Definitely not the PALS precourse assessment
1. : SVT converting to sinus rhythm after adenosine administration
2. : Sinus bradycardia
3. : Sinus bradycardia - version 2
4. : Normal sinus rhythm
5. : Asystole
6. : Wide complex tachycardia
7. : Wide complex tachycardia - version 2
8. : Torsades de pointes
9. : Supraventricular tachycardia
10. : VF with successful defib and resumption of organized rhythm
11. : Pulseless electrical activity
12. : Ventricular fibrillation
13. : Sinus tachycardia
14. Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and
also give D25W 2-4 ml/kg IV: A previously healthy infant with a history of vomiting
and diarrhea is brought to the emergency department by her parents. During your
assessment, you find that the infant responds only to painful stimulation. The infant's
respiratory rate is 40 breaths per minute, and central pulses are rapid and weak. The
infant has good bilateral breath sounds, cool extremities, and a capillary refill time
of more than 5 seconds. The infant's blood pressure is 85/65 mmHg, and glucose is
30 mg/dL (1.65 mmol/L). You administer 100% oxygen via face mask and start an
IV. Which treatment is most appropriate for this infant?
15. Albuterol (duh): A 9yo boy is agitated and leaning forward on the bed in obvious
respiratory distress. The patient is speaking in short phrases and tells you that he
has asthma but does not carry an inhaler. He has nasal flaring, severe suprasternal
and intercostal retractions, and decreased air movement with prolonged expiratory
time and wheezing. You administer 100% oxygen by a nonrebreathing mask. His
spO2 is 92%. Which med do you prepare to give to this patient?
16. Rapid bolus of 20ml/kg of isotonic crystalloid: Paramedics are called to
the home of a 1yo child. Their initial assessment reveals a child who responds
only to painful stimuli and has irregular breathing, faint central pulses, bruises
over the abdomen, abdominal distention, and cyanosis. Bag-mask ventilation with
100% oxygen is initiated. The child's heart rate is 36/min. Peripheral pulses cannot
be palpated, and central pulses are barely palpable. The cardiac monitor shows
sinus bradycardia. Two-rescuer CPR is started. Upon arrival to the emergency
department, the child is intubated and ventilated with 100% oxygen, and IV access
is established. The heart rate is now 150/min with weak central pulses but no distal
1/6
, Definitely not the PALS precourse assessment
pulses. Systolic blood pressure is 74 mmHg. Which intervention should be provided
next?
17. Epinephrine: You are called to help treat an infant with severe symptomatic
bradycardia (heart rate 66/min) associated with respiratory distress. The bradycardia
persists despite establishment of an effective airway, oxygenation, and ventilation.
There is no heart block present. Which is the first drug you should administer?
18. Routine administration is not indicated during cardiac arrest: Which state-
ment is correct about the use of calcium chloride in pediatric patients?
19. It is the least desirable route of administration: Which statement is correct
about endotracheal drug administration during resuscitative efforts for pediatric
patients?
20. Humidified oxygen as tolerated: Initial impression of a 2yo girl shows her
to be alert with mild breathing difficulty during inspiration and pale skin color. On
primary assessment, she makes high-pitched inspiratory sounds (mild stridor) when
agitated; otherwise, her breathing is quiet. Her spO2 is 92% on room air, and she
has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted
upper airway sounds with adequate distal breath sounds bilaterally. Which is the
most appropriate initial intervention for this child?
21. Amiodarone 5 mg/kg IO: You are part of a team attempting to resuscitate a child
with ventricular fibrillation cardiac arrest. You delivered 2 unsynchronized shocks.
A team member established IO access, so you give a dose of epinephrine, 0.01
mg/kg IO. At the next rhythm check, persistent ventricular fibrillation is present.
You administer a 4 J/kg shock and resume CPR. Which drug and dose should be
administered next?
22. Nonrebreathing face mask: Which oxygen delivery system most reliably deliv-
ers a high (90% or greater) concentration of inspired oxygen to a 7yo child?
23. Epinephrine stimulates spontaneous contractions when asystole is pre-
sent: Which statement is correct about the effects of epinephrine during attempted
resuscitation?
24. Epinephrine 0.01 mg/kg IV/IO: A 10mo infant boy is brought to the emer-
gency department. Your initial assessment reveals a lethargic, pale infant with slow
respirations and slow, weak central pulses. One team member begins ventilation
with a bag-mask device with 100% oxygen. A second team member attaches the
monitor/defibrillator and obtains vital signs while a third team member attempts to
establish IV/IO access. The patient's heart rate is 38/min with the rhythm shown here.
The infant's blood pressure is 58/38 mmHg, and capillary refill is 4 seconds. His cen-
tral pulses remain weak, and distal pulses cannot be palpated. Chest compressions
are started and IO access is obtained. Which medication do you anticipate will be
given next?
2/6
1. : SVT converting to sinus rhythm after adenosine administration
2. : Sinus bradycardia
3. : Sinus bradycardia - version 2
4. : Normal sinus rhythm
5. : Asystole
6. : Wide complex tachycardia
7. : Wide complex tachycardia - version 2
8. : Torsades de pointes
9. : Supraventricular tachycardia
10. : VF with successful defib and resumption of organized rhythm
11. : Pulseless electrical activity
12. : Ventricular fibrillation
13. : Sinus tachycardia
14. Administer a bolus of isotonic crystalloid 20 ml/kg over 5-20 minutes, and
also give D25W 2-4 ml/kg IV: A previously healthy infant with a history of vomiting
and diarrhea is brought to the emergency department by her parents. During your
assessment, you find that the infant responds only to painful stimulation. The infant's
respiratory rate is 40 breaths per minute, and central pulses are rapid and weak. The
infant has good bilateral breath sounds, cool extremities, and a capillary refill time
of more than 5 seconds. The infant's blood pressure is 85/65 mmHg, and glucose is
30 mg/dL (1.65 mmol/L). You administer 100% oxygen via face mask and start an
IV. Which treatment is most appropriate for this infant?
15. Albuterol (duh): A 9yo boy is agitated and leaning forward on the bed in obvious
respiratory distress. The patient is speaking in short phrases and tells you that he
has asthma but does not carry an inhaler. He has nasal flaring, severe suprasternal
and intercostal retractions, and decreased air movement with prolonged expiratory
time and wheezing. You administer 100% oxygen by a nonrebreathing mask. His
spO2 is 92%. Which med do you prepare to give to this patient?
16. Rapid bolus of 20ml/kg of isotonic crystalloid: Paramedics are called to
the home of a 1yo child. Their initial assessment reveals a child who responds
only to painful stimuli and has irregular breathing, faint central pulses, bruises
over the abdomen, abdominal distention, and cyanosis. Bag-mask ventilation with
100% oxygen is initiated. The child's heart rate is 36/min. Peripheral pulses cannot
be palpated, and central pulses are barely palpable. The cardiac monitor shows
sinus bradycardia. Two-rescuer CPR is started. Upon arrival to the emergency
department, the child is intubated and ventilated with 100% oxygen, and IV access
is established. The heart rate is now 150/min with weak central pulses but no distal
1/6
, Definitely not the PALS precourse assessment
pulses. Systolic blood pressure is 74 mmHg. Which intervention should be provided
next?
17. Epinephrine: You are called to help treat an infant with severe symptomatic
bradycardia (heart rate 66/min) associated with respiratory distress. The bradycardia
persists despite establishment of an effective airway, oxygenation, and ventilation.
There is no heart block present. Which is the first drug you should administer?
18. Routine administration is not indicated during cardiac arrest: Which state-
ment is correct about the use of calcium chloride in pediatric patients?
19. It is the least desirable route of administration: Which statement is correct
about endotracheal drug administration during resuscitative efforts for pediatric
patients?
20. Humidified oxygen as tolerated: Initial impression of a 2yo girl shows her
to be alert with mild breathing difficulty during inspiration and pale skin color. On
primary assessment, she makes high-pitched inspiratory sounds (mild stridor) when
agitated; otherwise, her breathing is quiet. Her spO2 is 92% on room air, and she
has mild inspiratory intercostal retractions. Lung auscultation reveals transmitted
upper airway sounds with adequate distal breath sounds bilaterally. Which is the
most appropriate initial intervention for this child?
21. Amiodarone 5 mg/kg IO: You are part of a team attempting to resuscitate a child
with ventricular fibrillation cardiac arrest. You delivered 2 unsynchronized shocks.
A team member established IO access, so you give a dose of epinephrine, 0.01
mg/kg IO. At the next rhythm check, persistent ventricular fibrillation is present.
You administer a 4 J/kg shock and resume CPR. Which drug and dose should be
administered next?
22. Nonrebreathing face mask: Which oxygen delivery system most reliably deliv-
ers a high (90% or greater) concentration of inspired oxygen to a 7yo child?
23. Epinephrine stimulates spontaneous contractions when asystole is pre-
sent: Which statement is correct about the effects of epinephrine during attempted
resuscitation?
24. Epinephrine 0.01 mg/kg IV/IO: A 10mo infant boy is brought to the emer-
gency department. Your initial assessment reveals a lethargic, pale infant with slow
respirations and slow, weak central pulses. One team member begins ventilation
with a bag-mask device with 100% oxygen. A second team member attaches the
monitor/defibrillator and obtains vital signs while a third team member attempts to
establish IV/IO access. The patient's heart rate is 38/min with the rhythm shown here.
The infant's blood pressure is 58/38 mmHg, and capillary refill is 4 seconds. His cen-
tral pulses remain weak, and distal pulses cannot be palpated. Chest compressions
are started and IO access is obtained. Which medication do you anticipate will be
given next?
2/6
