PALS – American Heart Association – 2020 Pediatric Advanced Life Support (PALS) Review
with Clinical Questions and Answer Key
Which of the following should be considered for stable SVT?
A) deliver an unsynchronized shock of 2 J/kg
B) place a bag with ice water over the upper half of the infant's face
C) ask an older child to try to blow through an obstructed straw
D) perform synchronized cardio version at 0.5-1 J/kg B and C
What is the initial dose of adenosine?
A) 0.1 mg/kg IV/IO
B) 0.2 mg/kg IV/IO
C) 1 mg/kg IV/IO
D) 6 mg IV/IO A) 0.1 mg/kg IV/IO
For stable patients with a regular wide complex and monomorphic tachycardia, consider:
A) synchronized cardioversion
B) 12-lead ECG
C) adenosine
D) vagal stimulation C) adenosine
If amiodarone or procainamide does not terminate the rapid rhythm, why should adenosine be
considered?
A) Torsades may be the underlying rhythm
B) adenosine inhibits the outward potassium current so it prolongs the QT duration
C) a wide complex tachycardia could be SVT with aberrant ventricular conduction
,D) adenosine inhibits sodium channels, which slows conduction in the ventricles and prolongs
QT duration C) a wide complex tachycardia could be SVT with aberrant ventricular
conduction
What is the appropriate initial dose if synchronized cardioversion is needed?
A) 0.5-1 J/kg
B) 1-2 J/kg
C) 2-4 J/kg
D) 4-6 J/kg A) 0.5-1 J/kg
Your ambulance is dispatched for a 5 month old boy who has difficulty breathing, poor feeding,
and vomiting. The infant is sitting in a baby carrier in the living room, appears irritable, and has
labored breathing. He has HR of 261 bpm, BP 72/54, RR 40/min, SpO2 96%, and he is crying.
Which of the following is the most appropriate initial intervention?
A) ventilate with a BVM
B) sit the child up
C) administer a bronchodilator
D) maintain a patent airway; administer O2 D) maintain a patent airway; administer O2
The patient has characteristics of SVT, including HR of more than 220/min. How would P waves
appear on an ECG in SVT?
A) absent
B) present
C) abnormal
D) normal A or C
What precautions should be taken when placing ice to the face of an infant?
A) gently perform carotid massage
,B) do not cover the nose or mouth
C) use warm water
D) apply slight ocular pressure for increased response B) do not cover the nose or mouth
The infant does not respond to the initial dose of adenosine for SVT and now has HR 265 bpm,
BP 72/50, RR 46/min, and SpO2 96%. What should your next action be?
A) attach a 12-lead
B) repeat vagal maneuvers
C) unsynchronized cardioversion
D) administer a second dose of adenosine at 0.2 mg/kg (max second dose of 12 mg) D)
administer a second dose of adenosine at 0.2 mg/kg (max second dose of 12 mg)
You administer a second dose of 0.2 mg/kg adenosine but it does not convert the SVT. The
patient's weight is 6 kg. What should be the setting for synchronized cardioversion?
A) 25 J
B) 30 J
C) 6 J
D) 2 J C) 6 J
After synchronized cardioversion of 6 J, the patient remains in SVT. A second synchronized
cardioversion is ordered. What is the recommended energy selection?
A) 20 J
B) 12 J
C) 24 J
D) 16 J B) 12 J
, What are the most common initial rhythms in both in-hospital and out-of-hospital pediatric
cardiac arrest, especially in children younger than 12 years?
A) pVT
B) PEA
C) VF
D) asystole B and D
When treating persistent VF/pVT during cardiac arrest, administer epinephrine:
A) every 1-3 mins
B) every 3-5 mins
C) every 5-7 mins
D) every 8-10 mins B) every 3-5 mins
What are the initial steps of treating asystole/PEA?
A) consider advanced airway
B) administer epinephrine
C) deliver 1 shock
D) provide CPR
E) establish IV/IO access A, B, D, and E
What are the initial steps of the VF/pVT pathway of the Pediatric Cardiac Arrest Algorithm?
A) perform CPR
B) administer atropine
C) deliver 1 shock
D) establish IV/IO access A, C, and D
with Clinical Questions and Answer Key
Which of the following should be considered for stable SVT?
A) deliver an unsynchronized shock of 2 J/kg
B) place a bag with ice water over the upper half of the infant's face
C) ask an older child to try to blow through an obstructed straw
D) perform synchronized cardio version at 0.5-1 J/kg B and C
What is the initial dose of adenosine?
A) 0.1 mg/kg IV/IO
B) 0.2 mg/kg IV/IO
C) 1 mg/kg IV/IO
D) 6 mg IV/IO A) 0.1 mg/kg IV/IO
For stable patients with a regular wide complex and monomorphic tachycardia, consider:
A) synchronized cardioversion
B) 12-lead ECG
C) adenosine
D) vagal stimulation C) adenosine
If amiodarone or procainamide does not terminate the rapid rhythm, why should adenosine be
considered?
A) Torsades may be the underlying rhythm
B) adenosine inhibits the outward potassium current so it prolongs the QT duration
C) a wide complex tachycardia could be SVT with aberrant ventricular conduction
,D) adenosine inhibits sodium channels, which slows conduction in the ventricles and prolongs
QT duration C) a wide complex tachycardia could be SVT with aberrant ventricular
conduction
What is the appropriate initial dose if synchronized cardioversion is needed?
A) 0.5-1 J/kg
B) 1-2 J/kg
C) 2-4 J/kg
D) 4-6 J/kg A) 0.5-1 J/kg
Your ambulance is dispatched for a 5 month old boy who has difficulty breathing, poor feeding,
and vomiting. The infant is sitting in a baby carrier in the living room, appears irritable, and has
labored breathing. He has HR of 261 bpm, BP 72/54, RR 40/min, SpO2 96%, and he is crying.
Which of the following is the most appropriate initial intervention?
A) ventilate with a BVM
B) sit the child up
C) administer a bronchodilator
D) maintain a patent airway; administer O2 D) maintain a patent airway; administer O2
The patient has characteristics of SVT, including HR of more than 220/min. How would P waves
appear on an ECG in SVT?
A) absent
B) present
C) abnormal
D) normal A or C
What precautions should be taken when placing ice to the face of an infant?
A) gently perform carotid massage
,B) do not cover the nose or mouth
C) use warm water
D) apply slight ocular pressure for increased response B) do not cover the nose or mouth
The infant does not respond to the initial dose of adenosine for SVT and now has HR 265 bpm,
BP 72/50, RR 46/min, and SpO2 96%. What should your next action be?
A) attach a 12-lead
B) repeat vagal maneuvers
C) unsynchronized cardioversion
D) administer a second dose of adenosine at 0.2 mg/kg (max second dose of 12 mg) D)
administer a second dose of adenosine at 0.2 mg/kg (max second dose of 12 mg)
You administer a second dose of 0.2 mg/kg adenosine but it does not convert the SVT. The
patient's weight is 6 kg. What should be the setting for synchronized cardioversion?
A) 25 J
B) 30 J
C) 6 J
D) 2 J C) 6 J
After synchronized cardioversion of 6 J, the patient remains in SVT. A second synchronized
cardioversion is ordered. What is the recommended energy selection?
A) 20 J
B) 12 J
C) 24 J
D) 16 J B) 12 J
, What are the most common initial rhythms in both in-hospital and out-of-hospital pediatric
cardiac arrest, especially in children younger than 12 years?
A) pVT
B) PEA
C) VF
D) asystole B and D
When treating persistent VF/pVT during cardiac arrest, administer epinephrine:
A) every 1-3 mins
B) every 3-5 mins
C) every 5-7 mins
D) every 8-10 mins B) every 3-5 mins
What are the initial steps of treating asystole/PEA?
A) consider advanced airway
B) administer epinephrine
C) deliver 1 shock
D) provide CPR
E) establish IV/IO access A, B, D, and E
What are the initial steps of the VF/pVT pathway of the Pediatric Cardiac Arrest Algorithm?
A) perform CPR
B) administer atropine
C) deliver 1 shock
D) establish IV/IO access A, C, and D
