Welcome To The Pre-course Self-Assessment
Welcome to the PALS Pre-course Self-Assessment!The PALS Pre-course Self-Assessment has been designed to identify gaps in yourknowledge of ECG Rhythm recognition, pharmacology, and the PASL algorithms andflowcharts since the PALS Provider Course does not teach these topics. The Precourse Self-Assessment consists of 3 self-assessment tests: ECG Rhythmidentification, Pharmacology, and Practical Application.Complete the answer sheet, and bring it to your PALS course. You will not be admittedto the PALS class without this sheet.ECG Rhythm IdentificationThe PALS ECG Rhythm Identification Self-Assessment is designed to test your ability toidentify rhythms you may encounter as a PALS provider. You should be able to identifythese rhythms during the PALS Provider Course’s teaching and testing stations. If youhave difficulty with pediatric ECG rhythm identification, it is strongly suggested that youspend additional time reviewing basic pediatric arrhythmias before the PALS ProviderCourse. Sources of information about pediatric ECG rhythm identification include theECG Basics section of the student CD, the PALS Course Guide, and the PALS ProviderManual.This self-assessment is composed of 13 questions. For all questions, select the singlebest answer. An answer may be used more than once. Only questions covering thecore PALS rhythms will be scored. There are other questions which contain advancedmaterial that is not necessary to know prior to the PALS course, but may be useful toyour clinical practice.PharmacologyThe PALS Pharmacology Self-Assessment is designed to test your knowledge of coredrugs which will be used in the PALS Provider Course. If this self-assessment testshows that your knowledge of the pharmacology and indications for these drugs isdeficient, it is strongly suggested that you spend additional time reviewing basicresuscitation drug pharmacology prior to taking a PALS course. Sources of PALS druginformation include the student CD, the PALS Course Guide, the PALS ProviderManual, and the Handbook of Emergency Cardiovascular Care.This self-assessment is composed of 11 multiple choice questions. Select the bestanswer.1
Practical ApplicationThe PALs Practical Application Self-Assessment is designed to test your knowledge ofappropriate selections based upon pediatric assessment information provided in casescenarios. This exercise specifically evaluates your ability to identify core PALSrhythms, knowledge of core drugs, knowledge of PALS flowsheets and algorithms forrespiratory distress/respiratory failure and shock, and knowledge of PALs rhythmdisturbances algorithms.If you have difficulty with the Practice Application questions, it is strongly suggested thatyou review the core PALS rhythms, core drug information, PALS flowsheets andalgorithms for respiratory distress/failure and shock, and PALS rhythm disturbancesalgorithms. Sources of this information include the student CD, the PALS CourseGuide, the PALS Provider Manual, and the Handbook of Emergency CardiovascularCare.This self assessment test is composed of 19 multiple choice questions. Select the bestanswer.2
ECG Rhythm Identification – Identify the rhythm with the single best answer.1.Clinical Clues: heart rate 214/min.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)Clinical Clues: no detectablepulses2.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)Clinical Clues: age 8 years, heartrate 50/min.3.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)3G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)
Clinical Clues: no detectablepulses4.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)Clinical Clues: no consistentheart rate detected, no detectablepulses5.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)Clinical Clues: age 3 years, heartrate 186/min.6.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)4G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)
7.Clinical Clues: heart rate 300/min.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)Clinical Clues: age 8 years, heartrate 75/min.8.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)Clinical Clues: initial rhythmassociated with no detectablepulses.9.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)5G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)
Clinical Clues: age 9 months,heart rate 38/min.10.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)Clinical Clues: heart rate 200/min,no detectable pulses11.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)G.H.I.J.K.12.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)Clinical Clues: heart rate 150/min.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)6G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)
Clinical Clues: initial rhythmassociated with heart rate300/min.13.A.B.C.D.E.F.Normal sinus rhythmSinus tachycardiaSinus bradycardiaSupraventricular tachycardia (SVT)Wide-complex tachycardiaVentricular fibrillation (VF)7G.H.I.J.K.AsystolePulseless electrical activity (PEA)SVT Converting to sinus rhythm withadenosine administrationTorsades de pointesVF converted to organized rhythmafter successful shock delivery(defibrillation)
Pharmacology – Select the single best answer1. You are called to help resuscitate an infant with severe symptomatic bradycardiaassociated with respiratory distress. The bradycardia persists despite establishmentof an effective airway, oxygenation, and ventilation. There is no heart block present.Which of the following is the first drug you should hrine2. Which of the following statements about the effects of epinephrine during attemptedresuscitation is true?A. Epinephrine decreases peripheral vascular resistance and reducesmyocardial afterload so that ventricular contractions are more effectiveB. Epinephrine improves coronary artery perfusion pressure and stimulatesspontaneous contractions when asystole is presentC. Epinephrine is contraindicated in ventricular fabrication because it increasedmyocardial irritabilityD. Epinephrine decreases myocardial oxygen consumption3. General assessment of a 2-year old female reveals her to be alert with mildbreathing difficulty during inspiration and pale skin color. On primary assessment,she makes high-pitched inspiratory sounds (mild stridor) when agitated, otherwiseher breathing is quiet. Her Sp02 is 92% in room air, and she has mild inspiratoryintercostal retractions. Lung auscultation reveals transmitted upper airway soundswith adequate distal breath sounds bilaterally. Which of the following is the mostappropriate initial therapeutic intervention for this child?A.B.C.D.Perform immediate endotracheal intubationAdminister an IV dose of dexamethasoneNebulize 2.5 mg of albuterolAdminister humidified supplementary oxygen as tolerated and continueevaluation8
4. Which of the following most reliably delivers a high (90% or greater) concentration ofinspired oxygen in a toddler or older child?A.B.C.D.Nasal cannula with 4 L/min oxygen flowSimple oxygen mask with 15 L/min oxygen flowNonrebreathing face mask with 12 L/min oxygen flowFace tent with 15 L/min oxygen flow5. Which of the following statements about endotracheal drug administration is true?A. Endotracheal drug administration is the preferred route of drug administrationduring resuscitation because it results in predictable drug levels and drugeffectsB. Endotracheal doses of resuscitation drugs in children have been wellestablished and are supported by evidence from clinical trialsC. Intravenous drug doses for resuscitation drugs should be used whether yougive the drugs by the IV, intrasseous (IO), or the endotracheal routeD. Endotracheal drug administration is the least desirable route of administrationbecause this route results in unpredictable drug levels and effects6. Which of the following statements most accurately reflects the PALSrecommendations for the use of magnesium sulfate in the treatment of cardiacarrest?A. Magnesium sulfate is indicated for VF refractory to repeated shocks andamiodarone or lidocaineB. Routine use of magnesium sulfate is indicated for shock-refractorymonomorphic VTC. Magnesium sulfate is indicated for torsades de pointes and VF/pulseless VTassociated with suspected hypomagnesemiaD. Magnesium sulfate is contradicted in VT associated with an abnormal QTinterval during the preceding sinus rhythm9
7. You enter a room to perform a general assessment of a previously stable 10-yearold male and find him unresponsive and apneic. A code is called and bag-maskventilation is performed with 100% oxygen. The cardiac monitor shows a widecomplex tachycardia. The boy has no detectable pulses so compressions andventilations are provided. As soon as the defibrillator arrives you deliver anunsynchronized shock with 2 J/kg. The rhythm check after 2 minutes of CPRreveals VF. You then deliver a shock of 4 J/kg and resume immediate CPRbeginning with compressions. A team member had established IO access, so yougive a dose of epinephrine, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO whenCPR is restarted after the second shock. At the next rhythm check, persistent VF ispresent. You administer a 4 J/kg shock and resume CPR. Based on the PALSPulseless Arrest Algorithm, what are the next drug and dose to administer whenCPR is restarted?A.B.C.D.Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution) IOAtropine 0.02 mg/kg IOAmiodarone 5 mg/kg IOMagnesium sulfate 25 to 50 mg/kg IO8. Parents of a 1-year old female phoned the Emergency Response System when theypicked up their daughter from the babysitter. Paramedics perform a generalassessment revealing an obfunded infant with irregular breathing, bruises over theabdomen, abdominal distention, and cyanosis. Assisted bag-mask ventilation with100% oxygen is initiated. On primary assessment heart rate is 36/min, peripheralpulses cannot be palpated, and central pulses are barely palpable. Cardiac monitorshows sinus bradycardia. Chest compressions are started with a 15:2 compressionto-ventilation ratio. In the emergency department the infant is intubated andventilated with 100% oxygen, and IV access is established. The heart rate is now upto 150/min but there are weak central pulses and no distal pulses. Systolic bloodpressure is 74 mm Hg. Of the following, which would be most useful in managementof this infant?A.B.C.D.Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IVRapid bolus of 20 mL/kg of isotonic crystalloidAtropine 0.02 mg/kg IVSynchronized cardioversion10
9. Which of the following statements about calcium is true?A. Routine administration of calcium is not indicated during cardiac arrestB. The recommended dose is 1 to 2 mg/kg of calcium chlorideC. Calcium chloride 10% has the same bioavailability of elemental calcium ascalcium gluconate in critically ill childrenD. Indications for administration of calcium include hypercalcemia, hypokalemia,and hypomagnesmia10. An infant with a history of vomiting and diarrhea arrives by ambulance. During yourprimary assessment the infant responds only to painful stimulation. The upperairway is patent, the respiratory rate is 40/min with good bilateral breath sounds, and100% oxygen is being administered. The infant has cool extremities, weak pulses,and a capillary refill time of more than 5 seconds. The infant’s blood pressure is85/65 mm Hg and glucose concentration (measured by bedside test) is 30 mg/dL(1.65 mmol/L). Which of the following is the most appropriate treatment to providefor this infant?A. Establish IV or IO access and administer 20 mL/kg D50.45% sodium chloridebolus over 15 minutesB. Establish IV or IO access and administer 20 mL/kg Lactated Ringer’s solutionover 60 minutesC. Perform endotracheal intubation and administer epinephrine 0.1 mg/kg1:1,000 via the endotracheal tubeD. Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over 10 to20 minutes, and simultaneously administer D25W 2 to 4 mL/kg in a separateinfusion11. General assessment of a 9-year old male with increased work of breathing revealsthe boy to be agitated and leaning forward on the bed with obvious respiratorydistress. You administer 100% oxygen by nonrebreathing mask. The patient isspeaking in short phrases and tells you that he has asthma but does not carry aninhaler. He has nasal flaring, severe supernatural and intercostals retractions, anddecreased air movement with prolong expiratory time and wheezing. His SpO2 is96% (on nonrebreathing mask). What is the next medical therapy to provide thispatient?A.B.C.D.Adenosine 0.1 mg/kgAmiodarone 5 mg/kgAlbuterol by nebulationProcainamide 15 mg/kg IV/IO11
Practical Application – Select the single best answer1.An 8-month old male is brought to the emergency department (ED) for evaluation ofsevere diarrhea and dehydration. In the ED, the child becomes unresponsive andpulseless. You shout for help and start CPR at a compression rate of 100/min and acompression-to-ventilation ratio of 30:2. Another provider arrives, at which point youswitch to 2-rescuer CPR with a compression-to-ventilation ratio of 15:2 The cardiacmonitor shows the following rhythm:The infant is intubated and ventilated with 100% oxygen. An IO line is rapidlyestablished and a dose of epinephrine is given. Of the following choices formanagement, which would be most appropriate to give next?A.B.C.D.2.Defibrilation 2 J/kgNormal saline 20 mL/kg IV rapidlyHigh-dose epinephrine, 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution), IOAmiodarone 5 mg/kg IOGeneral assessment of a 10-month old male in the emergency department reveals alethargic pale infant with slow respirations. You begin assisted ventilation with a bagmask device, using 100% oxygen. On primary assessment heart rate is 38/min, centralpulses are weak but distal pulses cannot be palpated, blood pressure is 60/40 mm Hg,and capillary refill is 4 seconds. During your assessment, a colleague places the childon a cardiac monitor and you observe the following rhythm:The rhythm remains unchanged despite ventilation with 100% oxygen. What are yournext management steps?A. Administer adenosine 0.1 mg/kg rapid IV/IO and prepare for synchronizedcardiodiversionB. Start chest compressions and give epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000dilution) IV/IOC. Start chest compressions and give epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000dilution) IV/IOD. Administer 20 mL/kg isotonic crystalloid epinephrine 0.1 mg/kg (0.1 mL/kg of1:10,000 dilution) IV/IO12
3.A 3-year old unresponsive, apneic child is brought to the emergency department. EMSpersonnel report that the child became unresponsive as they arrived at the hospital.The child is receiving CPR, including bag-mask ventilation with 100% oxygen and chestcompressions at a rate of 100/min. Compressions and ventilations are beingcoordinated at a ratio of 15:2. You confirm that apnea is present and that ventilation isproducing bilateral breath sounds and chest expansion while a colleague confirmsabsent pulses. Cardiac monitor shows the following rhythm:A biphasic manual defibrillator is present. You quickly use the crown-heel length of thechild on a length-based, color coded resuscitation tape to estimate the approximateweight as 15 kg. Which of the following therapies is most appropriate for this child atthis time?A.B.C.D.4.Establish IV/IO access and administer amiodarone 5 mg/kg IV/IOEstablish IV/IO access and administer lidocaine 1 mg/kg IV/IOAttempt defibrillation at 30 J, then resume CPR beginning with compressionsEstablish IV/IO access and administer epinephrine 0.01 mg/kg (0.1 mL/kg of1:10,000 dilution) IV/IOGeneral assessment of a 10-year old male shows him to be unresponsive. You shoutfor help, check breathing, find he is apneic, and give 2 breaths. After finding that he ispulseless, you begin cycles of compressions and ventilations with a compression rate of100/min and compression-to-ventilation ratio of 30:2. A colleague arrives and placesthe child on a cardiac monitor, revealing the following rhythm:The two of you attempt defibrillation at 2 J/kg and give 2 minutes of CPR. The rhythmpersists at the second rhythm check, at which point you attempt defibrillation using 4J/kg. A third colleague establishes IO access and administers one dose of epinephrine0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) during the compressions following thesecond shock. If VF or pulseless VT persists after 2 minutes of CPR, what is the nextdrug/dose to administer?A.B.C.D.Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution) IVAdenosine 0.1 mg/kg IVAmiodarone 5 mg/kg IV
resuscitation drug pharmacology prior to taking a PALS course. Sources of PALS drug information include the student CD, the PALS Course Guide, the PALS Provider Manual, and the Handbook of Emergency Cardiovascular Care. This self-assessment is composed of 11 multiple choice questions. Select the best answer. 1
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Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. 3 Crawford M., Marsh D. The driving force : food in human evolution and the future.
