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A 12 - year-old child being evaluated in the pediatric intensive care unit displays the following ECG waveform. The team interprets this as which arrhythmia? second degree Laboratory tests are ordered for a child who has been vomiting for 3 days and is diaphoretic, tachypneic, lethargic and pale. Which test would the provider use to determine the adequacy of oxygen delivery? Lactate A 9 - year-old patient is presenting with decreased breath sounds, bradycardia, slowed respiratory rate and a low O2 saturation level. The provider interprets these findings as indicating which condition? Respiratory failure A 4 - year-old child is brought to the emergency department by the parents. Assessment reveals that the child has only gasping respirations and the pulse rate is 65 beats per minute. Which action would the provider initiate first?
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Deliver 1 BVM ventilation every 3 to 5 seconds. A 15-year-old patient is being evaluated during a follow-up visit after being diagnosed with Lyme disease 2 months ago. A rhythm strip is obtained as shown below. The provider interprets this rhythm as indicating which arrhythmia? First-degree atrioventricular (AV) block A child in cardiac arrest experiences return of spontaneous circulation but is exhibiting signs of post–cardiac arrest syndrome (PCAS). The PALS resuscitation team determines that the child is experiencing a systemic response to ischemia/reperfusion. The team bases this determination on which finding(s)? Hypotension Fever Hyperglycemia
A provider is caring for a 4-year-old child in the urgent care clinic. Primary assessment reveals difficulty breathing and an oxygen saturation of 91%. The provider administers oxygen by nasal cannula with the goal of improving the child’s oxygen saturation above what percentage? Supplemental oxygen should be administered as needed to maintain an oxygen saturation above 94%. An 11 - year-old soccer player is brought to the emergency department. After a quick assessment, the team realizes this patient is experiencing a severe asthma exacerbation. Which medication would the team administer first? Albuterol plus ipratropium bromid A child in the pediatric step-down unit is exhibiting signs of respiratory distress. When assessing this child, which circulation finding might be present? Pallor is a circulation finding that may be seen in patients with respiratory distress.
A healthcare provider is performing a primary assessment of a child in respiratory distress. The provider documents increased work of breathing when which findings are observed? Nasal flaring, use of accessory muscles to breathe and intercostal, substernal or suprasternal retractions are all indicators of increased work or effort of breathing. Grunting and inspiratory stridor are abnormal breath sounds. An 11 - year-old child develops unstable wide-complex tachycardia. Assessment reveals signs of significant hemodynamic compromise, but the child has a pulse. The PALS team would prepare the child for which intervention? First-line treatment for unstable wide-complex tachycardias consists of synchronized electrical cardioversion, particularly when signs of hemodynamic compromise are apparent. A 4 - month old infant is brought to the emergency department in cardiac arrest. Which condition would the team identify as the most common cause of cardiac arrest in an infant of this age? Sudden infant death syndrome
A 6 - year-old child is brought to the emergency department. The child has been experiencing extremely watery stools over the past several days. After completing the assessment, the healthcare provider suspects that the child may be experiencing shock. Which type of shock would the provider most likely suspect? hypovolemic While performing a rapid assessment and formulating an initial impression using the Pediatric Assessment Triangle (PAT), the provider assesses the child’s circulation. Which information would be important to consider? When assessing the adequacy of circulation, consider skin color and visible mucous membranes for pallor (or gray/dusky color), cyanosis, mottling or flushing and evidence of any bleeding, including life-threatening bleeding. Assessment of a 3 - month-old infant admitted with respiratory distress reveals fever, grunting and a wet, “junky” cough. The infant’s parents said the child had a recent respiratory infection with a fever. A rapid respiratory syncytial virus (RSV) test is positive. Which condition would the provider most likely suspect as the cause? bronchiolitis
PALS resuscitation team notes the following ECG waveform and the child does not have a pulse. The team prepares to intervene to address which arrhythmia? torsades The emergency response team is providing care to a preschooler who is experiencing shock. The primary goal, common to all types of shock, is to restore a favorable balance between tissue perfusion and metabolic demand with a focus on what? The primary goal in shock, regardless of cause, is to restore a favorable balance between tissue perfusion and metabolic demand with a focus on oxygen delivery and oxygen demand. The PALS resuscitation team is providing care to an intubated child in cardiac arrest. Which result best determines the adequacy of the team’s chest compressions? End-tidal carbon dioxide level between 15 and 20 mmHg The PALS team leader is conducting a debriefing session with the team. Which topic(s) would the team leader most likely address during the session?
cardio A 10 - year-old child has collapsed in the gym of the elementary school. The school nurse arrives and determines that the child is unresponsive. The school nurse then simultaneously checks for breathing and a central pulse, limiting this assessment to which time frame? 5 seconds, but no more than 10. A child being cared for in the pediatric telemetry unit suddenly displays the following ECG waveform. The provider prepares to intervene because the child is demonstrating which type of arrhythmia? Supraventricular tachycardia A 6 - year-old patient is brought to the emergency department after a bicycle accident. Assessment reveals tracheal deviation to the left side, chest pain on inspiration and decreased breath sounds on the right side. The provider suspects obstructive shock caused by what condition? tension pneumothorax
A child is experiencing stable supraventricular tachycardia (SVT) and is to receive treatment. Which initial treatment would the provider administer? vagal An unresponsive 7 - year-old child with no pulse is brought to the pediatric urgent care center by his parents and CPR is initiated. The cardiac monitor reveals ventricular fibrillation. Which action would the PALS team take first? initiate defibrillation with 2 J/kg. A child who is stable and exhibiting a narrow-complex tachycardia is to receive adenosine. The provider would be alert for which result after administering this medication? Patients may have a brief period of "asystole" following the administration of adenosine. This is normal and typically self-limited. An 8-year-old child being treated in the emergency department has significant respiratory distress. The child also exhibits hives, wheezing, angioedema, tachycardia and dyspnea. The parents state that the child, who is allergic to peanuts, had eaten some popcorn that had peanuts in it. The team initiates care, preparing to administer which agent first?
A child requires cardiac monitoring. A three-electrode system is being used. At which location would the provider place the red electrode? On the lower left abdomen An advanced airway was placed in a 5 - year-old child. Which action(s) would be most appropriate for the team to take to confirm correct placement? Auscultate over the lungs and epigastrium for air movement, Observe for bilateral chest rise, Evaluate results of capnography. A 12 - lead ECG is ordered for a child complaining of a “racing heart.” When placing the electrodes on the child, at which location would the lead for V4 be placed? fifth intercostal space at the midclavicular line on the patient's left side. A 7 - year-old child collapses on the playground at school. The school nurse is called to the scene and determines that the child is unresponsive and is not breathing and has no pulse. The nurse initiates CPR. At what rate and depth would the nurse deliver compressions to this child? 100 to 120 compressions per minute at a depth of about 2 inch
Which action would the PALS team initiate to manage increased intracranial pressure in a pediatric patient? Maintain the head in midline position with 30 - degree elevation child is experiencing shock. The emergency response team prepares for imminent cardiac arrest when assessment reveals which finding(s)? Hypotension, Bradycardia, Diminished central pulses A 30 - month old child has been diagnosed with moderate croup. Which medication(s) would the provider administer? Corticosteroids, Racemic epinephrine After ROSC, a child is experiencing post–cardiac arrest hemodynamic instability. The PALS resuscitation team would administer which element to restore intravascular volume and optimize preload?
A child experiencing unstable bradycardia is receiving CPR. Despite efforts with CPR, including assuring oxygenation and ventilation, the child’s status remains unchanged. Which medication would the emergency response team expect to administer next? epi A 4-year-old child suddenly collapses in the playroom of the facility. A healthcare provider observes the event and hurries over to assess the child. The healthcare provider completes which assessment first? rapid
