Mixed Deck — All PALS Topics Flashcards

A 3-year-old presents with sudden onset stridor, drooling, and refusal to lie down. Which condition is most likely?

Answer: Epiglottitis

Epiglottitis classically presents with the 'tripod position,' drooling, high fever, and toxic appearance — lying down worsens airway obstruction.

A 6-year-old with SVT receives adenosine 0.1 mg/kg IV without conversion. What is the next dose of adenosine?

Answer: 0.2 mg/kg IV

If the first dose of adenosine (0.1 mg/kg) fails, the second dose is doubled to 0.2 mg/kg (max 12 mg).

Which reversible cause of pediatric cardiac arrest is represented by the 'T' for Tension pneumothorax in the H's and T's?

Answer: Tension pneumothorax

Tension pneumothorax is a reversible cause identified in the H's and T's mnemonic and is treated with needle decompression.

After endotracheal intubation of a pediatric patient, the capnography waveform is flat. What does this most likely indicate?

Answer: Esophageal intubation with tube in the wrong position

A flat capnography trace after intubation indicates no CO2 is being detected, which is consistent with esophageal placement where no gas exchange occurs.

A 6-year-old is in cardiac arrest. High-quality CPR has been ongoing for 8 minutes. ETCO2 readings have been consistently below 10 mmHg. What does this suggest?

Answer: CPR quality is poor and cardiac output is low

ETCO2 below 10 mmHg during CPR suggests poor CPR quality or very low cardiac output.

When using AVPU to assess pediatric level of consciousness, what does the 'V' represent?

Answer: Verbal — responds to voice stimuli

V in AVPU stands for Verbal, meaning the patient responds to voice or verbal stimuli.

A team leader gives an ambiguous order: 'Give the usual dose.' What should the team member receiving the order do?

Answer: Ask for clarification of the specific dose before proceeding

Vague orders must be clarified before execution to prevent medication errors; closed-loop communication requires specific, confirmed instructions.

A 6-year-old has decreased breath sounds on the left, tracheal deviation to the right, and hypotension. Which diagnosis does this assessment suggest?

Answer: Tension pneumothorax

Absent unilateral breath sounds, tracheal deviation away from the affected side, and hemodynamic compromise indicate tension pneumothorax requiring immediate needle decompression.

A 4-year-old develops a wide-complex tachycardia at 190 bpm with signs of shock. The team is uncertain if this is VT or SVT with aberrancy. What is the correct approach?

Answer: Treat as VT; perform synchronized cardioversion immediately

In an unstable child with wide-complex tachycardia, treat as VT and perform synchronized cardioversion without delaying for diagnostic workup.

In pediatric cardiac arrest, IO access should be considered when IV access cannot be established within:

Answer: 1–2 minutes or after 2 failed IV attempts

IO access should be obtained if IV access is not established within 1–2 minutes or after two failed IV attempts.

Which temperature range is recommended for targeted temperature management (TTM) in comatose pediatric survivors of cardiac arrest?

Answer: 32–34°C or 36–37.5°C depending on protocol

Current PALS guidelines support either 32–34°C or 36–37.5°C as acceptable TTM targets for comatose pediatric patients after cardiac arrest.

During reassessment after an intervention, which change in the PAT most clearly indicates clinical improvement in a child who had compensated shock?

Answer: Skin color normalizes and mental status improves

Normalization of circulation to skin (color, capillary refill) and improved appearance (mental status) on the PAT indicates effective treatment of shock.

A 9-year-old post-drowning victim is intubated and ventilated. ETCO2 reads 55 mmHg. Which action is correct?

Answer: Increase the respiratory rate to lower ETCO2

An ETCO2 of 55 mmHg indicates hypercapnia (hypoventilation); increasing the respiratory rate will blow off more CO2 and correct this.

You are managing a comatose toddler in the PICU following a prolonged resuscitation. Continuous EEG monitoring is initiated. What is the primary rationale for this intervention in post-cardiac arrest care?

Answer: To detect and guide the treatment of subclinical seizures.

Seizures, including non-convulsive or subclinical seizures, are common after cardiac arrest and can worsen secondary brain injury by increasing metabolic demand. [3, 9] Continuous EEG monitoring is recommended for comatose patients to detect these seizures so they can be treated promptly with anticonvulsants. [8, 9]

Which formula is most commonly used to estimate uncuffed endotracheal tube size for a child older than 1 year?

Answer: (Age in years / 4) + 4

The formula (Age in years ÷ 4) + 4 provides a reliable estimate of uncuffed ET tube internal diameter in millimeters for children over 1 year old.

After ROSC is achieved in a pediatric cardiac arrest patient, which post-resuscitation intervention is recommended to prevent secondary brain injury?

Answer: Targeted temperature management

Targeted temperature management (maintaining temperature between 32–37.5°C) is recommended post-ROSC to mitigate neurological injury.

A child with SVT who is stable is given adenosine 0.1 mg/kg IV without effect. What is the next step?

Answer: Double the dose to 0.2 mg/kg IV (max 12 mg)

If the first dose of adenosine is ineffective, PALS recommends doubling the dose to 0.2 mg/kg IV (maximum 12 mg).

An infant presents with a heart rate of 280 bpm, pallor, and cool extremities. Which finding would MOST indicate SVT over sinus tachycardia?

Answer: Absent P-waves with retrograde conduction on ECG

Absent or retrograde P-waves are characteristic of SVT, whereas sinus tachycardia always shows normal P-waves preceding each QRS.

Which finding is the MOST reliable early indicator of shock in a pediatric patient?

Answer: Tachycardia

Tachycardia is typically the earliest compensatory response to shock in children; hypotension is a late and ominous sign.

Which isotonic crystalloid is most commonly used for initial fluid resuscitation in pediatric shock per PALS?

Answer: Normal saline (0.9% NaCl) or lactated Ringer's solution

Normal saline and lactated Ringer's are recommended isotonic crystalloids for initial fluid resuscitation in pediatric emergencies.