. Cardioversion
B. Adenosine
C. Treat underlying cause
D. Amiodarone
C — Treat underlying cause
Sinus tachycardia results from conditions like fever, dehydration, or pain.
A child with ROSC becomes hypotensive. What is the next priority treatment?
A. Vasopressors and fluid support
B. Defibrillation
C. Adenosine
D. CPR
A — Vasopressors and fluid support
Post-cardiac arrest care focuses on maintaining adequate blood pressure and perfusion.
A 3-year-old choking victim becomes unconscious. What is the next step?
A. Heimlich maneuver
B. Start CPR and check airway
C. Give epinephrine
D. Perform cardioversion
B — Start CPR and check airway
Once the choking child becomes unconscious, begin CPR and inspect airway for obstruction.
A pulseless child is found in asystole. What is the priority intervention?
A. Defibrillation
B. Immediate epinephrine and CPR
C. Adenosine
D. Synchronized cardioversion
B — Immediate epinephrine and CPR
Asystole and PEA are non-shockable rhythms, treated with CPR and epinephrine.
A child in cardiac arrest is suspected to have hyperkalemia. Which reversible cause category is this?
A. H’s
B. T’s
C. Neither
D. Both
A — H’s
Hyperkalemia is one of the reversible “H’s” causes of cardiac arrest.
A 6-year-old has bradycardia caused by increased vagal tone during intubation. Which medication is most appropriate?
A. Epinephrine
B. Atropine
C. Adenosine
D. Amiodarone
B — Atropine
Atropine is recommended for bradycardia caused by increased vagal tone or AV block.
A child in cardiac arrest receives the first shock at 2 J/kg. What is the next shock dose?
A. 2 J/kg
B. 4 J/kg
C. 6 J/kg
D. 10 J/kg
B — 4 J/kg
Second defibrillation dose is 4 J/kg, with subsequent doses up to 10 J/kg.
A 3-year-old child becomes unresponsive at daycare. He is not breathing normally and has no pulse. What is the first intervention?
A. Administer epinephrine
B. Begin high-quality CPR
C. Defibrillate immediately
D. Intubate the patient
B — Begin high-quality CPR
High-quality CPR is the first step in pediatric cardiac arrest management, emphasizing proper rate, depth, and minimal interruptions.
A pediatric patient in VF receives three shocks and epinephrine but remains in VF. What is the next medication?
A. Adenosine
B. Amiodarone
C. Atropine
D. Magnesium sulfate
B — Amiodarone
Amiodarone is recommended for refractory VF/pVT after defibrillation and epinephrine
DOSE?
A 2-year-old with severe respiratory distress suddenly becomes unresponsive but has a pulse. What is the priority intervention?
A. Start chest compressions
B. Provide ventilation support
C. Defibrillate
D. Adenosine
B — Provide ventilation support
Respiratory failure with a pulse requires ventilation, not compressions.
A child in cardiac arrest has pulseless electrical activity (PEA). What is the priority management step?
A. Defibrillation
B. Epinephrine and treat reversible causes
C. Adenosine
D. Amiodarone
B — Epinephrine and treat reversible causes
PEA treatment focuses on epinephrine and identifying H’s and T’s.
A 5-year-old with narrow-complex SVT does not respond to vagal maneuvers. What medication should be given?
A. Epinephrine
B. Adenosine
C. Amiodarone
D. Lidocaine
B — Adenosine
First medication for stable SVT after vagal maneuvers.
DOSE?
A 1-year-old infant with bradycardia and poor perfusion does not respond to oxygen and ventilation. What drug should be given?
A. Epinephrine
B. Adenosine
C. Lidocaine
D. Magnesium
A — Epinephrine
Epinephrine is first-line medication for symptomatic bradycardia.
A pediatric patient achieves ROSC after cardiac arrest. What oxygen saturation should be targeted?
A. 85–90%
B. 90–94%
C. >94%
D. 100%
C — >94%
Post-ROSC care includes maintaining oxygen saturation above 94% while avoiding hyperoxia.
A 7-year-old presents with sudden collapse. The monitor shows ventricular fibrillation. What is the initial defibrillation dose?
A. 1 J/kg
B. 2 J/kg
C. 4 J/kg
D. 10 J/kg
B — 2 J/kg
The initial defibrillation dose for pediatric VF/pVT is 2 J/kg, followed by higher doses if needed.
A 4-year-old has respiratory failure and requires an advanced airway during CPR. What ventilation rate should be used?
A. 4–6 breaths/min
B. 8–10 breaths/min
C. 10 breaths/min
D. 20–30 breaths/min
D — 20–30 breaths/min
With an advanced airway during pediatric CPR, ventilation is 20–30 breaths/min.
A 10-year-old presents with narrow-complex tachycardia at 210 bpm but has normal blood pressure and no respiratory distress. What is the first treatment?
A. Defibrillation
B. Vagal maneuvers
C. Adenosine immediately
D. Amiodarone
B — Vagal maneuvers
Stable narrow-complex SVT should first be treated with vagal maneuvers before medication.
A 9-year-old has ventricular tachycardia with a pulse and severe hypotension. What treatment is indicated?
A. Adenosine
B. Synchronized cardioversion
C. CPR
D. Amiodarone infusion first
B — Synchronized cardioversion
Unstable tachycardia with a pulse requires immediate synchronized cardioversion.
A 2-year-old with septic shock remains hypotensive after 40 mL/kg fluid bolus. What is the next best step?
A. Intubation
B. Vasopressor infusion
C. Defibrillation
D. Adenosine
B — Vasopressor infusion
Fluid-refractory septic shock requires vasopressors such as epinephrine or norepinephrine.
A child with suspected hypovolemic shock presents with tachycardia, delayed capillary refill, and hypotension. What is the initial fluid bolus?
A. 5 mL/kg
B. 10 mL/kg
C. 20 mL/kg
D. 40 mL/kg
C — 20 mL/kg
Initial treatment of hypovolemic shock is 20 mL/kg isotonic crystalloid bolus.
A 5-year-old presents with supraventricular tachycardia and signs of hypotension. What is the recommended initial synchronized cardioversion energy dose?
A. 0.5–1 J/kg
B. 2 J/kg
C. 4 J/kg
D. 10 J/kg
A — 0.5–1 J/kg
Initial synchronized cardioversion for unstable tachycardia is 0.5–1 J/kg, increasing to 2 J/kg if ineffective.