AHA PALS EXAM STUDY GUIDE
2026 – COMPLETE CONCEPT
REVIEW & PRACTICE
MATERIALS (LATEST EDITION)
Part 1: General Approach & Assessment
1. Q: What is the first step in the Pediatric Assessment Triangle (PAT)?
A: General Appearance (Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry).
2. Q: The three components of the PAT are?
A: Appearance, Work of Breathing, Circulation to Skin.
3. Q: What does the "C" in the primary assessment (ABCDE) stand for?
A: Circulation (Heart rate, pulses, capillary refill, BP).
4. Q: A capillary refill time >2 seconds suggests what?
A: Poor perfusion or shock.
5. Q: What is the single most important sign of respiratory failure?
A: Altered mental status (e.g., lethargy, decreased responsiveness).
6. Q: What is the key difference between respiratory failure and respiratory arrest?
A: Failure: Inadequate oxygenation/ventilation but still breathing. Arrest: Absence of
effective breathing.
7. Q: What is the first and most important intervention for a pediatric patient in cardiac
arrest?
A: High-Quality Chest Compressions (Push hard, push fast, allow full recoil).
Part 2: Bradycardia
, 8. Q: What heart rate defines bradycardia in a pediatric patient?
A: A rate less than the lower limit of normal for age AND associated with poor
perfusion.
9. Q: The most common cause of bradycardia in children is?
A: Hypoxia.
10. Q: What is the first action for a symptomatic, poorly perfused bradycardia?
A: Open the airway, provide 100% oxygen, assist ventilation if needed.
11. Q: If bradycardia with poor perfusion persists despite effective ventilation and
oxygenation, what is the next step?
A: Begin chest compressions if HR <60/min with poor perfusion AND start
Epinephrine.
12. Q: The drug of choice for symptomatic bradycardia is?
A: Epinephrine (IV/IO: 0.01 mg/kg [1:10,000]; ETT: 0.1 mg/kg [1:1,000]).
13. Q: Atropine is considered for bradycardia only in what specific situation?
A: Increased vagal tone or primary AV block. (Not for hypoxia-induced bradycardia).
Part 3: Tachycardia
14. Q: What are the two main categories of tachycardia?
A: Narrow-Complex (Supraventricular) and Wide-Complex.
15. Q: What is the key feature of Sinus Tachycardia?
A: Rate varies, P waves present and normal, consistent PR interval. It's a response to a
cause (fever, pain, shock).
16. Q: What defines Supraventricular Tachycardia (SVT)?
A: Very rapid rate (often >220 infant, >180 child), abrupt onset/offset, P waves
absent/abnormal, fixed HR.
17. Q: A child with SVT and poor perfusion requires immediate?
A: Synchronized Cardioversion (0.5-1 J/kg, then 2 J/kg).
18. Q: For a child with SVT and adequate perfusion, what is the first vagal maneuver?
A: Have child bear down (Valsalva) or apply ice to face (diving reflex for
infants).
, 19. Q: The first-line medication for stable SVT is?
A: Adenosine (Rapid IV/IO push: 0.1 mg/kg, max 6 mg; 2nd dose: 0.2 mg/kg, max 12
mg).
20. Q: How must adenosine be administered?
A: As rapidly as possible, followed by an immediate saline flush, closest to the
heart.
21. Q: What rhythm can adenosine temporarily help diagnose by slowing the rate?
A: Atrial Flutter (may reveal flutter waves).
Part 4: Cardiac Arrest Rhythms
22. Q: The two "shockable" rhythms in pediatric cardiac arrest are?
A: Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (pVT).
23. Q: The two "non-shockable" rhythms are?
A: Asystole and Pulseless Electrical Activity (PEA).
24. Q: What is the first step upon identifying VF/pVT?
A: Resume CPR immediately and prepare to defibrillate within 2 minutes.
25. Q: What is the initial energy dose for defibrillation?
A: 2 J/kg.
26. Q: If the first shock is unsuccessful, what is the next energy dose?
A: 4 J/kg for second and subsequent shocks.
27. Q: What is the single most important action to improve survival in cardiac arrest?
A: Minimize interruptions in chest compressions.
28. Q: The primary drug for all pediatric arrest rhythms (shockable and non-shockable) is?
A: Epinephrine.
29. Q: When is the first dose of Epinephrine given in a shockable rhythm arrest?
A: After the SECOND shock (i.e., after 2 minutes of CPR).
30. Q: When is the first dose of Epinephrine given in a non-shockable rhythm
(Asystole/PEA)?
A: As soon as IV/IO access is established, after starting CPR.
31. Q: The antiarrhythmic for refractory VF/pVT is?
A: Amiodarone (5 mg/kg IV/IO) or Lidocaine (if amiodarone unavailable).
2026 – COMPLETE CONCEPT
REVIEW & PRACTICE
MATERIALS (LATEST EDITION)
Part 1: General Approach & Assessment
1. Q: What is the first step in the Pediatric Assessment Triangle (PAT)?
A: General Appearance (Tone, Interactiveness, Consolability, Look/Gaze, Speech/Cry).
2. Q: The three components of the PAT are?
A: Appearance, Work of Breathing, Circulation to Skin.
3. Q: What does the "C" in the primary assessment (ABCDE) stand for?
A: Circulation (Heart rate, pulses, capillary refill, BP).
4. Q: A capillary refill time >2 seconds suggests what?
A: Poor perfusion or shock.
5. Q: What is the single most important sign of respiratory failure?
A: Altered mental status (e.g., lethargy, decreased responsiveness).
6. Q: What is the key difference between respiratory failure and respiratory arrest?
A: Failure: Inadequate oxygenation/ventilation but still breathing. Arrest: Absence of
effective breathing.
7. Q: What is the first and most important intervention for a pediatric patient in cardiac
arrest?
A: High-Quality Chest Compressions (Push hard, push fast, allow full recoil).
Part 2: Bradycardia
, 8. Q: What heart rate defines bradycardia in a pediatric patient?
A: A rate less than the lower limit of normal for age AND associated with poor
perfusion.
9. Q: The most common cause of bradycardia in children is?
A: Hypoxia.
10. Q: What is the first action for a symptomatic, poorly perfused bradycardia?
A: Open the airway, provide 100% oxygen, assist ventilation if needed.
11. Q: If bradycardia with poor perfusion persists despite effective ventilation and
oxygenation, what is the next step?
A: Begin chest compressions if HR <60/min with poor perfusion AND start
Epinephrine.
12. Q: The drug of choice for symptomatic bradycardia is?
A: Epinephrine (IV/IO: 0.01 mg/kg [1:10,000]; ETT: 0.1 mg/kg [1:1,000]).
13. Q: Atropine is considered for bradycardia only in what specific situation?
A: Increased vagal tone or primary AV block. (Not for hypoxia-induced bradycardia).
Part 3: Tachycardia
14. Q: What are the two main categories of tachycardia?
A: Narrow-Complex (Supraventricular) and Wide-Complex.
15. Q: What is the key feature of Sinus Tachycardia?
A: Rate varies, P waves present and normal, consistent PR interval. It's a response to a
cause (fever, pain, shock).
16. Q: What defines Supraventricular Tachycardia (SVT)?
A: Very rapid rate (often >220 infant, >180 child), abrupt onset/offset, P waves
absent/abnormal, fixed HR.
17. Q: A child with SVT and poor perfusion requires immediate?
A: Synchronized Cardioversion (0.5-1 J/kg, then 2 J/kg).
18. Q: For a child with SVT and adequate perfusion, what is the first vagal maneuver?
A: Have child bear down (Valsalva) or apply ice to face (diving reflex for
infants).
, 19. Q: The first-line medication for stable SVT is?
A: Adenosine (Rapid IV/IO push: 0.1 mg/kg, max 6 mg; 2nd dose: 0.2 mg/kg, max 12
mg).
20. Q: How must adenosine be administered?
A: As rapidly as possible, followed by an immediate saline flush, closest to the
heart.
21. Q: What rhythm can adenosine temporarily help diagnose by slowing the rate?
A: Atrial Flutter (may reveal flutter waves).
Part 4: Cardiac Arrest Rhythms
22. Q: The two "shockable" rhythms in pediatric cardiac arrest are?
A: Ventricular Fibrillation (VF) and Pulseless Ventricular Tachycardia (pVT).
23. Q: The two "non-shockable" rhythms are?
A: Asystole and Pulseless Electrical Activity (PEA).
24. Q: What is the first step upon identifying VF/pVT?
A: Resume CPR immediately and prepare to defibrillate within 2 minutes.
25. Q: What is the initial energy dose for defibrillation?
A: 2 J/kg.
26. Q: If the first shock is unsuccessful, what is the next energy dose?
A: 4 J/kg for second and subsequent shocks.
27. Q: What is the single most important action to improve survival in cardiac arrest?
A: Minimize interruptions in chest compressions.
28. Q: The primary drug for all pediatric arrest rhythms (shockable and non-shockable) is?
A: Epinephrine.
29. Q: When is the first dose of Epinephrine given in a shockable rhythm arrest?
A: After the SECOND shock (i.e., after 2 minutes of CPR).
30. Q: When is the first dose of Epinephrine given in a non-shockable rhythm
(Asystole/PEA)?
A: As soon as IV/IO access is established, after starting CPR.
31. Q: The antiarrhythmic for refractory VF/pVT is?
A: Amiodarone (5 mg/kg IV/IO) or Lidocaine (if amiodarone unavailable).
