Paediatric Emergencies (PALS) Flashcards

Status epilepticus in a child is defined as a seizure lasting longer than:

Answer: 5 minutes, or two seizures without a return to baseline consciousness between them

Status epilepticus is defined as a seizure lasting ≥5 minutes (or recurrent seizures without full recovery between), requiring active pharmacological intervention to prevent neurological injury.

First-line medication for status epilepticus in the pre-hospital setting is:

Answer: Benzodiazepines — midazolam IM/buccal/intranasal, or diazepam rectal

Benzodiazepines are first-line for status epilepticus; midazolam (IM, buccal, or intranasal) is preferred pre-hospital as it does not require IV access; diazepam (rectal or IV) is an alternative.

Bronchiolitis in infants is most commonly caused by:

Answer: Respiratory Syncytial Virus (RSV)

RSV is responsible for the majority of bronchiolitis cases in infants, causing lower respiratory tract inflammation, wheeze, and hyperinflation; the disease peaks in winter and can cause severe respiratory failure in young infants.

The management of a conscious infant (under 1 year) with a foreign body causing complete airway obstruction includes:

Answer: 5 back blows followed by 5 chest thrusts — repeated until the object is dislodged or infant becomes unconscious

The Heimlich manoeuvre (abdominal thrusts) is NOT used in infants — it risks abdominal organ injury; instead, alternating cycles of 5 back blows and 5 chest thrusts are used to dislodge the foreign body.

Signs of decompensated shock in a paediatric patient include:

Answer: Hypotension, altered mental status, and mottled/cold extremities — late and ominous signs

Children compensate remarkably well — hypotension is a late and ominous sign indicating decompensation; earlier signs (tachycardia, prolonged CRT, cool extremities) indicate compensated shock and should trigger intervention.

The priority in managing respiratory failure in an infant is:

Answer: Opening and maintaining the airway and providing effective ventilation before any other intervention

As most paediatric arrests are respiratory in origin, opening the airway and providing effective ventilation to correct hypoxia is the primary life-saving intervention — often reversing bradycardia and preventing cardiac arrest.