DCAS Paediatric Emergencies (PALS) 3 — Questions and Answers
Question 1: Status epilepticus in a child is defined as a seizure lasting longer than:
- 5 minutes, or two seizures without a return to baseline consciousness between them (Correct answer)
- 30 minutes
- 1 hour
- Any seizure in a child under 2 years
Correct 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.
Question 2: First-line medication for status epilepticus in the pre-hospital setting is:
- Benzodiazepines — midazolam IM/buccal/intranasal, or diazepam rectal (Correct answer)
- Phenytoin IV as first-line
- Phenobarbitone IM
- Levetiracetam IV only in hospital
Correct 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.
Question 3: Bronchiolitis in infants is most commonly caused by:
- Respiratory Syncytial Virus (RSV) (Correct answer)
- Influenza virus
- Streptococcus pneumoniae
- COVID-19 in all cases
Correct 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.
Question 4: The management of a conscious infant (under 1 year) with a foreign body causing complete airway obstruction includes:
- 5 back blows followed by 5 chest thrusts — repeated until the object is dislodged or infant becomes unconscious (Correct answer)
- Abdominal thrusts (Heimlich manoeuvre) as in adults
- Blind finger sweeps of the mouth
- Blind suctioning of the pharynx
Correct 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.
Question 5: Signs of decompensated shock in a paediatric patient include:
- Hypotension, altered mental status, and mottled/cold extremities — late and ominous signs (Correct answer)
- Tachycardia and prolonged capillary refill (compensated shock) — not yet decompensated
- Normal blood pressure with mild tachycardia
- Fever and tachycardia only
Correct 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.
Question 6: The priority in managing respiratory failure in an infant is:
- Opening and maintaining the airway and providing effective ventilation before any other intervention (Correct answer)
- IV access and fluid bolus
- Chest compressions regardless of heart rate
- Pharmacological therapy first
Correct 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.
DCAS Paediatric Emergencies (PALS) 3
Status epilepticus in a child is defined as a seizure lasting longer than: