DCAS Paediatric Emergencies (PALS) 1 — Questions and Answers
Question 1: Normal respiratory rate for an infant (0-1 year) is approximately:
- 30-60 breaths per minute (Correct answer)
- 12-20 breaths per minute
- 20-30 breaths per minute
- 60-80 breaths per minute
Correct answer: 30-60 breaths per minute
Infants have a significantly higher respiratory rate than adults (30-60/min) due to their smaller tidal volumes and higher metabolic rate; rates outside this range indicate respiratory distress or failure.
Question 2: The Paediatric Assessment Triangle (PAT) assesses which three parameters?
- Appearance, Work of breathing, and Circulation to the skin (Correct answer)
- Airway, Breathing, and Circulation
- Heart rate, respiratory rate, and blood pressure
- Consciousness, skin colour, and temperature
Correct answer: Appearance, Work of breathing, and Circulation to the skin
The PAT provides a rapid (30-second) visual assessment: Appearance (tone, interactiveness, consolability, gaze, speech/cry), Work of breathing (sounds, position, retractions, nasal flaring), and Circulation to skin (pallor, mottling, cyanosis).
Question 3: In PALS, the primary cause of cardiac arrest in children differs from adults in that it is most commonly:
- Respiratory failure or shock leading to hypoxic cardiac arrest (Correct answer)
- Primary cardiac arrhythmia (VF/pVT)
- Traumatic cardiac arrest
- Pulmonary embolism
Correct answer: Respiratory failure or shock leading to hypoxic cardiac arrest
Unlike adults where VF/pVT is common, paediatric cardiac arrest is predominantly caused by respiratory failure or shock progressing to hypoxia, making airway management and early oxygenation the most critical interventions.
Question 4: The first-line medication for anaphylaxis in a child is:
- Epinephrine (adrenaline) IM into the anterolateral thigh — 0.01mg/kg of 1:1000 (max 0.5mg) (Correct answer)
- Diphenhydramine (antihistamine) IV as first-line
- Hydrocortisone IV as first-line
- Salbutamol nebuliser as sole treatment
Correct answer: Epinephrine (adrenaline) IM into the anterolateral thigh — 0.01mg/kg of 1:1000 (max 0.5mg)
Epinephrine IM is the only first-line, life-saving treatment for anaphylaxis in children; antihistamines and corticosteroids are adjuncts only and should never delay or replace epinephrine.
Question 5: In a child with signs of upper airway obstruction (croup), the recommended pre-hospital treatment is:
- Nebulised adrenaline (epinephrine) 5ml of 1:1000, dexamethasone, and cool humidified oxygen (Correct answer)
- Immediate RSI intubation
- IV antibiotics and cooling
- Direct laryngoscopy to assess the glottis
Correct answer: Nebulised adrenaline (epinephrine) 5ml of 1:1000, dexamethasone, and cool humidified oxygen
Nebulised adrenaline (reduces subglottic oedema through vasoconstriction), oral/IM dexamethasone (reduces inflammation), and humidified oxygen are the cornerstones of moderate-to-severe croup management.
Question 6: Normal systolic blood pressure for a 5-year-old child is approximately:
- 90-100 mmHg (formula: 90 + (2 × age in years)) (Correct answer)
- 120-130 mmHg
- 60-70 mmHg
- 150 mmHg
Correct answer: 90-100 mmHg (formula: 90 + (2 × age in years))
The normal lower limit for systolic BP in children is estimated at 70 + (2 × age in years); the normal value is approximately 90 + (2 × age). A 5-year-old's normal SBP is approximately 90-100 mmHg.
DCAS Paediatric Emergencies (PALS) 1
Normal respiratory rate for an infant (0-1 year) is approximately: