, Question 1
During a simulated pediatric resuscitation, the team leader notes pulseless
electrical activity (PEA) on the monitor. Which intervention should be
prioritized immediately after initiating high-quality CPR and obtaining IV/IO
access?
A. Administer epinephrine 0.01 mg/kg IV/IO and continue CPR for 2
minutes.
B. Deliver a synchronized shock at 2 J/kg.
C. Administer amiodarone 5 mg/kg IV/IO bolus.
D. Perform immediate endotracheal intubation before any medication.
Correct Answer: A - Administer epinephrine 0.01 mg/kg IV/IO
and continue CPR for 2 minutes.
RATIONALE
In PEA, the rhythm is not shockable; epinephrine is the first-line drug
to increase coronary perfusion pressure. Defibrillation (B) is for
VF/pVT, amiodarone (C) is for shock-refractory VF/pVT, and
intubation (D) should not delay compressions or epinephrine.
Question 2
A 12-lead ECG obtained during a pediatric resuscitation shows a
wide-complex tachycardia at 220 bpm with a QRS duration of 0.14 seconds.
The child has a palpable pulse but is hypotensive and lethargic. Which
intervention is most appropriate?
A. Adenosine 0.1 mg/kg rapid IV push
B. Synchronized cardioversion at 0.5-1 J/kg
C. Amiodarone 5 mg/kg IV over 20 minutes
D. Unsynchronized defibrillation at 2 J/kg
Correct Answer: B - Synchronized cardioversion at 0.5-1 J/kg
Page 2
, RATIONALE
Wide-complex tachycardia with a pulse and hemodynamic instability
requires synchronized cardioversion. Adenosine (A) is ineffective for
ventricular tachycardia and may worsen hemodynamics. Amiodarone
(C) is for stable VT or shock-refractory VF/pVT. Unsynchronized
defibrillation (D) is for pulseless VT/VF.
Question 3
After return of spontaneous circulation (ROSC) in a pediatric patient, which set
of parameters best reflects the 2024 AHA post-cardiac arrest care targets?
A. PaCO2 30-35 mmHg, SpO2 94-99%, systolic BP > 5th percentile for
age
B. PaCO2 35-45 mmHg, SpO2 94-99%, systolic BP > 10th percentile for
age
C. PaCO2 50-60 mmHg, SpO2 > 99%, systolic BP > 50th percentile for
age
D. PaCO2 25-30 mmHg, SpO2 90-94%, systolic BP > 90th percentile for
age
Correct Answer: B - PaCO2 35-45 mmHg, SpO2 94-99%, systolic
BP > 10th percentile for age
RATIONALE
Current guidelines recommend normocapnia (PaCO2 35-45 mmHg),
normoxemia (SpO2 94-99%), and avoidance of hypotension (systolic
BP >10th percentile for age). Hyperventilation (A, D) and hyperoxia
(C) are associated with worse neurological outcomes.
Question 4
Which statement accurately describes the pharmacokinetic advantage of
intraosseous (IO) versus endotracheal (ET) drug administration during
pediatric cardiac arrest?
A. IO administration achieves faster and more reliable plasma
Page 3
, concentrations than ET.
B. ET administration provides a more predictable absorption due to
pulmonary vascular surface area.
C. IO administration requires higher doses than IV to achieve equivalent
effect.
D. ET administration is preferred for epinephrine because of reduced
first-pass metabolism.
Correct Answer: A - IO administration achieves faster and more
reliable plasma concentrations than ET.
RATIONALE
IO access provides a direct route to the central circulation, yielding
rapid and reliable drug delivery comparable to IV. ET absorption is
erratic and unpredictable (B, D). IO doses are identical to IV doses
(C).
Question 5
A child with a known congenital heart disease and a baseline SpO2 of 85%
presents with severe respiratory distress. Which finding would most strongly
indicate the need for immediate assisted ventilation?
A. Nasal flaring and intercostal retractions
B. SpO2 of 80% on 2 L/min nasal cannula
C. Respiratory rate of 40/min with grunting
D. Use of accessory muscles with head bobbing
Correct Answer: D - Use of accessory muscles with head bobbing
RATIONALE
Head bobbing indicates imminent respiratory failure and need for
immediate ventilation. While other signs (A, B, C) are concerning,
head bobbing reflects severe diaphragmatic fatigue and is a late
decompensation sign requiring urgent intervention.
Page 4
During a simulated pediatric resuscitation, the team leader notes pulseless
electrical activity (PEA) on the monitor. Which intervention should be
prioritized immediately after initiating high-quality CPR and obtaining IV/IO
access?
A. Administer epinephrine 0.01 mg/kg IV/IO and continue CPR for 2
minutes.
B. Deliver a synchronized shock at 2 J/kg.
C. Administer amiodarone 5 mg/kg IV/IO bolus.
D. Perform immediate endotracheal intubation before any medication.
Correct Answer: A - Administer epinephrine 0.01 mg/kg IV/IO
and continue CPR for 2 minutes.
RATIONALE
In PEA, the rhythm is not shockable; epinephrine is the first-line drug
to increase coronary perfusion pressure. Defibrillation (B) is for
VF/pVT, amiodarone (C) is for shock-refractory VF/pVT, and
intubation (D) should not delay compressions or epinephrine.
Question 2
A 12-lead ECG obtained during a pediatric resuscitation shows a
wide-complex tachycardia at 220 bpm with a QRS duration of 0.14 seconds.
The child has a palpable pulse but is hypotensive and lethargic. Which
intervention is most appropriate?
A. Adenosine 0.1 mg/kg rapid IV push
B. Synchronized cardioversion at 0.5-1 J/kg
C. Amiodarone 5 mg/kg IV over 20 minutes
D. Unsynchronized defibrillation at 2 J/kg
Correct Answer: B - Synchronized cardioversion at 0.5-1 J/kg
Page 2
, RATIONALE
Wide-complex tachycardia with a pulse and hemodynamic instability
requires synchronized cardioversion. Adenosine (A) is ineffective for
ventricular tachycardia and may worsen hemodynamics. Amiodarone
(C) is for stable VT or shock-refractory VF/pVT. Unsynchronized
defibrillation (D) is for pulseless VT/VF.
Question 3
After return of spontaneous circulation (ROSC) in a pediatric patient, which set
of parameters best reflects the 2024 AHA post-cardiac arrest care targets?
A. PaCO2 30-35 mmHg, SpO2 94-99%, systolic BP > 5th percentile for
age
B. PaCO2 35-45 mmHg, SpO2 94-99%, systolic BP > 10th percentile for
age
C. PaCO2 50-60 mmHg, SpO2 > 99%, systolic BP > 50th percentile for
age
D. PaCO2 25-30 mmHg, SpO2 90-94%, systolic BP > 90th percentile for
age
Correct Answer: B - PaCO2 35-45 mmHg, SpO2 94-99%, systolic
BP > 10th percentile for age
RATIONALE
Current guidelines recommend normocapnia (PaCO2 35-45 mmHg),
normoxemia (SpO2 94-99%), and avoidance of hypotension (systolic
BP >10th percentile for age). Hyperventilation (A, D) and hyperoxia
(C) are associated with worse neurological outcomes.
Question 4
Which statement accurately describes the pharmacokinetic advantage of
intraosseous (IO) versus endotracheal (ET) drug administration during
pediatric cardiac arrest?
A. IO administration achieves faster and more reliable plasma
Page 3
, concentrations than ET.
B. ET administration provides a more predictable absorption due to
pulmonary vascular surface area.
C. IO administration requires higher doses than IV to achieve equivalent
effect.
D. ET administration is preferred for epinephrine because of reduced
first-pass metabolism.
Correct Answer: A - IO administration achieves faster and more
reliable plasma concentrations than ET.
RATIONALE
IO access provides a direct route to the central circulation, yielding
rapid and reliable drug delivery comparable to IV. ET absorption is
erratic and unpredictable (B, D). IO doses are identical to IV doses
(C).
Question 5
A child with a known congenital heart disease and a baseline SpO2 of 85%
presents with severe respiratory distress. Which finding would most strongly
indicate the need for immediate assisted ventilation?
A. Nasal flaring and intercostal retractions
B. SpO2 of 80% on 2 L/min nasal cannula
C. Respiratory rate of 40/min with grunting
D. Use of accessory muscles with head bobbing
Correct Answer: D - Use of accessory muscles with head bobbing
RATIONALE
Head bobbing indicates imminent respiratory failure and need for
immediate ventilation. While other signs (A, B, C) are concerning,
head bobbing reflects severe diaphragmatic fatigue and is a late
decompensation sign requiring urgent intervention.
Page 4
