PALS Cardiac Arrest Algorithm 5 — Questions and Answers
Question 1: During two-rescuer infant CPR without an advanced airway, which technique is preferred for chest compressions?
- Two-thumb encircling technique (Correct answer)
- Two-finger technique on lower sternum
- Heel-of-hand technique
- Single-thumb technique
Correct answer: Two-thumb encircling technique
The two-thumb encircling technique is preferred for two-rescuer infant CPR because it generates higher coronary perfusion pressure.
Question 2: A 10-year-old in VF receives 2 J/kg shock, CPR resumes. At the next check, VF persists. Epinephrine has been given. What defibrillation energy should be used for the SECOND shock?
- 4 J/kg (Correct answer)
- 2 J/kg
- 6 J/kg
- 10 J/kg
Correct answer: 4 J/kg
The second and subsequent defibrillation doses should be 4 J/kg (double the initial dose).
Question 3: Which of the following scenarios BEST represents a shockable pediatric cardiac arrest rhythm?
- A monitor shows coarse, irregular waveforms and the child has no pulse (Correct answer)
- A monitor shows a flat line and the child has no pulse
- A monitor shows narrow QRS complexes at a rate of 90 and the child has no pulse
- A monitor shows P waves followed by QRS complexes and the child has a faint pulse
Correct answer: A monitor shows coarse, irregular waveforms and the child has no pulse
Coarse, irregular waveforms without a pulse describe ventricular fibrillation, which is a shockable rhythm.
Question 4: What is the recommended target oxygen saturation AFTER return of spontaneous circulation (ROSC) in a pediatric patient?
- 94–99% (Correct answer)
- 100%
- 88–92%
- 70–80%
Correct answer: 94–99%
After ROSC, titrate oxygen to maintain SpO2 of 94–99% to avoid both hypoxia and hyperoxia.
Question 5: Which H in the PALS H's and T's refers to an electrolyte abnormality that can cause cardiac arrest and is treated with calcium chloride?
- Hyperkalemia (Correct answer)
- Hypokalemia
- Hyponatremia
- Hypoglycemia
Correct answer: Hyperkalemia
Severe hyperkalemia can cause fatal arrhythmias and cardiac arrest; calcium chloride stabilizes the myocardial membrane.
Question 6: During pediatric cardiac arrest resuscitation, which action should be taken IMMEDIATELY after defibrillation?
- Resume CPR for 2 minutes before checking rhythm again (Correct answer)
- Check rhythm and pulse immediately after the shock
- Administer epinephrine before resuming CPR
- Increase oxygen flow and wait 30 seconds before resuming CPR
Correct answer: Resume CPR for 2 minutes before checking rhythm again
CPR should resume immediately after defibrillation without delaying for a pulse or rhythm check; 2 minutes of CPR follow each shock.
Question 7: When should you consider stopping resuscitative efforts in a pediatric cardiac arrest patient?
- After prolonged resuscitation with no ROSC and no reversible causes identified, following team discussion (Correct answer)
- After exactly 20 minutes regardless of circumstances
- Once asystole has been present for more than 2 minutes
- Only when parents request cessation
Correct answer: After prolonged resuscitation with no ROSC and no reversible causes identified, following team discussion
Decisions to stop resuscitation require clinical judgment based on duration, quality of CPR, reversible causes, and team discussion — no fixed time rule applies.
PALS Cardiac Arrest Algorithm 5
During two-rescuer infant CPR without an advanced airway, which technique is preferred for chest compressions?