PALS FINAL RED CROSS
A child in cardiac arrest experiences return of spontaneous circulation but is exhibiting signs of post-cardiac arrest syndrome (PCAS). The PALS resuscitation team determines that the child is experiencing a systemic response to ischemia/reperfusion. The team bases this determination on which finding(s)?
Fever, Hyperglycemia, Hypotension
A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with Lyme disease 2 months ago. A rhythm strip is obtained as shown below. The provider interprets this rhythm as indicating which arrhythmia?
First-degree AV block
A provider is assessing a child with suspected shock. Which statement correctly describes hypotension and shock?
Hypotension is not a consistent feature of shock in children.
A child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)?
Hypotension, Bradycardia, Diminished central pulses
An unresponsive 7-year-old child with no pulse is brought to the pediatric urgent care center by his parents and CPR is initiated. The cardiac monitor reveals ventricular fibrillation. Which action would the PALS team take first?
Initiate defibrillation with 2 J/kg.
Following a cardiac arrest, a child is experiencing post-cardiac arrest hemodynamic instability. The PALS resuscitation team would administer which element to restore intravascular volume and optimize preload?
Isotonic fluid boluses
Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic, tachypneic, lethargic and pale. Which test would the provider use to determine the adequacy of oxygen delivery?
Lactate
Which action would the PALS resuscitation team initiate to minimize increased intracranial pressure after cardiac arrest?
Maintain the head in midline position with 30-degree elevation
A child requires cardiac monitoring. A three-electrode system is being used. At which location would the provider place the red electrode?
On the lower left abdomen
A 4-year-old child suddenly collapses in the playroom of the facility. A healthcare provider observes the event and hurries over to assess the child. The healthcare provider completes which assessment first?
Rapid assessment
A 9-year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition?
Respiratory failure
A 12-year-old child being evaluated in the pediatric intensive care unit displays the following ECG waveform. The team interprets this as which arrhythmia?
Second-degree atrioventricular (AV) block, type I
A 12-year-old is being treated in the urgent care clinic. The mother reports that the child came home from school yesterday with a high fever, vomiting and multiple episodes of watery diarrhea. The healthcare provider obtains a rhythm strip and notes the following waveform. The provider interprets this as which type of arrhythmia?
Sinus tachycardia
While formulating initial impressions using the Pediatric Assessment Triangle, the provider assesses the child's circulation. Which information would be important to consider?
Skin pallor (or gray/dusky color), Evidence of bleeding, Flushing of the skin
A healthcare provider is performing a primary assessment of a child in respiratory distress. The provider documents increased work of breathing when which findings are observed?
Sternal retractions, Nasal flaring, Accessory muscle use
The PALS team leader is conducting a debriefing session with the team. Which topic(s) would the team leader most likely address during the session?
Summary of the event, including what actions were taken, Discussion of the pros and cons of the interventions, Identification of ways to improve, Evaluation of the objective data gathered during the event
A child being cared for in the pediatric telemetry unit suddenly displays the following ECG waveform. The provider prepares to intervene because the child is demonstrating which type of arrhythmia?
Supraventricular tachycardia
An 11-year-old child develops unstable wide complex tachycardia. Assessment reveals signs of significant hemodynamic compromise, but the child has a pulse. The PALS team would prepare the child for which intervention?
Synchronized cardioversion
A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial treatment would the provider administer?
Vagal maneuvers
A PALS resuscitation team is preparing to defibrillate a child experiencing cardiac arrest. For which rhythm(s) would this action be appropriate?
Ventricular fibrillation (VF), Pulseless ventricular tachycardia (pVT),
A 4-year-old patient presents with tachycardia, tachypnea, cold extremities and weak pulses. Assessment also reveals an enlarged liver and neck vein distension. The provider interprets these assessment findings as suggesting which type of shock?
cardiogenic shock
A 12-lead ECG is ordered for a child complaining of a "racing heart." When placing the electrodes on the child, at which location would the lead for V4 be placed?
fifth intercostal space at the midclavicular line on the patient's left side.
Assessment of a 7-year-old patient with septic shock reveals capillary refill of 3 seconds, diminished pulse and narrow pulse pressure. The emergency response team interprets these findings as indicating which type of septic shock?
hypotensive
child in the pediatric intensive care unit displays the following ECG waveform and does not have a palpable central pulse. The resuscitation team interprets this as which arrhythmia?
pulseless ventricular tachycardia (pVT)
A 4-month old infant is brought to the emergency department in cardiac arrest. Which condition would the team identify as the most common cause of cardiac arrest in an infant of this age?
sudden infant death syndrome is the most common cause in infants younger than 6 months of age.
A 7-year-old child collapses on the playground at school. The school nurse is called to the scene and determines that the child is unresponsive and is not breathing and has no pulse. The nurse initiates CPR. At what rate and depth would the nurse deliver compressions to this child?
100 to 120 compressions per minute at a depth of about 2 inches
A 9-year-old child is brought to the emergency department because the child suddenly collapsed at school. The child's ECG reveals the following waveform, and primary assessment findings indicate that the child is hemodynamically unstable. Which primary assessment findings indicate this?
Decreased level of consciousness, Hypotension, Difficulty breathing, Mottling
A 4-year-old child is brought to the emergency department by the parents. Assessment reveals that the child is gasping and the pulse rate is 65 beats per minute. Which action would the provider initiate first?
Deliver 1 BVM ventilation every 3 to 5 seconds
Primary assessment of a 10-year-old child reveals septic shock. As part of the secondary assessment, laboratory testing is completed to evaluate the child's status. Which finding(s) would support the diagnosis?
Elevated creatinine level, Elevated lactate level, Prolonged prothrombin time (PT)
A 10-year-old child has collapsed in the gym of the elementary school. The school nurse arrives and determines that the child is unresponsive. The school nurse then simultaneously checks for breathing and a central pulse, limiting this assessment to which time frame?
5 seconds, but no more than 10.
The PALS resuscitation team is providing care to an intubated child in cardiac arrest. Which result best determines the adequacy of the team's chest compressions?
End-tidal carbon dioxide level between 15 and 20 mmHg
The PALS team is providing post-cardiac arrest care to an 8-year-old child in the pediatric intensive care unit. Which intervention would the team implement to achieve the primary goal of post-cardiac arrest care?
Ensuring adequate mean arterial pressure
A child experiencing unstable bradycardia is receiving CPR. Despite efforts with CPR, the child's status remains unchanged. Which medication would the emergency response team expect to administer next?
Epinephrine
A provider is caring for a 4-year-old child in the urgent care clinic. Primary assessment reveals difficulty breathing and an oxygen saturation of 91%. The provider administers oxygen by nasal cannula with the goal of improving the child's oxygen saturation to at least what percentage?
94%
A 5-year-old child with a history of a chronic neuromuscular disease is experiencing respiratory distress. The child is breathing spontaneously and receiving supplemental oxygen. Which additional intervention is a critical component of airway management for this patient?
Airway clearance
An 11-year-old soccer player is brought to the emergency department. After a quick assessment, the team realizes this patient is experiencing a severe asthma exacerbation. Which medication would the team administer first?
Albuterol plus ipratropium bromide
A 6-year-old patient is brought to the emergency department after a bicycle accident. Assessment reveals tracheal deviation to the left side, chest pain on inspiration and decreased breath sounds on the right side. The provider suspects obstructive shock caused by what condition?
Tension pneumothorax
The emergency response team is providing care to a preschooler who is experiencing shock. Which therapeutic goal, common to all types of shock, does the team work to achieve?
The primary therapeutic goal in shock, regardless of cause, is to restore a favorable balance between oxygen delivery and oxygen demand.
The PALS resuscitation team notes the following ECG waveform and the child does not have a pulse. The team prepares to intervene to address which arrhythmia?
Torsades de pointes
A child who is stable and exhibiting a wide-complex tachycardia is to receive adenosine. The provider would be alert for which result after administering this medication?
Transient asystole
A 6-year-old child is brought to the emergency department. The child has been experiencing extremely watery stools over the past several days. After completing the assessment, the healthcare provider suspects that the child may be experiencing shock. Which type of shock would the provider most likely suspect?
Hypovolemic shock
A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which finding would be considered a late sign for this condition?
Cyanosis
An 8-year-old child being treated in the emergency department has significant respiratory distress. The child also exhibits hives, wheezing, angioedema, tachycardia and tachypnea. The parents state that the child, who is allergic to peanuts, had eaten some popcorn that had peanuts in it. The team initiates care, preparing to administer which agent first?
Epinephrine
A 2-year-old child arrives at the emergency department with the parents. The child is unresponsive, is not breathing and has no pulse. Two emergency department providers begin high-quality CPR. Which action(s) by the providers demonstrates high-quality CPR?
Allowing the chest to recoil fully after each compression, Giving 2 ventilations to every 15 compressions, Providing ventilations that last about 1 second each, Compressing the chest about 2 inches
A provider is forming an initial impression of a child using the Pediatric Assessment Triangle (PAT). During which step of the PAT may the provider use the mnemonic TICLS to assess the patient?
Appearance
A 2-year-old child of unknown weight arrives at the emergency department in cardiac arrest. When preparing to administer medications, which action would be appropriate for the team to take?
Estimate weight using a length-based resuscitation tape.
A 2-year-old child is brought to the pediatric urgent care clinic by the parent who says that the child has had a barking cough for two days. During the rapid assessment of the child, the provider hears audible inspiratory stridor. Which diagnosis would the provider most likely suspect? Select the correct answer to this
Croup
A 30-month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer?
Corticosteroids, Racemic epinephrine
An advanced airway was placed in a 5-year-old child. Which action(s) would be most appropriate for the team to take to confirm correct placement?
Auscultate over the lungs and epigastrium for air movement, Observe for bilateral chest rise, Evaluate results of capnography.
Assessment of a 3-month-old infant admitted with respiratory distress reveals fever, grunting and a wet, "junky" cough. The infant's parents said the child had a recent respiratory infection with a fever. A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the provider most likely suspect as the cause?
Bronchiolitis
