PALS Cardiac Arrest 5 — Questions and Answers
Question 1: Which post-cardiac arrest intervention is recommended to prevent secondary brain injury in a comatose child after ROSC?
- Active cooling to 32°C for 48 hours
- Targeted temperature management (normothermia 36-37.5°C or mild hypothermia 32-34°C) (Correct answer)
- Immediate warming to 38°C
- Fever induction to burn pathogens
Correct answer: Targeted temperature management (normothermia 36-37.5°C or mild hypothermia 32-34°C)
Targeted temperature management (TTM) — either normothermia or mild hypothermia — is recommended post-ROSC in comatose pediatric patients.
Question 2: A 3-year-old is found unresponsive and pulseless. After 2 minutes of CPR, the monitor shows a shockable rhythm. What is the correct sequence?
- Shock → check pulse → restart CPR
- Shock → immediately resume CPR for 2 min → rhythm check (Correct answer)
- Shock → give epinephrine → CPR
- Epinephrine → CPR → shock
Correct answer: Shock → immediately resume CPR for 2 min → rhythm check
After delivering a shock, immediately resume CPR for 2 minutes before the next rhythm check to maximize perfusion.
Question 3: Which of the following describes the correct hand placement for two-finger chest compressions in an infant?
- Center of the chest, just above the xiphoid process
- Just below the nipple line, center of chest (lower half of sternum) (Correct answer)
- Left of the sternum, 4th intercostal space
- Upper half of the sternum
Correct answer: Just below the nipple line, center of chest (lower half of sternum)
For infant single-rescuer CPR, place two fingers just below the nipple line on the center of the chest (lower half of sternum).
Question 4: During CPR, a child's EtCO2 remains at 5 mmHg despite what appears to be adequate compressions. What should be considered?
- This value is normal for CPR
- Improve compression quality and reassess for reversible causes (Correct answer)
- Stop CPR — low EtCO2 means ROSC
- Increase ventilation rate immediately
Correct answer: Improve compression quality and reassess for reversible causes
A persistently low EtCO2 (< 10 mmHg) during CPR indicates poor cardiac output; improve compressions and search for reversible causes.
Question 5: A child remains in refractory VF after 3 shocks, epinephrine, and amiodarone. What is the next recommended action?
- Discontinue resuscitation
- Give a second dose of amiodarone (5 mg/kg) or lidocaine (1 mg/kg) and shock again (Correct answer)
- Switch to atropine
- Increase defibrillation energy to 20 J/kg
Correct answer: Give a second dose of amiodarone (5 mg/kg) or lidocaine (1 mg/kg) and shock again
A repeat antiarrhythmic dose (amiodarone 5 mg/kg or lidocaine 1 mg/kg) followed by defibrillation is indicated for persistent VF.
Question 6: Which glucose management strategy is recommended for a pediatric patient post-cardiac arrest?
- Maintain blood glucose > 200 mg/dL
- Maintain normoglycemia (avoid both hypoglycemia and hyperglycemia) (Correct answer)
- Administer dextrose bolus immediately regardless of glucose level
- Target blood glucose 150-250 mg/dL
Correct answer: Maintain normoglycemia (avoid both hypoglycemia and hyperglycemia)
Post-ROSC, maintain normoglycemia — both hypoglycemia and hyperglycemia worsen neurological outcomes.
Question 7: When is it appropriate to use a pediatric dose attenuator (key or pad) with an AED on a child?
- Never — use adult pads only
- For children 1-8 years old or weighing less than 25 kg, if available (Correct answer)
- Only for infants under 1 year
- Only if the child is unconscious
Correct answer: For children 1-8 years old or weighing less than 25 kg, if available
Pediatric dose attenuators reduce AED energy and should be used for children age 1-8 years (or < 25 kg) when available.
PALS Cardiac Arrest 5
Which post-cardiac arrest intervention is recommended to prevent secondary brain injury in a comatose child after ROSC?