PALS High-Quality Pediatric BLS 4 — Questions and Answers
Question 1: When using a bag-mask device during pediatric CPR, what tidal volume is targeted for each rescue breath?
- Enough to cause visible and significant chest rise
- Enough to cause visible chest rise only (Correct answer)
- A fixed volume of 500 mL regardless of age
- 10 mL/kg body weight
Correct answer: Enough to cause visible chest rise only
Deliver just enough volume to produce visible chest rise; over-inflating causes gastric insufflation and reduces cardiac output.
Question 2: During high-quality pediatric CPR, compressor fatigue typically degrades compression quality after approximately:
- 1 minute
- 2 minutes (Correct answer)
- 5 minutes
- 10 minutes
Correct answer: 2 minutes
Compressor fatigue causes significant deterioration in compression rate and depth after approximately 2 minutes, which is why rotation every 2 minutes is recommended.
Question 3: An infant is pulseless. Two rescuers are available. Which compression landmark is correct for the two thumb-encircling technique?
- Center of the chest, on the upper half of the sternum
- Just above the xiphoid process, on the lower sternum
- Just below the nipple line, on the lower half of the sternum (Correct answer)
- Left lateral chest wall over the cardiac apex
Correct answer: Just below the nipple line, on the lower half of the sternum
For infant CPR, place thumbs just below the nipple line on the lower half of the sternum, avoiding the xiphoid process.
Question 4: What CPR feedback device metric most directly helps rescuers avoid leaning on the chest during CPR?
- Compression rate display
- Compression depth display
- Chest recoil (baseline) sensor (Correct answer)
- End-tidal CO₂ monitor
Correct answer: Chest recoil (baseline) sensor
A chest recoil sensor detects incomplete decompression (leaning), providing direct feedback to ensure full chest recoil between compressions.
Question 5: A 6-year-old is found in cardiac arrest in a witnessed, shockable rhythm. How many cycles of CPR should be performed before the FIRST rhythm check with the AED?
- No CPR — attach AED and shock immediately (Correct answer)
- 1 cycle (approximately 30 seconds)
- 2 minutes of CPR first
- 5 cycles (approximately 2 minutes)
Correct answer: No CPR — attach AED and shock immediately
For a witnessed cardiac arrest with an AED immediately available, attach and use the AED as soon as possible without preceding CPR.
Question 6: During pediatric resuscitation, which finding on capnography suggests ROSC (return of spontaneous circulation) has occurred?
- Sudden drop in ETCO₂ below 10 mmHg
- Gradual rise in ETCO₂ over several minutes
- Sudden increase in ETCO₂ to 35–45 mmHg (Correct answer)
- Flat ETCO₂ waveform throughout
Correct answer: Sudden increase in ETCO₂ to 35–45 mmHg
A sudden abrupt increase in ETCO₂ to normal values (35–45 mmHg) during CPR is a reliable indicator of ROSC.
Question 7: When performing mouth-to-mouth-and-nose rescue breathing on an infant, how should the rescuer position the infant's head?
- Hyperextended (fully tilted back) to maximize airway opening
- Neutral or slight sniffing position to avoid airway kinking (Correct answer)
- Flexed forward with the chin to the chest
- Rotated 45 degrees to one side
Correct answer: Neutral or slight sniffing position to avoid airway kinking
Infant airways are flexible; hyperextension can kink and obstruct the airway, so a neutral or slight sniffing position is optimal.
PALS High-Quality Pediatric BLS 4
When using a bag-mask device during pediatric CPR, what tidal volume is targeted for each rescue breath?