PALS Cardiac Arrest Algorithm 4 — Questions and Answers
Question 1: A 4-year-old weighing 16 kg presents in VF. What is the correct initial defibrillation energy?
- 32 J (Correct answer)
- 64 J
- 16 J
- 48 J
Correct answer: 32 J
Initial defibrillation dose is 2 J/kg; for a 16 kg child, 2 × 16 = 32 J.
Question 2: Which of the following H's represents a common and correctable cause of pediatric cardiac arrest related to blood volume?
- Hypovolemia (Correct answer)
- Hyperthermia
- Hyperkalemia
- Hypercalcemia
Correct answer: Hypovolemia
Hypovolemia is a common reversible cause of pediatric cardiac arrest and is treated with IV/IO fluid resuscitation.
Question 3: What is the correct epinephrine dose for a pediatric patient in cardiac arrest?
- 0.01 mg/kg IV/IO (max 1 mg) (Correct answer)
- 0.1 mg/kg IV/IO (max 10 mg)
- 0.001 mg/kg IV/IO
- 1 mg IV/IO regardless of weight
Correct answer: 0.01 mg/kg IV/IO (max 1 mg)
Epinephrine for pediatric cardiac arrest is 0.01 mg/kg (1:10,000 solution) IV/IO, with a maximum single dose of 1 mg.
Question 4: After ROSC is achieved in a pediatric cardiac arrest patient, which post-resuscitation intervention is recommended to prevent secondary brain injury?
- Targeted temperature management (Correct answer)
- Immediate active rewarming to 39°C
- Routine prophylactic antiarrhythmic infusion
- Immediate extubation
Correct answer: Targeted temperature management
Targeted temperature management (maintaining temperature between 32–37.5°C) is recommended post-ROSC to mitigate neurological injury.
Question 5: A rhythm check during CPR reveals organized electrical activity, but no pulse is felt. Which category does this rhythm fall into?
- Non-shockable (PEA) (Correct answer)
- Shockable (VF)
- Shockable (pVT)
- Normal sinus rhythm
Correct answer: Non-shockable (PEA)
PEA is a non-shockable rhythm; the treatment is to continue high-quality CPR and identify reversible causes.
Question 6: Which finding on ETCO2 monitoring during CPR suggests ROSC has occurred?
- Abrupt sustained rise in ETCO2 to ≥40 mmHg (Correct answer)
- Gradual decrease in ETCO2 below 10 mmHg
- Stable ETCO2 at 20 mmHg
- ETCO2 drops to zero
Correct answer: Abrupt sustained rise in ETCO2 to ≥40 mmHg
An abrupt, sustained increase in ETCO2 to ≥40 mmHg during CPR is a reliable indicator of ROSC.
Question 7: For a child in cardiac arrest due to known or suspected opioid toxicity, which medication should be administered in addition to standard CPR?
- Naloxone (Correct answer)
- Flumazenil
- Atropine
- Calcium chloride
Correct answer: Naloxone
Naloxone can reverse opioid-induced respiratory depression; however, standard PALS resuscitation takes priority in cardiac arrest.
PALS Cardiac Arrest Algorithm 4
A 4-year-old weighing 16 kg presents in VF.
What is the correct initial defibrillation energy?