PALS 2025 Questions with Correct Solutions, Graded A+

Which pulses should be assessed to monitor systemic perfusion in a child? - peripheral and central What should the first rescuer arriving on the scene of an unresponsive infant or child do? (in order) - 1. verify scene safety 2. check for responsiveness 3. shout for help 4. activate the emergency response system Why may excessive ventilation during CPR be harmful? - - it increases intrathoracic pressure - it impedes venous return If you cannot achieve effective ventilation (ie, the chest does not rise), do the following: - - reposition/reopen the airway (sniffing position) - verify mask size and ensure a tight face-mask seal - suction the airway if needed - check the O2 source - check the ventilation bag and mask - treat gastric inflation (NG/OG) - consider 2-person bag-mask ventilation and inserting an OPA Ventilation rate - 1 breath every 2-3 seconds delivered over 1 second (20-30 breaths per minute) Early signs of tissue hypoxia - - tachypnea - increased respiratory effort (nasal flaring, retractions) - tachycardia - pallor, mottling, cyanosis - agitation, anxiety, irritability Late signs of tissue hypoxia - - bradypnea, inadequate respiratory effort, apnea - increased respiratory effort (head bobbing, seesaw respirations, grunting) - bradycardia - pallor, mottling, cyanosis - decreased level of consciousness What is the role of the diaphragm during normal breathing in infants? - pulls the ribs slightly inward S/S mild respiratory distress - - mild tachypnea - mild increase in respiratory effort (nasal flaring, retractions) - abnormal airway sounds (stridor, wheezing, grunting) S/S Severe respiratory distress - - marked tachypnea - marked increase in respiratory effort - paradoxical throacoabdominal breathing (seesaw breathing) - accessory muscle use (head bobbing) - abnormal airway sounds (grunting) - decreased level of consciousness S/S Impending respiratory arrest - - bradypnea, apnea, respiratory pauses - low oxygen saturation (hypoxemia) despite high-flow supplemental oxygen - inadequate respiratory effort (shallow respirations) - decreased level of consciousness (unresponsive) - bradycardia What steps should be taken as part of initial management of a child in respiratory distress? - - monitor O2 sat by pulse ox - monitor HR, rhythm, and, BP - support an open airway Stridor - high-pitched breathing during inspirations Crackles - breath sounds heart during expirations How should 1-rescuer infant compressions be delivered? - - two fingers or two thumbs - rate of 100-120 - single rescuer (30:2) - two rescuer (15:2) How should 1-rescurer child compressions be delivered? - either one or two hands - compress at least 1/3 the chest diameter (approximately 2 inches) Guidelines for rescue breathing for infants and children - - give 1 breath every 2-3 seconds (about 20-30/min) - given each breath in 1 second - visible chest rise - check pulse every 2 minutes - use oxygen as soon as it is available