DCAS Paediatric Emergencies (PALS) 4 — Questions and Answers
Question 1: Paediatric defibrillation energy in PALS is dosed at:
- 2 J/kg for the first shock, escalating to 4 J/kg for subsequent shocks (Correct answer)
- 200 J for all paediatric patients
- 1 J/kg maximum regardless of weight
- Same as adults (200 J biphasic)
Correct answer: 2 J/kg for the first shock, escalating to 4 J/kg for subsequent shocks
PALS defibrillation uses weight-based dosing: 2 J/kg for the first shock, 4 J/kg for the second, and 4-10 J/kg (maximum 10 J/kg or adult dose) for subsequent shocks.
Question 2: In PALS, epinephrine for cardiac arrest is dosed at:
- 0.01mg/kg IV/IO every 3-5 minutes (maximum single dose 1mg) (Correct answer)
- 0.1mg/kg IV/IO every 5 minutes
- 1mg IV regardless of weight
- 0.1mg IV for all children
Correct answer: 0.01mg/kg IV/IO every 3-5 minutes (maximum single dose 1mg)
PALS epinephrine dosing is 0.01mg/kg (0.1ml/kg of 1:10,000) IV/IO every 3-5 minutes; the maximum single dose is 1mg to avoid excessive vasopressor effect.
Question 3: Paediatric septic shock is recognised by:
- Tachycardia with signs of poor perfusion (prolonged CRT, altered mental status, reduced urine output) with or without hypotension (Correct answer)
- Fever alone without circulatory signs
- Hypotension as the earliest sign
- Bradycardia and hypotension as the first signs
Correct answer: Tachycardia with signs of poor perfusion (prolonged CRT, altered mental status, reduced urine output) with or without hypotension
Paediatric septic shock presents early with compensated shock (tachycardia, prolonged CRT, cool extremities, altered consciousness) often without hypotension; early aggressive treatment improves outcomes significantly.
Question 4: Intraosseous epinephrine during cardiac arrest should be followed by:
- 5-10ml normal saline flush to move drug from the IO into central circulation (Correct answer)
- No flush — IO delivers drugs directly to central circulation
- A second dose of epinephrine without waiting
- IV access establishment before any drug is effective
Correct answer: 5-10ml normal saline flush to move drug from the IO into central circulation
IO medications require a saline flush to move drug from the relatively slow IO uptake into the central venous circulation rapidly — ensuring the drug reaches the heart in a therapeutically effective bolus.
Question 5: Hypoglycaemia in a neonate is defined as blood glucose below:
- 2.6 mmol/L (47 mg/dL) (Correct answer)
- 4.0 mmol/L
- 1.0 mmol/L
- 3.5 mmol/L
Correct answer: 2.6 mmol/L (47 mg/dL)
Neonatal hypoglycaemia is defined at a lower threshold than older children/adults: <2.6 mmol/L (47 mg/dL) requires treatment to prevent neurological injury; symptomatic neonates are treated at even higher values.
Question 6: The 'TICLS' mnemonic used in the paediatric Appearance assessment of the PAT stands for:
- Tone, Interactiveness, Consolability, Look/gaze, Speech/cry (Correct answer)
- Temperature, Irritability, Colour, Level of consciousness, Skin condition
- Tachycardia, Infection, Cyanosis, Lethargy, Shock
- Tachypnoea, Intercostal retractions, Crepitations, Listening, Sensorium
Correct answer: Tone, Interactiveness, Consolability, Look/gaze, Speech/cry
TICLS assesses appearance: Tone (muscle tone and movement), Interactiveness (response to environment), Consolability (response to comfort), Look/gaze (eye contact and attention), and Speech/cry (quality and appropriateness).
DCAS Paediatric Emergencies (PALS) 4
Paediatric defibrillation energy in PALS is dosed at: