2025 AHA PALS Exam A Questions and
100% Verified Answers new
Capillary refill //- ANS.//Capillary refill time is the time it takes for blood to return to tissue
blanched by pressure. It increases as skin perfusion decreases. Note that normal
capillary refill time is 2 seconds or less, and a prolonged capillary refill time may indicate
low cardiac output
Early signs of tissue hypoxia //- ANS.//• Fast respiratory rate (tachypnea)
• Increased respiratory effort: nasal flaring, retractions
• Tachycardia
• Pallor, mottling, cyanosis* Agitation, anxiety, irritability
Late signs of tissue hypoxia //- ANS.//• Slow respiratory rate (bradypnea), inadequate
respiratory effort, apnea
• Increased respiratory effort: head bobbing, seesaw respirations, grunting
• Bradycardia
• Pallor, mottling, cyanosis*
• Decreased level of consciousness
Alveolar hypoventilation causes //- ANS.//• Central nervous system infection
• Traumatic brain injury
• Drug overdose
• Neuromuscular weakness
• Apnea
Alveolar ventilation mechanism //- ANS.//Increased arterial CO, tension (hypercarbia)
displaces alveolar o2, resulting in decreased alveolar and arterial o2 tension (low PaO2
or hypoxemia)
Hypercarbia signs //- ANS.//Most children with hypercarbia present with respiratory
distress and tachypnea. Children may become tachypneic in an attempt to eliminate
excess COz. However, the child with hypercarbia may also present with poor respiratory
effort, including decreased respiratory rate. In this case, hypercarbia results from
inadequate ventilation secondary to impaired respiratory drive. This inadequate
ventilation may result from drugs, such as a narcotic overdose. It may also result from a
,central nervous system disorder with respiratory muscle weakness, preventing the
development of compensatory tachypnea.
When to Suspect Hypercarbia //- ANS.//Decreased level of consciousness is a critical
symptom of both inadequate ventilation and hypoxia. If a child's clinical condition
deteriorates from agitation and anxiety to decreased responsiveness despite
supplemental oxygen, this may indicate that the Paco, is rising. Even if the pulse
oximeter indicates adequate oxygen saturation, ventilation may be impaired and
hypercarbia may be present. If a child with respiratory distress has a decreased level of
consciousness despite adequate oxygenation, ventilation may be inadequate and
hypercarbia and respiratory acidosis may be present.
Severe respiratory distress //- ANS.//• Marked tachypnea
• Marked increase in respiratory effort (eg, nasal flaring, retractions)
• Paradoxical thoracoabdominal breathing (eg, seesaw breathing)
• Accessory muscle use (eg, head bobbing)
• Abnormal airway sounds (eg, grunting)
• Decreased level of consciousness (eg, less responsive)
Impending respiratory arrest //- ANS.//• Bradypnea, apnea, or respiratory pauses
• Low oxygen saturation (hypoxemia) despite high-flow supplemental oxygen
• Inadequate respiratory effort (eg, shallow respirations)
• Decreased level of consciousness (unresponsive)
• Bradycardia
Signs of probable respiratory failure //- ANS.//• Very rapid or inadequate respiratory rate
or possible apnea
• Significant, inadequate, or absent respiratory effort
• Absent distal air movement
• Extreme tachycardia; bradycardia often indicates life-threatening deterioration
• Low oxygen saturation (hypoxemia) despite high-flow supplemental oxygen
• Decreased level of consciousness
Guidelines for rescue breathing for infants and children //- ANS.//• Give 1 breath every 2
to 3 seconds (about 20 to 30 breaths per minute).
• Give each breath in 1 second.
• Each breath should result in visible chest rise.
• Check the pulse about every 2 minutes; if the child becomes pulseless, shout for help
and provide compressions as well as ventilation (CPR).
• Use oxygen as soon as it is available.
DOPE //- ANS.//• Displacement of the tube: The tube may be displaced out of the
trachea or advanced into the right or left main bronchus.
• Obstruction of the tube: Obstruction may be caused by secretions, blood, pus, a
foreign body, or kinking of the tube.
, • Pneumothorax: Simple pneumothorax usually results in a sudden deterioration in
oxygenation (reflected by a sudden decrease in Spo,) and decreased chest expansion
and breath sounds on the involved side. Tension pneumothorax may result in the above
plus evidence of hypotension and decreased cardiac output. The trachea is usually
shifted away from the involved side.
• Equipment failure: Equipment may fail for several reasons, such as disconnection of
the O, supply from the ventilation system, leak in the ventilator circuit, failure of power
supply to the ventilator, and malfunction of valves in the bag or circuit.
Common causes of upper airway obstruction //- ANS.//• Foreign-body aspiration (eg,
food or a small object)
• Airway swelling (eg, anaphylaxis, tonsillar hypertrophy, croup, or epiglottitis)
• Mass that compromises the airway lumen (eg, pharyngeal or peritonsillar abscess,
retropharyngeal abscess, tumor)
• Thick secretions obstructing the nasal passages
• Congenital airway abnormality (eg, congenital subglottic stenosis) resulting in
narrowing of the airway
• Poor control of the upper airway due to a decreased level of consciousness
• Hospital acquired (eg, subglottic stenosis may develop secondary to trauma induced
by endotracheal intubation)
Anatomical Differences //- ANS.//• Due to their small airway, infants and small children
may easily develop upper airway obstruction.
Because an infant's tongue is large in proportion to the oropharyngeal cavity, if the
infant has a decreased level of consciousness, the muscles may relax and allow the
tongue to fall back and obstruct the oropharynx.
• Infants also have a prominent occiput. If the infant with a decreased level of
consciousness is supine, resting on the large occiput can cause flexion of the neck,
resulting in upper airway obstruction.
Signs of upper airway obstruction //- ANS.//• The major clinical signs of upper airway
obstruction, such as stridor, hoarseness, or a change in voice or cry, typically occur
during the inspiratory phase of the respiratory cycle.
• Inspiratory retractions, use of accessory muscles, and nasal flaring are often present.
The respiratory rate is often only mildly elevated because upper airway obstruction is
worse with faster breathing.
Examples include foreign body obstruction, croup, and epiglottitis.
Other signs of upper airway obstruction include //- ANS.//• Increased respiratory rate
and effort
• Drooling, snoring, or gurgling sounds
• Poor chest rise
• Poor air entry on auscultation
Opening the airway may include //- ANS.//• Allowing the child to assume a position of
comfort
100% Verified Answers new
Capillary refill //- ANS.//Capillary refill time is the time it takes for blood to return to tissue
blanched by pressure. It increases as skin perfusion decreases. Note that normal
capillary refill time is 2 seconds or less, and a prolonged capillary refill time may indicate
low cardiac output
Early signs of tissue hypoxia //- ANS.//• Fast respiratory rate (tachypnea)
• Increased respiratory effort: nasal flaring, retractions
• Tachycardia
• Pallor, mottling, cyanosis* Agitation, anxiety, irritability
Late signs of tissue hypoxia //- ANS.//• Slow respiratory rate (bradypnea), inadequate
respiratory effort, apnea
• Increased respiratory effort: head bobbing, seesaw respirations, grunting
• Bradycardia
• Pallor, mottling, cyanosis*
• Decreased level of consciousness
Alveolar hypoventilation causes //- ANS.//• Central nervous system infection
• Traumatic brain injury
• Drug overdose
• Neuromuscular weakness
• Apnea
Alveolar ventilation mechanism //- ANS.//Increased arterial CO, tension (hypercarbia)
displaces alveolar o2, resulting in decreased alveolar and arterial o2 tension (low PaO2
or hypoxemia)
Hypercarbia signs //- ANS.//Most children with hypercarbia present with respiratory
distress and tachypnea. Children may become tachypneic in an attempt to eliminate
excess COz. However, the child with hypercarbia may also present with poor respiratory
effort, including decreased respiratory rate. In this case, hypercarbia results from
inadequate ventilation secondary to impaired respiratory drive. This inadequate
ventilation may result from drugs, such as a narcotic overdose. It may also result from a
,central nervous system disorder with respiratory muscle weakness, preventing the
development of compensatory tachypnea.
When to Suspect Hypercarbia //- ANS.//Decreased level of consciousness is a critical
symptom of both inadequate ventilation and hypoxia. If a child's clinical condition
deteriorates from agitation and anxiety to decreased responsiveness despite
supplemental oxygen, this may indicate that the Paco, is rising. Even if the pulse
oximeter indicates adequate oxygen saturation, ventilation may be impaired and
hypercarbia may be present. If a child with respiratory distress has a decreased level of
consciousness despite adequate oxygenation, ventilation may be inadequate and
hypercarbia and respiratory acidosis may be present.
Severe respiratory distress //- ANS.//• Marked tachypnea
• Marked increase in respiratory effort (eg, nasal flaring, retractions)
• Paradoxical thoracoabdominal breathing (eg, seesaw breathing)
• Accessory muscle use (eg, head bobbing)
• Abnormal airway sounds (eg, grunting)
• Decreased level of consciousness (eg, less responsive)
Impending respiratory arrest //- ANS.//• Bradypnea, apnea, or respiratory pauses
• Low oxygen saturation (hypoxemia) despite high-flow supplemental oxygen
• Inadequate respiratory effort (eg, shallow respirations)
• Decreased level of consciousness (unresponsive)
• Bradycardia
Signs of probable respiratory failure //- ANS.//• Very rapid or inadequate respiratory rate
or possible apnea
• Significant, inadequate, or absent respiratory effort
• Absent distal air movement
• Extreme tachycardia; bradycardia often indicates life-threatening deterioration
• Low oxygen saturation (hypoxemia) despite high-flow supplemental oxygen
• Decreased level of consciousness
Guidelines for rescue breathing for infants and children //- ANS.//• Give 1 breath every 2
to 3 seconds (about 20 to 30 breaths per minute).
• Give each breath in 1 second.
• Each breath should result in visible chest rise.
• Check the pulse about every 2 minutes; if the child becomes pulseless, shout for help
and provide compressions as well as ventilation (CPR).
• Use oxygen as soon as it is available.
DOPE //- ANS.//• Displacement of the tube: The tube may be displaced out of the
trachea or advanced into the right or left main bronchus.
• Obstruction of the tube: Obstruction may be caused by secretions, blood, pus, a
foreign body, or kinking of the tube.
, • Pneumothorax: Simple pneumothorax usually results in a sudden deterioration in
oxygenation (reflected by a sudden decrease in Spo,) and decreased chest expansion
and breath sounds on the involved side. Tension pneumothorax may result in the above
plus evidence of hypotension and decreased cardiac output. The trachea is usually
shifted away from the involved side.
• Equipment failure: Equipment may fail for several reasons, such as disconnection of
the O, supply from the ventilation system, leak in the ventilator circuit, failure of power
supply to the ventilator, and malfunction of valves in the bag or circuit.
Common causes of upper airway obstruction //- ANS.//• Foreign-body aspiration (eg,
food or a small object)
• Airway swelling (eg, anaphylaxis, tonsillar hypertrophy, croup, or epiglottitis)
• Mass that compromises the airway lumen (eg, pharyngeal or peritonsillar abscess,
retropharyngeal abscess, tumor)
• Thick secretions obstructing the nasal passages
• Congenital airway abnormality (eg, congenital subglottic stenosis) resulting in
narrowing of the airway
• Poor control of the upper airway due to a decreased level of consciousness
• Hospital acquired (eg, subglottic stenosis may develop secondary to trauma induced
by endotracheal intubation)
Anatomical Differences //- ANS.//• Due to their small airway, infants and small children
may easily develop upper airway obstruction.
Because an infant's tongue is large in proportion to the oropharyngeal cavity, if the
infant has a decreased level of consciousness, the muscles may relax and allow the
tongue to fall back and obstruct the oropharynx.
• Infants also have a prominent occiput. If the infant with a decreased level of
consciousness is supine, resting on the large occiput can cause flexion of the neck,
resulting in upper airway obstruction.
Signs of upper airway obstruction //- ANS.//• The major clinical signs of upper airway
obstruction, such as stridor, hoarseness, or a change in voice or cry, typically occur
during the inspiratory phase of the respiratory cycle.
• Inspiratory retractions, use of accessory muscles, and nasal flaring are often present.
The respiratory rate is often only mildly elevated because upper airway obstruction is
worse with faster breathing.
Examples include foreign body obstruction, croup, and epiglottitis.
Other signs of upper airway obstruction include //- ANS.//• Increased respiratory rate
and effort
• Drooling, snoring, or gurgling sounds
• Poor chest rise
• Poor air entry on auscultation
Opening the airway may include //- ANS.//• Allowing the child to assume a position of
comfort
