INDEPENDENT LEARNING PALS PREP - AHA - EMC Medical Training

Please review our PALS review videos at www.MedicalTraining.cc – training videos- PALS series and complete the review questions for each section. PALS Shock/Cardiopulmonary Failure 1. You are brought an infant with bradycardia (heart rate 50 min) associated with respiratory distress. Which is the initial emergent treatment for bradycardia? A. Epinephrine IV B. Dopamine drip C. IV or IO blow by oxygen D. Oxygen via BVM 2. A 2-year-old is rushed in by a neighbor. Initial assessment reveals a child who responds only to painful stimuli and has faint central pulses, bruises over abdomen, and cyanosis. Bag-mask ventilation with 100% oxygen is initiated. The child’s heart rate is 36/min. Peripheral pulses cannot be palpated, and central pulses are present but weak. The cardiac monitor shows sinus bradycardia. Two-rescuer CPR is started. The child is intubated and ventilated with 100% oxygen, and IV access is established. The heart rate is now 170/min with weak central pulses but no distal pulses. Systolic blood pressure is 90mm Hg. Which intervention should be provided next? A. Atropine 0.02 mg/kg IV B. Rapid bolus of 20 mL/kg of isotonic crystalloid C. Epinephrine 0.01 mg/kg IV D. Amiodarone 5 mg/kg IV 3. An infant with a history of vomiting and diarrhea is brought to the emergency department by a BLS EMS Crew. During your assessment, you find that the infant responds only to painful stimulation. The infant’s respiratory rate is 44, and central pulses are rapid and weak. The infant has good bilateral breath sounds, cool extremities, and a capillary refill time of 4 seconds. The infant’s blood pressure is 85/65 mm Hg, and glucose is 30 mg/dL. You administer 100% oxygen via facemask and start an IO. Which treatment is the most appropriate for this infant? A. Administer lactated Ringer’s solution 20 mL/kg over 60 minutes, and D50W as a slow push B. Administer D10W 20 ML/kg bolus over 5 minutes C. Administer a bolus of isotonic crystalloid 20 mL/kg over 5 to 20 minutes, and also give D25W 2 to 4 mL/kg IV D. Administer D5W 0.45% sodium chloride 20 mL/kg bolus over 15 minutes 4. Peripheral IV access is the preferred method of vascular access when available. Intraosseous (IO) is nearly as effective when IV sites are unavailable. Which cases may call for rapid use of the IO access, even prior to IV attempts? A. Arrest or near arrest status B. The child who will not allow an IV C. When the rescuer is less skilled in pediatric IV’s D. When greater fluid flow is required 5. In a child who develops shock, which is the latest finding? A. Hypotension B. Restlessness (altered mentation) C. Tachycardia D. Tachypnea 6. An infant with a 4-day history of diarrhea, presents sleepy, mottled, with respiratory rate of 50, oxygen saturation of 95%, B/P of 80/45, and heart rate of 180. The history and presentation suggest? A. Hypotensive (decompensated) shock B. Septic diarrhea C. Early respiratory failure D. Compensated shock 7. When assessing lung sounds, “rhonchi” generally occurs in lower airway disease (conditions), while “crackles” (pulmonary edema) is indicative of? A. Lung tissue insult (disease) B. Anaphylaxis initial stages C. Bronchitis/ Bronchiolitis D. Upper airway obstruction

8. Children who present in compensated shock and an adequate blood pressure should receive oxygen and IV fluids run at? A. Keep open rate B. 20 mL/kg in under 20 minutes (flow time) C. Fluids are not indicated for compensated shock D. 250 mL per hour 9. A 9-year-old fell from a roof and was complaining of flank pain. Currently he is cool, pale, with a 5 second capillary refill and BP of 80/50. His heart rate is 160 and respiratory rate is 40 with bilateral lung sounds and saturation of 93%. The best describes? A. Pneumothorax B. Hypotensive shock C. Compensated shock D. Cardiac tamponade 10. A 9-year-old you previously assessed who had fallen from a roof and is still complaining of flank pain. Currently he is cool, pale, with a 5 second capillary refill and BP of 80/50. His heart rate is 160 and respiratory rate is 40 with bilateral lung sounds and saturation of 93%. The patient requires? A. Oxygen, spinal motion restriction, IV NaCl 20 mL/kg over 5-10 min B. Spinal immobilization, oxygen, IV at KVO rate C. Oxygen by mask, IV D5W/ ½ NS. 20 mL/kg over 20 min D. C-spine x-ray for spinal clearance, oxygen by mask, IO access 11. A home health nurse calls EMS for her long term/bed ridden 9-year-old who has had “the flu” for 3 days. She has a diminished alertness, respiratory rate 40 with crackles, the nurse has her on O 2 by mask, her saturation is 94%, she has a productive cough. Her temperature is 102 F (39C), she has a brisk capillary refill with weak distal pulses and a blood pressure of 100/50. This clinical picture represents? A. Septic shock B. Respiratory Acidosis C. Cardiopulmonary failure D. Hypovolemic shock 12. Which of the following indicates the severity or the “level” of shock a child is presenting with? A. Blood pressure B. Level of consciousness C. Distal pulse D. Pulse oximetry

Please review our PALS review videos at www.MedicalTraining.cc – training videos- PALS series and complete the review questions for each section. PALS Cardiac Events and Algorhythm Review 1. You are part of a team attempting to resuscitate a child with this rhythm in cardiac arrest. CPR is in progress. The next most important modality is? A. Atropine 0.02 mg/kg IO B. Epinephrine .01 mg/kg IV or IO C. Defibrillate 2 Joules/kg D. Amiodarone 5 mg/kg IV or IO 2. A child in ventricular fibrillation or pulseless tachycardia who has received an initial defibrillation should have additional shocks performed at 2-minute intervals (along with CPR and appropriate medications). The repeat defibrillation energy settings should be: A. 1-2 Joules/kg B. 4 Joules/kg or higher (up to 10 J/kg) C. 2 Joules/kg D. The same as the initial 3. A 5-year-old is found after inhaling fumes at an abandoned trailer. He is unresponsive and cyanotic. His EKG is shown above. He has no palpable pulses. This condition describes? A. Pulseless Electrical Activity (PEA) B. Asphyxia Poisoning C. Complete (3 ) heart block D. Respiratory failure

4. The case of a 5-year-old found after inhaling fumes at an abandoned trailer. He is unresponsive and cyanotic. His EKG is shown above. He has no palpable pulses. You realize the case requires CPR. Which ratio of compressions to breaths should be used for 1-rescuer child CPR? A. 30 compressions to 2 breaths B. 100 to 120 compressions per minute with no breaths C. 50 compressions to 1 breath D. 15 compressions to 2 breaths 5. The case of a 5-year-old found after inhaling fumes at an abandoned trailer. He is unresponsive and cyanotic. His EKG is shown above. He has no palpable pulses. CPR is performed and the child is resuscitated, has a pulse, and is breathing. He remains lethargic and confused, HR 140, RR 30, Sa O 2 97%, skin pale, pupils 3 mm, ET CO2 40. A diagnostic test which should be performed bedside first is? A. Toxicology screen B. Deep tendon reflexes C. Blood glucose D. Chest x-ray 6. Once a resuscitation team arrives and 2 persons are performing CPR on a child or infant the ratio of compressions to ventilations is? A. 15:2 B. 15:1 C. 30:2 D. 30:1 7. The physician has intubated an infant during a cardiac arrest secondary to drowning. The person performing the ventilations should know to ventilate? A. Every 15 compressions B. Every 6 seconds C. Every 3 seconds D. At the ratio of 15:2 8. Recognizing appropriate parameters in the peri and post arrest period is crucial to long term successful outcomes, as such the goal of maintaining oxygen saturation should be to keep the reading at? A. 100% B. 98-100% C. 95-100% D. 94-99%

9. An infant seems to be taking occasional gasps. You see the above on the EKG monitor. You are not sure if you feel a pulse or not, you should? A. Immediately administer Epinephrine .01 mg/kg B. Administer Atropine based on a weight-based chart C. Begin CPR in 10 seconds or less if unsure D. Evaluate the pulse for 30 seconds 10. During an arrest, the EMT is becoming fatigued. The physician offers to take over. You notice that the compression rate is too slow. What should you say to offer constructive feedback? A. Nothing, this is the doctor B. Sir/Ma’am, remember you need to compress at a rate of at least 100 per minute C. Sir/Ma’am, remember you need to compress at a rate of at least 80 to 120 per minute D. Sir/Ma’am, remember you need to compress at a rate of at least 100 to 120 per minute 11. The 1 year old with the above rhythm is lethargic but arousable. He has labored breathing, very rapid pulses, and a dusky color. His respiratory rate is 68/min, heart rate 300/min, and blood pressure 70/45 mm Hg. He has weak brachial pulses and absent radial pulses, a capillary refill of 6 seconds, SpO2 85% on room air, and good bilateral breath sounds. You administer high-flow oxygen and place the child on a cardiac monitor and see the rhythm shown above. The emergent treatment in this case is? A. Defibrillation 2 Joules/kg B. Amiodarone 5 mg/kg C. Consult a pediatric cardiology expert for transfer D. Cardioversion 0.5 – 1 Joules/kg

12. The 1-year old boy that was brought to the emergency department for evaluation of poor feeding, irritability, and sweating. Who was lethargic but arousable, had labored breathing, very rapid pulses, and a dusky color. His respiratory rate was 68/min, heart rate 300/min, and blood pressure 70/45 mm Hg. He had weak brachial pulses and absent radial pulses, a capillary refill of 6 seconds, SpO 2 85% on room air, and good bilateral breath sounds. You administered high-flow oxygen and placed the child on a cardiac monitor and saw the rhythm shown here. Had this child been awake and alert with normal skin color and perfusion, an initial option may have been? A. Lower dose cardioversion, synchronized B. Vagal maneuvers C. 30-60 seconds of CPR D. Adenosine 6mg IV push 13. Efficient and effective CPR is crucial in successful resuscitations. Compressions must be of proper rate and depth, 1/2 - 1/3 the depth of the chest (1.5” infant, 2” child). Why is allowing complete chest recoil important when performing high-quality CPR? A. It will reduce the risk of rib fractures B. There will be a reduction in rescuer fatigue C. The heart will refill with blood between compressions D. The rate of chest compressions will increase 14. The rhythm above represents: A. A normal variant B. Wide complex Tachycardia (V-Tach) C. Supraventricular Tachycardia (SVT) D. Atrial Tachycardia 15. Following resuscitation from asystole, a 7-year-old patient who weighs 45lbs or approximately 20kg, develops ventricular fibrillation. The best immediate action is? A. Defibrillate 40 Joules B. Defibrillate 90 Joules C. Perform CPR for 2 minutes then defibrillate D. Confirm rhythm in 2 leads for up to 10 seconds, defibrillate 80 Joules

PALS Video Review Questions (All participants must still complete the mandatory online self-assessment) These questions relate to the online videoswww.Heart.org/ECCstudent PALS Management of Arrhythmia Video 1. Which of the following would make the provider consider a child with a cardia arrythmia (fast or slow) unstable? a. Signs of poor perfusion b. Decreased or altered consciousness c. Respiratory distress d. All of the above 2. The most serious and common cause of bradycardia in children is? a. Overdose b. Hypovolemic c. Hypoxia d. Fever 3. In children (over 1 year old) with a heart rate of 180 1 min who has hypotension, the appropriate treatment is? a. Synchronized cardioversion starting at 0.5-1 joule kg b. Attempt 2 types of vagal maneuvers before medications c. Administer adenosine 0-1 mg/kg bolus d. Perform unsynchronized counter shock 2 joules/kg 4. A child in ventricular fibrillation must be defibrillated quickly, the preferred device to accomplish this is? a. An AED b. A bispectrum unit c. A synchronized pacemaker d. A manual defibrillator 5. An infant or child in cardiac arrest with ventricular fibrillation should be defibrillated starting at 2 joules/ kg, if unsuccessful after 2 minutes, the energy should be increased to 4 joules/ kg or higher in subsequent attempts. After each shock, the team should? a. Review the rhythm and check pulse b. Perform 2 minutes of CPR c. Give 2 slow breathes to obtain chest rise d. Assure the heart monitor is in “peds” mode These questions relate to the online videoswww.Heart.org/ECCstudent PALS Management of Shock Videos 1. Which of the following is not a type of pediatric shock. a. Obstructive b. Fluid overload c. Hypovolemic d. Distributive 2. In early shock, the blood pressure is often a. Falling rapidly b. Normal or possibly high c. Irregular d. Unequal

3. The preferred vascular access type for a patient in early shock is? a. Intraosseous tibia b. Intraosseous humerus c. Femoral site d. Peripheral IV 4. A 6-year-old who was struck by a car has abdominal has a HR of 130, B/P of 110/160, RR of 20 and capillary refill of 4 seconds should receive oxygen and ? a. IV bolus 20 mL/kg of an isotonic crystalloid b. IV D5W KVO c. IV 20 mL/kg over 60 min d. No IV at this time PALS Management of Respiratory Emergencies Video 1. Which of the following is NOT seen in a child with upper airway obstruction (anatomic or foreign body)? a. Prolonged expiration b. Stridor c. Barking cough d. Gurgling sounds 2. If a child requires oxygen by simple mask, the appropriate flow rate should be? a. Oxygen by mask is not indicated in children b. 2-4 liters per minute c. Full flow d. At least 6 liters per minute 3. High flow nasal cannulas are used in pediatrics often in the in-patient ICU setting, these devices utilize flow rates of? a. 4-40 liters per minute b. 1-4 liters per minute c. There is no such thing as a high flow nasal cannula d. 0.5-2 liters per minute 4. Oral pharyngeal airways can be placed by most basic and advanced providers (nurses, EMT, Paramedic, RT, etc.), to keep the tongue from blocking the trachea in the unconscious child. The proper size is estimated by measuring the device from? a. Anterior to posterior b. From the corner of the mouth to the angle of the jaw c. From the nose to the ear d. From the base of the tongue to the vallecula. 5. During cardiac arrest, if an advanced airway is placed (intubation, LMA, iGel, etc.) the CPR sequence is performed by 2 or more rescuers in what order? a. 15 compressions to 2 breaths b. 30 compressions to 2 breaths c. Continual compressions with 1 breath every 6 seconds d. At a rate of 12-20 breaths per minute 6. The most common pediatric emergency is? a. Seizures b. Fever c. Cardiovascular shock d. Respirator issues

These questions relate to the online videoswww.Heart.org/ECCstudent PALS Systematic Assessment Video 1. The pediatric Assessment Triangle (PAT) is used as the initial “across the room” evaluation of a child. The components of this assessment are? a. Pulse, Aptitude, temperature b. Parental assessment to events c. Airway, breathing, circulation d. Appearance, work of breathing, ovulation to skin 2. The primary assessment is described as? a. A rapid hand on, A B C D E sequence assessment b. A search for the primary cause of the child’s condition c. An interview with the primary caregiver d. Primarily overlooked procedure in children, IE not generally necessary. 3. A child in respiratory distress is becoming bradycardic, this often indicates? a. Poor pulse oxygenation readings b. Impending cardiac arrest c. There is no way to tell what this indicates d. Opiate ingestion, such as fentanyl 4. Blood pressure reading in children a. May be normal, even during the on set of shock b. Are a good early indicator of a child going into shock c. Should be one of the earliest vital signs assessed d. Should not be evaluated with an automatic device. 5. The Secondary Assessment includes a head to toe evaluation as indicated, other diagnostic exams, and gathering a SAMPLE history, The PALS program utilizes the assessment and treatment sequence? a. Circulation support, oxygen, IV therapy b. Evaluate, identify, intervene c. Advanced airway and intraosseous support d. Family support, medications, pediatric consult

Please review our PALS review videos at www.MedicalTraining.cc - Training Videos- PALS series and complete the review questions for each section. PALS Respiratory Review 1. A 6-year-old boy is leaning forward on a chair in obvious respiratory distress. The patient is speaking in short phrases and says he has asthma.