PALS Cardiac Arrest 4 — Questions and Answers
Question 1: Which intraosseous (IO) site is generally preferred for rapid vascular access in a child in cardiac arrest?
- Distal femur
- Proximal tibia (Correct answer)
- Iliac crest
- Calcaneus
Correct answer: Proximal tibia
The proximal tibia is the preferred IO site in children due to ease of access and large marrow cavity.
Question 2: A child arrests due to suspected tension pneumothorax (T cause). What is the immediate intervention?
- IV epinephrine
- Defibrillation
- Needle thoracostomy (Correct answer)
- Pericardiocentesis
Correct answer: Needle thoracostomy
Needle thoracostomy (decompression) at the 2nd intercostal space mid-clavicular line relieves tension pneumothorax.
Question 3: Lidocaine is an alternative antiarrhythmic to amiodarone in pediatric cardiac arrest. What is its IV/IO dose?
- 0.5 mg/kg
- 1 mg/kg (Correct answer)
- 5 mg/kg
- 10 mg/kg
Correct answer: 1 mg/kg
Lidocaine 1 mg/kg IV/IO is the PALS dose for shock-refractory VF/pVT when amiodarone is unavailable.
Question 4: After ROSC is achieved in a pediatric cardiac arrest patient, what SpO2 target should be maintained to avoid hyperoxia?
- 94-99% (Correct answer)
- 100%
- 90-93%
- >99% at all times
Correct answer: 94-99%
Post-ROSC, titrate oxygen to maintain SpO2 94-99% to avoid both hypoxia and harmful hyperoxia.
Question 5: Which finding on waveform capnography (EtCO2) during CPR suggests effective compressions and possible ROSC?
- EtCO2 < 10 mmHg
- Sudden rise in EtCO2 to > 40 mmHg (Correct answer)
- Flat EtCO2 waveform
- EtCO2 15-20 mmHg
Correct answer: Sudden rise in EtCO2 to > 40 mmHg
A sudden increase in EtCO2 above 40 mmHg during CPR indicates ROSC due to restored pulmonary blood flow.
Question 6: A child with hypovolemic shock secondary to trauma arrests. Which fluid is given first to address this reversible T cause?
- D5W at maintenance rate
- Normal saline 20 mL/kg bolus (Correct answer)
- Albumin 5% infusion
- Packed red blood cells only
Correct answer: Normal saline 20 mL/kg bolus
Normal saline (or LR) 20 mL/kg IV/IO bolus is given to rapidly address hypovolemia as a reversible cause of arrest.
Question 7: What is the minimum acceptable EtCO2 value during CPR that suggests adequate compression quality?
- < 5 mmHg
- ≥ 10-15 mmHg (Correct answer)
- ≥ 40 mmHg
- 5-8 mmHg
Correct answer: ≥ 10-15 mmHg
EtCO2 ≥ 10-15 mmHg during CPR suggests adequate cardiac output; values below this indicate poor compression quality.
PALS Cardiac Arrest 4
Which intraosseous (IO) site is generally preferred for rapid vascular access in a child in cardiac arrest?