Pals Heartcode 2025 QUESTIONS WITH COMPLETE
SOLUTIONS
Course
PALS RED CROSS
Question 1:
What is the recommended initial dose of epinephrine during pediatric cardiac arrest?
Answer:
0.01 mg/kg (0.1 mL/kg of the 1:10,000 concentration) IV/IO.
Rationale:
Epinephrine is a critical drug for pediatric cardiac arrest to increase heart rate and
contractility by stimulating adrenergic receptors. It’s given every 3–5 minutes during
resuscitation.
Question 2:
In the context of pediatric bradycardia with poor perfusion, after ensuring adequate
oxygenation and ventilation, what is the next step?
Answer:
Administer epinephrine and consider atropine if the bradycardia persists.
Rationale:
For pediatric bradycardia unresponsive to oxygenation and ventilation, epinephrine is the
first-line drug. Atropine (0.02 mg/kg) may be considered if the bradycardia is caused by
increased vagal tone or AV block.
Question 3:
What is the preferred defibrillation energy dose for a child with ventricular fibrillation or
pulseless ventricular tachycardia?
Answer:
2-4 joules/kg for the first shock.
Rationale:
Defibrillation is crucial for treating shockable rhythms like VF/pVT. A dose of 2-4 joules/kg
is recommended for the first shock, followed by escalating doses if necessary.
,Question 4:
In pediatric patients, what is the first-line treatment for shock due to hypovolemia?
Answer:
Rapid infusion of isotonic crystalloid (20 mL/kg).
Rationale:
Hypovolemic shock in children is typically treated with fluid resuscitation using isotonic
solutions like normal saline or lactated Ringer’s to restore circulating volume.
Question 5:
What is the correct ratio of compressions to breaths for a single rescuer performing CPR on
an infant or child?
Answer:
30:2.
Rationale:
When a single rescuer is performing CPR on an infant or child, the compression-to-
ventilation ratio is 30 compressions to 2 breaths, ensuring sufficient blood flow and
oxygenation.
Question 6:
What is the most common cause of cardiac arrest in pediatric patients?
Answer:
Hypoxia and respiratory failure.
Rationale:
Unlike adults, pediatric cardiac arrest typically results from respiratory issues like hypoxia or
respiratory failure, leading to bradycardia and cardiac arrest if untreated.
Question 7:
During PALS resuscitation, what is the primary reason for assessing capillary refill in a
pediatric patient?
Answer:
To evaluate perfusion and circulatory status.
,Rationale:
Capillary refill time helps assess the effectiveness of circulation. Delayed capillary refill
(greater than 2 seconds) can indicate poor perfusion, often associated with shock or
dehydration.
Question 8:
For a child in anaphylactic shock, what is the first-line treatment?
Answer:
Intramuscular epinephrine (0.01 mg/kg).
Rationale:
Epinephrine is the first-line treatment for anaphylaxis, rapidly countering severe allergic
reactions by reversing airway constriction and increasing blood pressure.
Question 9:
What is the appropriate action if a pediatric patient is found in asystole during a resuscitation
attempt?
Answer:
Begin high-quality CPR and administer epinephrine every 3-5 minutes.
Rationale:
In asystole, there is no electrical activity or cardiac output. Immediate high-quality CPR,
along with epinephrine administration, is the best chance of restarting cardiac activity.
Question 10:
What is the correct ventilation rate during CPR with an advanced airway in place?
Answer:
One breath every 2-3 seconds (20-30 breaths per minute).
Rationale:
When an advanced airway (like an endotracheal tube) is in place, compressions are
continuous, and the rescuer should provide one breath every 2-3 seconds without pausing
compressions.
Question 11:
What is the first priority in managing a child with suspected septic shock?
, Answer:
Begin fluid resuscitation with isotonic crystalloid (20 mL/kg bolus).
Rationale:
Early fluid resuscitation is key in treating septic shock to restore perfusion and maintain
blood pressure. Additional fluids or vasopressors may be needed if shock persists.
Question 12:
In a pediatric patient with supraventricular tachycardia (SVT), what is the initial treatment
if the patient is stable?
Answer:
Vagal maneuvers, such as applying an ice pack to the face.
Rationale:
For stable SVT, non-invasive vagal maneuvers can help stimulate the vagus nerve, slowing
the heart rate by affecting the electrical activity in the heart.
Question 13:
Which rhythm is most commonly associated with pediatric cardiac arrest?
Answer:
Bradycardia leading to asystole.
Rationale:
In pediatric patients, cardiac arrest is often secondary to respiratory failure, leading to
progressive bradycardia and then asystole.
Question 14:
For an unconscious pediatric patient with a foreign body airway obstruction, what is the
first step after confirming the obstruction?
Answer:
Begin CPR, starting with chest compressions.
Rationale:
For an unconscious child with a foreign body airway obstruction, initiating CPR may help
dislodge the object by creating pressure changes in the airway.
SOLUTIONS
Course
PALS RED CROSS
Question 1:
What is the recommended initial dose of epinephrine during pediatric cardiac arrest?
Answer:
0.01 mg/kg (0.1 mL/kg of the 1:10,000 concentration) IV/IO.
Rationale:
Epinephrine is a critical drug for pediatric cardiac arrest to increase heart rate and
contractility by stimulating adrenergic receptors. It’s given every 3–5 minutes during
resuscitation.
Question 2:
In the context of pediatric bradycardia with poor perfusion, after ensuring adequate
oxygenation and ventilation, what is the next step?
Answer:
Administer epinephrine and consider atropine if the bradycardia persists.
Rationale:
For pediatric bradycardia unresponsive to oxygenation and ventilation, epinephrine is the
first-line drug. Atropine (0.02 mg/kg) may be considered if the bradycardia is caused by
increased vagal tone or AV block.
Question 3:
What is the preferred defibrillation energy dose for a child with ventricular fibrillation or
pulseless ventricular tachycardia?
Answer:
2-4 joules/kg for the first shock.
Rationale:
Defibrillation is crucial for treating shockable rhythms like VF/pVT. A dose of 2-4 joules/kg
is recommended for the first shock, followed by escalating doses if necessary.
,Question 4:
In pediatric patients, what is the first-line treatment for shock due to hypovolemia?
Answer:
Rapid infusion of isotonic crystalloid (20 mL/kg).
Rationale:
Hypovolemic shock in children is typically treated with fluid resuscitation using isotonic
solutions like normal saline or lactated Ringer’s to restore circulating volume.
Question 5:
What is the correct ratio of compressions to breaths for a single rescuer performing CPR on
an infant or child?
Answer:
30:2.
Rationale:
When a single rescuer is performing CPR on an infant or child, the compression-to-
ventilation ratio is 30 compressions to 2 breaths, ensuring sufficient blood flow and
oxygenation.
Question 6:
What is the most common cause of cardiac arrest in pediatric patients?
Answer:
Hypoxia and respiratory failure.
Rationale:
Unlike adults, pediatric cardiac arrest typically results from respiratory issues like hypoxia or
respiratory failure, leading to bradycardia and cardiac arrest if untreated.
Question 7:
During PALS resuscitation, what is the primary reason for assessing capillary refill in a
pediatric patient?
Answer:
To evaluate perfusion and circulatory status.
,Rationale:
Capillary refill time helps assess the effectiveness of circulation. Delayed capillary refill
(greater than 2 seconds) can indicate poor perfusion, often associated with shock or
dehydration.
Question 8:
For a child in anaphylactic shock, what is the first-line treatment?
Answer:
Intramuscular epinephrine (0.01 mg/kg).
Rationale:
Epinephrine is the first-line treatment for anaphylaxis, rapidly countering severe allergic
reactions by reversing airway constriction and increasing blood pressure.
Question 9:
What is the appropriate action if a pediatric patient is found in asystole during a resuscitation
attempt?
Answer:
Begin high-quality CPR and administer epinephrine every 3-5 minutes.
Rationale:
In asystole, there is no electrical activity or cardiac output. Immediate high-quality CPR,
along with epinephrine administration, is the best chance of restarting cardiac activity.
Question 10:
What is the correct ventilation rate during CPR with an advanced airway in place?
Answer:
One breath every 2-3 seconds (20-30 breaths per minute).
Rationale:
When an advanced airway (like an endotracheal tube) is in place, compressions are
continuous, and the rescuer should provide one breath every 2-3 seconds without pausing
compressions.
Question 11:
What is the first priority in managing a child with suspected septic shock?
, Answer:
Begin fluid resuscitation with isotonic crystalloid (20 mL/kg bolus).
Rationale:
Early fluid resuscitation is key in treating septic shock to restore perfusion and maintain
blood pressure. Additional fluids or vasopressors may be needed if shock persists.
Question 12:
In a pediatric patient with supraventricular tachycardia (SVT), what is the initial treatment
if the patient is stable?
Answer:
Vagal maneuvers, such as applying an ice pack to the face.
Rationale:
For stable SVT, non-invasive vagal maneuvers can help stimulate the vagus nerve, slowing
the heart rate by affecting the electrical activity in the heart.
Question 13:
Which rhythm is most commonly associated with pediatric cardiac arrest?
Answer:
Bradycardia leading to asystole.
Rationale:
In pediatric patients, cardiac arrest is often secondary to respiratory failure, leading to
progressive bradycardia and then asystole.
Question 14:
For an unconscious pediatric patient with a foreign body airway obstruction, what is the
first step after confirming the obstruction?
Answer:
Begin CPR, starting with chest compressions.
Rationale:
For an unconscious child with a foreign body airway obstruction, initiating CPR may help
dislodge the object by creating pressure changes in the airway.
