PALS Cardiac Arrest Algorithm 3 — Questions and Answers
Question 1: In pediatric cardiac arrest, IO access should be considered when IV access cannot be established within:
- 1–2 minutes or after 2 failed IV attempts (Correct answer)
- 5 minutes or after 5 failed attempts
- 30 seconds
- 10 minutes
Correct 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.
Question 2: Which of the following best describes Pulseless Electrical Activity (PEA) in a pediatric patient?
- Organized rhythm on monitor with no palpable pulse (Correct answer)
- Absence of both electrical activity and pulse
- Chaotic electrical activity with no pulse
- Normal sinus rhythm with poor perfusion
Correct answer: Organized rhythm on monitor with no palpable pulse
PEA is defined as an organized (or semi-organized) cardiac rhythm on the monitor without a palpable pulse.
Question 3: 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?
- CPR quality is poor and cardiac output is low (Correct answer)
- Return of spontaneous circulation is imminent
- The child has a pulmonary embolism
- Ventilation rate is too slow
Correct 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.
Question 4: When should the rhythm check occur during the PALS cardiac arrest algorithm?
- Every 2 minutes after each CPR cycle (Correct answer)
- Every 5 minutes
- Only after medication administration
- Every 1 minute
Correct answer: Every 2 minutes after each CPR cycle
Rhythm checks should occur every 2 minutes, coinciding with the end of each CPR cycle to minimize interruptions.
Question 5: Which reversible cause of pediatric cardiac arrest is represented by the 'T' for Tension pneumothorax in the H's and T's?
- Tension pneumothorax (Correct answer)
- Thrombosis (pulmonary)
- Tamponade (cardiac)
- Toxins
Correct answer: Tension pneumothorax
Tension pneumothorax is a reversible cause identified in the H's and T's mnemonic and is treated with needle decompression.
Question 6: A child in asystole receives high-quality CPR and two doses of epinephrine. Which action is MOST appropriate if asystole persists?
- Continue CPR, reassess every 2 minutes, and search for reversible causes (Correct answer)
- Defibrillate immediately
- Increase epinephrine dose to 0.1 mg/kg
- Administer adenosine
Correct answer: Continue CPR, reassess every 2 minutes, and search for reversible causes
For persistent asystole or PEA, continue CPR and systematically evaluate and treat reversible causes (H's and T's).
Question 7: During pediatric CPR, what chest compression depth is recommended for an infant?
- At least 1.5 inches (4 cm) (Correct answer)
- At least 2 inches (5 cm)
- At least 1 inch (2.5 cm)
- At least 2.5 inches (6 cm)
Correct answer: At least 1.5 inches (4 cm)
For infants, compress the chest at least 1.5 inches (approximately 4 cm), which is about one-third the anterior-posterior diameter.
PALS Cardiac Arrest Algorithm 3
In pediatric cardiac arrest, IO access should be considered when IV access cannot be established within: