PALS Tachycardia With a Pulse 5

Question 1

A 9-year-old with SVT receives adenosine via a peripheral IV in the antecubital fossa. The rhythm does not convert. What is the most likely reason for failure?

Accepted Answer

Adenosine was not followed by a rapid saline flush

Answer

Failure to immediately flush adenosine with normal saline allows the drug to be inactivated before reaching the central circulation due to its 10-second half-life.

Question 2

In pediatric tachycardia assessment, what does the PALS algorithm define as the primary distinction between 'stable' and 'unstable' tachycardia?

Accepted Answer

Presence or absence of signs of cardiopulmonary compromise

Answer

PALS classifies tachycardia as unstable when there are signs of cardiopulmonary compromise such as poor perfusion, hypotension, or altered mental status.

Question 3

A 1-year-old infant is in SVT with a rate of 260 bpm and is feeding poorly with mottled skin. There is no IV or IO access. What is the most appropriate immediate step?

Accepted Answer

Apply ice bag to the face briefly to stimulate the diving reflex

Answer

Ice application to the infant's face stimulates the diving reflex as a vagal maneuver and can be performed immediately without IV access.

Question 4

Which statement correctly describes ventricular tachycardia (VT) with a pulse in a pediatric patient compared to SVT with aberrancy?

Accepted Answer

VT more commonly shows AV dissociation and fusion beats on ECG

Answer

AV dissociation (P-waves unrelated to QRS complexes) and fusion beats are classic ECG findings that favor VT over SVT with aberrancy.

Question 5

For a child with SVT who has IV access established, at what site should adenosine ideally be injected for fastest effect?

Accepted Answer

A large proximal vein such as the antecubital or central line

Answer

Adenosine should be injected into a large proximal vein (or central line) to minimize transit time to the heart given its ultra-short half-life.

PALS - Pediatric Advanced Life Support Practice Test

PALS - Pediatric Advanced Life Support Practice Test

PALS Tachycardia With a Pulse 5