Dear Student:
HLTH 1644-01H – 02/21/15 – 02/22/15, 9:00 a.m. to 6:00 p.m. both days
Pediatric Advanced Life Support (PALS)
This e-mail will serve as confirmation of registration for the class. Please read all sections carefully.
You must bring a copy of your current BLS Provider card to class. These will be collected for the course record.
Attached is the PALS pretest, which you should print, complete, and bring with you to class.
REQUIRED TEXTBOOK: Pediatric Advanced Life Support Provider Manual (AHA# 90-1052); ISBN: 978-1-61669-112-7. Textbooks can
be purchased at NVCC’s Medical Education Campus Bookstore (703/822-6605). Bookstores at other NVCC campuses do not stock this
textbook. The MEC bookstore closes early (2pm) on Fridays and is also not open on weekends. Please make arrangements to obtain
your textbook(s) prior to your scheduled class. Order online at: http://nvccmedical.bncollege.com/
RECOMMENDED TEXTBOOK: 2010 Handbook of Emergency Cardiovascular Care for Healthcare Providers (AHA# 90-1000); ISBN:
978-1-61669-007.
OPTIONAL ONLINE RESOURCES:
AHA Student Website – www.heart.org/eccstudent Enter the password located on page “ii” of your PALS Provider Manual. This
student only page contains several flash videos and 84 pages of supplementary materials in PDF format.
Students are not required to purchase this online course, however some first-time students may find it helpful.
Learn: Rhythm Pediatric (Product #90-1423) - This course is designed for healthcare professionals needing basic rhythm recognition
skills, telemetry staff, neonatal and pediatric ICU personnel, ambulatory care personnel, and those preparing for ACLS such as
paramedics/EMTs, nurses, physicians, clinical pharmacists, and respiratory therapists.
http://www.onlineaha.org/index.cfm?fuseaction=main.courseCatalog&f=filter_healthcare
PRE-CLASS PREPARATION: Students will need to read the textbook, and complete the pretest prior to class in order to be properly
prepared for class. It is strongly recommended that students visit the AHA Student website and review all materials posted.
Students must pass a skills and a written exam at the end of the class in order to receive their card. Please review the Skills Testing
Sheets on pages 234 through 257 of your Pediatric Advanced Life Support Provider Manual/Textbook.
IMPORTANT: You MUST be on time for this class! Students arriving late may be denied entry at the discretion of the instructor, and
NO refund or rescheduled date will be permitted. Instructors are not permitted to allow students to join the class once the
DVD/Course Instructional time has started.
HEALTH RISK: The course for which you are enrolled may include physical strain, the possibility of cross-infection, and emotional
stress. If your physician has recommended that you avoid strenuous activity or limit your activity in any way, you need to realize
that cardiopulmonary resuscitation (CPR) is hard work. This is true both in practicing on the manikin and in doing CPR for a cardiac
arrest victim. Students are encouraged to contact the Training Center Coordinator prior to class if they have any concerns or
questions regarding the physical requirements of this course. Additional information on Disability Services is attached.
LOCATION: This class will be held at the NVCC Medical Education Campus, 6699 Springfield Center Drive, Springfield, VA 22150.
CLASSROOM: Classroom assignments are posted on the day of class on the TV monitor outside Room 210 and on the door of Room
210. Please look for the sign that says PALS.
LUNCH BREAK: A 30 minute lunch break will be provided during this course. Please note that the Campus Bookstore is closed and
no other food services are available on campus. Please remember to bring a lunch with you to class.
WEATHER/CLOSING INFORMATION: If an adverse weather situation exists the day of your class, please check NVCC's website,
http://www.nvcc.edu/depts/homepage/closing.htm for updated closing information. If the College (or Medical Education Campus) is
closed the day of your class, the class is canceled. If this is a class that begins in the morning and the College has a delayed opening,
the class is considered canceled. If this is an afternoon or evening class and the College closes early, the class is considered canceled.
In the event of a canceled class due to College closure, our office will contact you the next possible business day. Students, who do
not attend a scheduled class due to weather when the College is NOT officially closed, will not receive a refund or rescheduled class
date.
REFUNDS, SWAPS, and CANCELLED CLASSES: You will receive prompt notification of course changes and cancellations by telephone
or email. In the unlikely event that your course is cancelled, you will automatically receive a full refund. If you are unable to attend a
course that has not been cancelled, you are eligible to receive a full refund or reschedule (the opportunity to reschedule is only
allowed once) by emailing [email protected] a minimum of four business days before the starting date of the first scheduled
class meeting. There will be no refund after this time.
To request a Refund or Swap you must email [email protected] with the following information: your name, student ID number
(EMPLID), course name/code, and date of class. Once a refund is approved a check will be sent to your mailing address within four to
six weeks. Refunds for payments made in person using cash, check or credit card will be issued in the form of a check processed
through Richmond.
Thank You,
April McMullen-Eldert, AHA Training Center Coordinator
Design and Implementation Group, Workforce Development, Northern Virginia Community College
Direct - 703-822-9040, Fax - 703-822-2083, [email protected]
Directions to the Medical Education Campus (MEC)
Address: 6699 Springfield Center Drive - Springfield, VA 22150-1913
Overview
Street Level
By Metro: The MEC is very accessible by Metro; the Franconia-Springfield metro station is the closest stop. Contact the Fairfax Connector Shuttle at
(703) 339-7200 or at www.fairfaxconnector.com to find out the closest bus stop to the MEC. The current route # is 332 to the corner of Springfield
Center Drive and Loisdale Road.
From Washington DC: Take I-395 towards Richmond. Before the I-95 south merge, take exit 1B onto the VA-644 S exit towards Franconia Road/
Franconia. At the first traffic light, make a right onto Loisdale Road. Stay on Loisdale road with the mall on your left and Kaiser Permanente and
a Barnes and Noble on your right. After passing a Ford dealership on your left hand side, start looking for a small business park on your left. You are
making a left turn right past the business park onto Springfield Center Drive. The MEC will be on your left in approximately 1/4 mile.
From Woodbridge: Take the I-95 North ramp toward Washington DC. Merge onto I-95N. Take the 169 A-B (VA-644) exits towards Franconia Road/
Franconia. Turn right at the traffic light onto Loisdale Road. Turn left onto Springfield Center Drive. The MEC will be on your left in approximately
1/4 mile.
From Manassas: Take I-66 East towards Washington. Merge onto I-495 South towards Richmond (away from Rockville MD). Merge onto I-95 South.
As soon as you merge onto I-95 South, take the first exit, the VA-644 exit towards Franconia Road/ Franconia. At the first traffic light, make a right
onto Loisdale Road. Stay on Loisdale road with the mall on your left and Kaiser Permanente and a Barnes and Noble on your right. After passing a
Ford dealership on your left hand side, start looking for a small business park on your left. You are making a left turn right past the business
park onto Springfield Center Drive. The MEC will be on your left in approximately 1/4 mile.
From Maryland (Rockville/Bethesda): Take I-495 West toward Northern Virginia. Merge onto I-95 South. . As soon as you merge onto I-95 South,
take the first exit, the VA-644 exit towards Franconia Road/ Franconia. At the first traffic light, make a right onto Loisdale Road. Stay on Loisdale
road with the mall on your left and Kaiser Permanente and a Barnes and Noble on your right. After passing a Ford dealership on your left hand side,
start looking for a small business park on your left. You are making a left turn right past the business park onto Springfield Center Drive. The MEC
will be on your left in approximately 1/4 mile.
• Northern Virginia traffic can be unpredictable at times, please plan your travel accordingly.
• The Medical Education Campus in Springfield is a one building campus with a parking garage attached. If you do not have a
st
valid NVCC parking sticker, please park on the 1 level of the garage in visitor parking.
• Please bring a snack or lunch, we do not have a cafeteria at this campus however, vending machines are available.
• For more information please, visit our website@ www.nvcc.edu/workforce . Email us at [email protected] or Call (703)
822-6523.
Thank you for your interest in Workforce Development Division Programs at NVCC’s Medical Education Campus!
IMPORTANT INFORMATION!!!
1) myNOVA Email address:
All students who have registered for a class with WDD/NOVA receive a college email address. To access this email account
visit www.nvcc.edu. Click on the myNOVA tab on the upper right of the page. Or go to http://www.nvcc.edu/aboutnova/mynova.html. The college uses this email address to communicate with students in case of emergencies and also to
update students on changes to their courses. It is very important that students check this email address for updates and
cancellations. If you prefer to receive notification emails at a different email address you will need to login to your
MyNOVA account and update your preferred email address.
2) NOVA Card:
As of July 1, 2008 all currently enrolled WDD students will receive a NOVA ID Card free of charge. Please visit the NOVA
Card Website at www.nvcc.edu/novacard. Lost NOVA ID Cards can be replaced for a $10.00 fee.
3) NOVA Alert:
This helpful system will help to keep you informed when emergency occurs. You will receive email and/or text messages
from the College giving instructions about campus closing, where to go, what to do, who to contact, etc. in case of an
emergency. Please visit this website http://alert.nvcc.edu click on NOVA Alert and take few minutes to sign up. New
users may also register by sending a text message to 411911, keyword: NOVA.
4) NOVA Emergency Evacuation Plan:
Providing a safe environment for faculty, staff, visitors, and students is a primary concern of the Northern Virginia
Community College administration. Critical to this goal is being knowledgeable about what to do in the event of an
emergency. Planning and being prepared is our shared responsibility.
Please visit www.nvcc.edu/medical/epp for information about emergency preparedness.
We do ask that you familiarize yourself with this website and ask any questions you may have. Please check back once a
semester to ensure you're prepared!
5) LiveSafe:
This free mobile app, called “LiveSafe”, will improve communication between students, faculty, staff and college police. The
app goes live on April 1, 2014 and it will allow students, faculty, staff and parents to report tips anonymously to college
police, ask the police questions, and offer security suggestions. The LiveSafe app will also let friends and family monitor
your location as you walk with a virtual escort. The app has many other features that will help keep you safe.
College Wide Syllabus Statement on Disability Services
The College is committed to the goal of providing each qualified student and equal opportunity to pursue a college education
regardless of disability. Efforts will be made toward meeting reasonable requests for services to students with disabilities eligible
under Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA), and the ADAAA (ADA Amendments
Act of 2008). Students with disabilities are encouraged to contact a Counselor for Disability Services in the Student Services or
Counseling Center of any campus to discuss possible accommodations.
Contact a Disability Services Counselor at the campus of your choice to request an appointment. Deaf or hard of hearing students
should contact NOVA’s Interpreter Services Office.
Disability Services Staff
Alexandria Campus
Telephone: 703.933.1840
Email: Latacha Berluche
View Map
Annandale Campus
Room CA 112
Telephone: 703.323.3200
Email: Tracy Bell, Susie Ko, Vicky
White
View Map
Extended Learning Institute
Telephone: 703.323.2404
Email: Dr. David Highsmith
Loudoun Campus
Room LR 253
Email: Kimberly Heck
Telephone: 703.450.2591
View Map
Woodbridge Campus
Room 202-E
Telephone: 703.878.5760
Email: Pamela Manuel
View Map
Manassas Campus
Room MH 110
Telephone: 703.257.6610
Email: Asante Clarke, Corey Esparza
View Map
Assistive Technology Coordinator
Telephone: 703.323.3349
Email: Stephanie E. Gernert
Medical Education Campus
Room 202
Telephone: 703.822.6633
Email: Donna Smith
View Map
Interpreter Services Office
Dr. Joan Ehrlich, Coordinator
7630 Little River Turnpike, Suite 306
Annandale, VA 22003-3796
Telephone: 703.323.3187 (V/TTY)
Cell: 703.975.4772 (calls and texts)
Email: [email protected]
For More information on Disability Services, please visit: http://www.nvcc.edu/current-students/disability-services/
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
HEALTH RISK STATEMENT FOR BASIC AND ADVANCED LIFE SUPPORT COURSES
The technical standards for the course for which you are enrolled in include long periods of time kneeling on the floor,
giving effective breaths with a barrier device, giving effective breaths with a Bag-Valve Device, giving effective chest
compressions to an adult, giving effective chest compressions to an infant utilizing two fingers on one hand, and giving
effective chest compressions to an infant utilizing the two thumb encircling hands technique. Please review the Skills
Testing Sheets on pages 234 through 257 of your Pediatric Advanced Life Support Provider Manual/Textbook.
If you are a student with a documented disability and you anticipate that you will require accommodations for the
classroom, written exam, or skills testing component of this course, please visit a Disability Services Counselor at one of
the locations listed above. Please note: Academic accommodations are unique to individuals and some
accommodations may require advanced time and preparation.
Students who have a current Memo of Accommodation (MOA) are encouraged to submit a copy to the NVCC AHA
Training Center Coordinator early for implementation of requested accommodations.
2012 PALS Provider
Welcome to the Pre-course Self-Assessment
The PALS Pre-course Self-Assessment is designed to identify gaps in your knowledge of ECG
rhythm recognition, pharmacology, and the PALS algorithms and flow charts, because the PALS
Provider Course does not teach these topics.
The Pre-course Self-Assessment consists of 3 self-assessment tests: ECG Rhythm Identification,
Pharmacology and Practical Application. Please print, complete and bring this Pre-course SelfAssessment with you to class. Your Instructor will review this with you in class.
Increase your knowledge by studying applicable content in the PALS Provider Manual , (AHA# 901052), the 2010 Handbook of Emergency Cardiovascular Care for Healthcare Providers (AHA# 901000), or other supplementary resources.
Page 1 of 15
ECG Rhythm Identification
The PALS ECG Rhythm Identification self-assessment test is designed to test your ability to identify rhythms you may
encounter as a PALS provider. The rhythms in the list below are the core PALS rhythms that you should be able to
identify during the PALS Provider Course teaching and testing stations. If you have difficulty with pediatric ECG rhythm
identification, it is strongly suggested that you spend additional time reviewing basic pediatric arrhythmias before taking
the PALS Provider Course. Sources of information about Pediatric ECG rhythm identification include the PALS Provider
Manual and Learn Rhythm Pediatric, available at www.onlineAHA.org.
This section of the self-assessment test is composed of 13 multiple-choice questions. For all questions, select the single
best answer. An answer may be used more than once.
Core PALS Rhythms:
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
Pulseless electrical activity
Question 1 of 13
Identify the rhythm with the single best answer. Clinical clues: heart rate 214/min
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Question 2 of 13
Identify the rhythm with the single best answer. Clinical clues: age 8 years; pulse rate 75/min
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Page 2 of 15
Question 3 of 13
Identify the rhythm with the single best answer. Clinical clues: heart rate 150/min
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Question 4 of 13
Identify the rhythm with the single best answer. Clinical clues: heart rate of 300/min
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Question 5 of 13
Identify the rhythm with the single best answer. Clinical clues: no consistent heart rate detected; no detectable pulses
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Page 3 of 15
Question 6 of 13
Identify the rhythm with the single best answer. Clinical clues: age 3 years; heart rate 188/min
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Question 7 of 13
Identify the rhythm with the single best answer. Clinical clues: age 8 years; heart rate 50/min
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Question 8 of 13
Identify the rhythm with the single best answer. Clinical clues: age 9 months; heart rate 38/min
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Page 4 of 15
Question 9 of 13
Identify the rhythm with the single best answer. Clinical clues: initial rhythm associated with no detectable pulses
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Question 10 of 13
Identify the rhythm with the single best answer. Clinical clues: no detectable pulses
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Question 11 of 13
Identify the rhythm with the single best answer. Clinical clues: heart rate 200/min; no detectable pulses
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Page 5 of 15
Question 12 of 13
Identify the rhythm with the single best answer. Clinical clues: initial rhythm associated with heart rate of 300/min
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
Question 13 of 13
Identify the rhythm with the single best answer. Clinical clues: no detectable pulses
A.
B.
C.
D.
E.
F.
G.
Normal sinus rhythm
Sinus tachycardia
Sinus bradycardia
Supraventricular tachycardia (SVT)
Wide-complex tachycardia
Ventricular fibrillation (VF)
Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine
administration
J. Torsades de pointes
K. VF converted to organized rhythm after
successful shock delivery (defibrillation)
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Pharmacology
The PALS Pharmacology self-assessment test is designed to test your knowledge of core drugs that will be used in the
PALS Provider Course. If this self-assessment test shows that your knowledge of the pharmacology and indications of
these drugs is deficient, it is strongly suggested that you spend additional time reviewing basic resuscitation drug
pharmacology before taking a PALS course. Sources of PALS drug information include the PALS Provider Manual and
the 2010 Handbook of Emergency Cardiovascular Care for Healthcare Providers.
This self-assessment test is composed of 11 multiple-choice questions. Select the single best answer.
Question 1 of 11
Which of the following statements about calcium is true?
A. Calcium chloride 10% has the same bioavailability of elemental calcium as calcium gluconate in critically ill
children.
B. Routine administration of calcium in not indicated during cardiac arrest.
C. Indications for administration of calcium include hypercalcemia, hypokalemia, and hypomagnesemia
D. The recommended dose is 1 to 2 mg/kg of calcium chloride
Page 6 of 15
Question 2 of 11
You enter a room to perform an initial impression of a previously stable 10-year-old male and find him unresponsive and
apneic. A code is called and bag-mask ventilation is performed with 100% oxygen. The cardiac monitor shows a widecomplex tachycardia. The boy has no detectable pulses so compressions and ventilations are provided. As soon as the
defibrillator arrives you deliver an unsynchronized shock with 2 J/kg. The rhythm check after 2 minutes of CPR reveals
VF. You then deliver a shock of 4 J/kg and resume immediate CPR beginning with compressions. A team member had
established IO access, so you give a dose of epinephrine, 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IO when CPR is
restarted after the second shock. At the next rhythm check, persistent VF is present. You administer a 4 J/kg shock and
resume CPR. Based on the PALS Pulseless Arrest Algorithm, what are the next drug and dose to administer when CPR is
restarted?
A. Atropine 0.02 mg/kg IO
C. Amiodarone 5 mg/kg IO
B. Magnesium sulfate 25 to 50 mg/kg IO
D. Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000
dilution) IO
Question 3 of 11
You are called to help resuscitate an infant with severe symptomatic bradycardia associated with respiratory distress. The
bradycardia persists despite establishment of an effective airway, oxygenation, and ventilation. There is no heart block
present. Which of the following is the first drug you should administer?
A. Dopamine
C. Epinephrine
B. Adenosine
D. Atropine
Question 4 of 11
Parents of a 1-year-old female phoned the Emergency Response System when they picked up their daughter from the
baby-sitter. Paramedics perform an initial impression revealing an obtunded infant with irregular breathing, bruising over
the abdomen, abdominal distention, and cyanosis. Assisted bag-mask ventilation with 100% oxygen is initiated. On
primary assessment heart rate is 36/min, peripheral pulses cannot be palpated, and central pulses are barely palpable.
Cardiac monitor shows sinus bradycardia. Chest compressions are started with a 15:2 compression-to-ventilation ratio. In
the emergency department the infant is intubated and ventilated with 100% oxygen, and IV access is established. The
heart rate is now up to 150/min but there are weak central pulses and no distal pulses. Systolic blood pressure is 74 mm
Hg. Of the following, which would be most useful in management of this infant?
A. Rapid bolus of 20 mL/kg of isotonic crystalloid
C. Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000
dilution) IV
B. Synchronized cardioversion
D. Atropine 0.02 mg/kg IV
Question 5 of 11
Which of the following statements about endotracheal drug administration is true?
A. Endotracheal drug administration is the preferred route of drug administration during resuscitation because it
results in predictable drug levels and drug effects
B. Intravenous drug doses for resuscitation drugs should be used whether you give the drug by the IV, intraosseous
(IO), or the endotracheal route
C. Endotracheal drug administration is the least desirable route of administration because this route results in
unpredictable drug levels and effects.
D. Endotracheal doses of resuscitation drugs in children have been well established and are supported by evidence
from clinical trials.
Page 7 of 15
Question 6 of 11
Which of the following most reliably delivers a high (90% or greater) concentration of inspired oxygen in a toddler or older
child?
A. Nonrebreathing face mask with 12 L/min oxygen
flow
C. Face tent with 15 L/min oxygen flow
D. Simple oxygen mask with 15 L/min oxygen flow
B. Nasal cannula with 4 L/min oxygen flow
Question 7 of 11
An infant with a history of vomiting and diarrhea arrives by ambulance. During your primary assessment the infant
responds only to painful stimulation. The upper airway is patent, the respiratory rate is 40/min with good bilateral breath
sounds, and 100% 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 is 85/65 mm Hg and glucose concentration is 30 mg/dL (1.65
mmol/L). Which of the following is the most appropriate treatment to provide for this infant?
A. Establish IV or IO access, administer 20 mL/kg isotonic crystalloid over 10 to 20 minutes, and simultaneously
administer D25W 2 to 4 mL/kg in a separate infusion
B. Establish IV or IO access and administer 20 mL/kg Lactated Ringer's solution over 60 minutes
C. Perform endotracheal intubation and administer epinephrine 0.1 mg/kg 1:1,000 via the endotracheal tube
D. Establish IV or IO access and administer 20 mL/kg D5 0.45% sodium chloride bolus over 15 minutes
Question 8 of 11
Initial impression of a 9-year-old male with increased work of breathing reveals the boy to be agitated and leaning forward
on the bed with obvious respiratory distress. You administer 100% oxygen by nonrebreathing mask. The patient is
speaking in short phrases and tells you that he has asthma but does not carry an inhaler. He has nasal flaring, severe
suprasternal and intercostal retractions, and decreased air movement with prolonged expiratory time and wheezing. His
SpO2 is 96% (on nonrebreathing mask). What is the next medical therapy to provide to this patient?
A. Albuterol by nebulization
C. Procainamide 15 mg/kg IV/IO
B. Amiodarone 5 mg/kg IV/IO
D. Adenosine 0.1 mg/kg
Question 9 of 11
Initial impression of a 2-year-old female reveals her to be alert with mild breathing difficulty during inspiration and pale skin
color. On primary assessment, she makes high-pitched inspiratory sounds (mild stridor) when agitated; otherwise her
breathing is quiet. Her SpO2 is 92% in room air, and she has mild inspiratory intercostal retractions. Lung auscultation
reveals transmitted upper airway sounds with adequate distal breath sounds bilaterally. Which of the following is the most
appropriate initial therapeutic intervention for this child?
A. Nebulize 2.5 mg of albuterol
C. Administer humidified supplementary oxygen as
tolerated and continue evaluation
B. Administer an IV dose of dexamethasone
D. Perform immediate endotracheal intubation
Page 8 of 15
Question 10 of 11
Which of the following statements about the effects of epinephrine during attempted resuscitation is true?
A. Epinephrine is contraindicated in ventricular fibrillation because it increases myocardial irritability
B. Epinephrine decreases peripheral vascular resistance and reduces myocardial afterload so that ventricular
contractions are more effective
C. Epinephrine decreases myocardial oxygen consumption
D. Epinephrine improves coronary artery perfusion pressure and stimulates spontaneous contractions when asystole
is present
Question 11 of 11
Which of the following statements most accurately reflects the PALS recommendations for the use of magnesium sulfate
in the treatment of cardiac arrest?
A. Routine use of magnesium sulfate is indicated for shock-refractory monomorphic VT
B. Magnesium sulfate is contraindicated in VT associated with an abnormal QT interval during the preceding sinus
rhythm
C. Magnesium sulfate is indicated for torsades de pointes and VF/pulseless VT associated with suspected
hypomagnesemia
D. Magnesium sulfate is indicated for VF refractory to repeated shocks and amiodarone or lidocaine
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Practical Application
The PALS Practical Application self-assessment test is designed to test your knowledge of appropriate treatment
selections based on pediatric assessment information provided in case scenarios. This exercise specifically evaluates
your ability to identify core PALS rhythms (if presented), knowledge of core drugs, knowledge of PALS flowcharts and
algorithms for respiratory distress/respiratory failure and shock, and knowledge of PALS rhythm disturbances algorithms.
If you have difficulty with the Practical Application questions, it is strongly suggested that you review the core PALS
rhythms, core drug information, PALS flowcharts and algorithms for respiratory distress/respiratory failure and shock, and
PALS rhythm disturbances algorithms. Sources of this information include the PALS Provider Manual, the PALS Pocket
Reference Cards, and the 2010 Handbook of Emergency Cardiovascular Care for Healthcare Providers.
This self-assessment test is composed of 19 multiple-choice questions. Select the single best answer.
Page 9 of 15
Question 1 of 19
A 3-year-old unresponsive, apneic child is brought to the emergency department. EMS personnel 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 chest compressions at a rate of at least 100/min. Compressions and ventilations are being coordinated
at a rate of 15:2. You confirm that apnea is present and that ventilation is producing bilateral breath sounds and chest
expansion while a colleague confirms absent pulses. Cardiac monitor shows the above rhythm. A biphasic manual
defibrillator is present. You quickly use the crown-heel length of the child on a length-based, color-coded resuscitation
tape to estimate the approximate weight as 15kg. Which of the following therapies is most appropriate for this child at this
time?
A. Establish IV/IO access and administer lidocaine
1mg/kg IV/IO
C. Establish IV/IO access and administer
amiodarone 5 mg/kg IV/IO
B. Establish IV/IO access and administer
epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000
dilution) IV/IO
D. Attempt defibrillation at 30 J, then resume CPR
beginning with compressions
Question 2 of 19
An 18-month-old child presents with a 1-week history of cough and runny nose. You perform an initial impression, which
reveals a toddler responsive only to painful stimulation with slow respirations and diffuse cyanosis. You begin a primary
assessment and find that the child’s respiratory rate has fallen from 65/min to 10/min, severe inspiratory intercostal
retractions are present, heart rate is 160/min, SpO2 is 65% in room air, and capillary refill is less than 2 seconds. Which of
the following is the most appropriate immediate treatment for this toddler?
A. Open the airway and provide positive-pressure ventilations using 100% oxygen and a bad-mask device
B. Establish vascular access and administer a 20 ML/kg bolus of isotonic crystalloid
C. Administer 100% oxygen by face mask, obtain an arterial blood gas, and establish vascular access
D. Administer 100% oxygen by face mask, establish vascular access and obtain a STAT chest x-ray
Question 3 of 19
You are transporting a 6-year-old endotracheally intubated patient who is receiving positive-pressure mechanical
ventilation. The child begins to move his head and suddenly becomes cyanotic and bradycardic. Sp02 is 65% with good
pulse signal. You remove the child from the mechanical ventilator circuit and provide manual ventilation with a bag via the
endotracheal tube. During manual ventilation with 100% oxygen, the child’s color and heart rate improve slightly and his
blood pressure remains adequate. Breath sounds and chest expansion are present and adequate on the right side, but
they are consistently diminished on the left side. The trachea is not deviated, and the neck veins are not distended. A
suction catheter passes easily beyond the tip of the endotracheal tube. Which of the following is the most likely cause of
this child’s acute deterioration?
A. Tracheal tube displacement into the right main
bronchus
C. Equipment failure
D. Tension pneumothorax on the right side
B. Tracheal tube obstruction
Page 10 of 15
Question 4 of 19
A child becomes unresponsive in the emergency department and is not breathing. You provide ventilation with 100%
oxygen. You are uncertain if a faint pulse is present with the above rhythm. What is your next action?
A. Start and IV and give atropine 0.01mg/kg IV
C.
Start high quality CPR, beginning with chest
compressions
B. Start and IV and give epinephrine 0.01 mg/kg IV
(0.1 mL/kg of 1:10,000 dilution)
D. Order transcutaneous pacing
Question 5 of 19
You have just assisted with the elective endotracheal intubation of a child with respiratory failure and a perfusing rhythm.
Which of the following provides the most reliable, prompt assessment of correct endotracheal tube placement in this
child?
A. Absence of audible breath sounds over the abdomen during positive-pressure ventilation
B. Auscultation of breath sounds over the lateral chest bilaterally plus the presence of mist in the endotracheal tube
C. Clinical assessment of adequate bilateral breath sounds and chest expansion plus the presence of exhaled CO2
in a colorimetric detection device after delivery of 6 positive-pressure ventilations
D. Confirmation of appropriate oxygen and carbon dioxide tensions on arterial blood gas analysis
Question 6 of 19
You are participating in the elective intubation of a 4-year-old child with respiratory failure. You must select the appropriate
sized uncuffed endotracheal tube. You do not have a color-coded, length-based tape to use to estimate the correct
endotracheal tube size. Which of the following is the most appropriate uncuffed endotracheal tube for an average 4-yearold?
A. 3-mm tube
C. 6-mm tube
B. 4-mm tube
D. 5-mm tube
Question 7 of 19
You are supervising another healthcare provider who is inserting an intraosseous (IO) needle into an infant’s tibia. Which
of the following signs should you tell the provider is the best indication of successful insertion of a needle into the bone
marrow cavity?
A. Pulsatile blood flow will be present in the needle hub
B. You are unable to aspirate any blood through the needle
C. Fluids can be administered freely without local soft tissue swelling
D. Once inserted, the needle shaft of the needle moves easily in all directions within the bone
Page 11 of 15
Question 8 of 19
A 1-year-old male is brought to the emergency department for evaluation of poor feeding, fussiness, and sweating. On
initial impression he is lethargic but arousable and has labored breathing and a dusky color. Primary assessment reveals
a respiratory rate of 68/min. heart rate of 300/min that does not vary with activity or sleep, blood pressure is 70/45 mm Hg,
weak brachial pulses and absent radial pulses, capillary refill of 6 seconds, SpO2 85% in room air, and good bilateral
breath sounds. You administer high-flow oxygen and place the child on a cardiac monitor. You see the above rhythm with
little beat-to-beat variability of the heart rate. Secondary assessment reveals no history of congenital heart diseases. IV
access has been established. Which of the following therapies is most appropriate for this infant?
A. Adenosine 0.1 mg/kg IV rapidly; if adenosine is not immediately available, perform synchronized cardioversion
B. Establish IV access and administer a fluid bolus of 20 mL/kg isotonic crystalloid
C. Make an appointment with a pediatric cardiologist for later in the week
D. Perform immediate defibrillation without waiting for IV access
Question 9 of 19
An 8-year-old child was struck by a car. He arrives in the emergency department alert, anxious, and in respiratory
distress. His cervical spine is immobilized and he is receiving 10 L/min flow of 100% oxygen by nonrebreathing face
mask. Primary assessment reveals respiratory rate 60/min, heart rate 150/min, systolic blood pressure 70 mm Hg, and
SpO2 84% on supplementary oxygen. Breath sounds are absent over the right chest, and the trachea is deviated to the
left. He has weak central pulses and absent distal pulses. Which of the following is the most appropriate immediate
intervention for this child?
A. Perform endotracheal intubation and call for a STAT x-ray
B. Establish IV access and administer a 20 mL/kg normal saline bolus
C. Provide bag-mask ventilation and call for a STAT chest x-ray
D. Perform needle decompression of the right chest and assist ventilation with a bag and mask if necessary
Question 10 of 19
A 3-year-old boy presents with multiple system trauma. The child was an unrestrained passenger in a motor vehicle
crash. On primary assessment he is unresponsive to voice or painful stimulation. His respiratory rate is less than 6/min,
heart rate is 170/min, systolic blood pressure is 60 mm Hg, capillary refill is 5 seconds, and SpO2 is 75% in room air.
Which of the following most accurately summarizes the first interventions you should take to support this child?
A. Provide 100% oxygen by simple mask, stabilize the cervical spine, establish vascular access, and provide
maintenance IV fluids
B. Open the airway (jaw-thrust technique) which stabilizing the cervical spine, administer positive-pressure
ventilation with 100% oxygen, and establish immediate IV/IO access
C. Establish immediate vascular access, administer 20 mL/hg isotonic crystalloid, and reassess the patient; if the
child’s systemic perfusion does not improve, administer 10 to 20 mL/kg packed red blood cells
D. Provide 100% oxygen by simple mask and perform head-to-toe survey to identify the extent of all injuries; begin
an epinephrine infusion and titrate to maintain a systolic blood pressure of at least 76 mm Hg
Page 12 of 15
Question 11 of 19
A pale and obtunded 3-year-old child with a history of diarrhea is brought to the hospital. Primary assessment reveals
respiratory rate of 45/min with good breath sounds bilaterally. Heart rate is 150/min, blood pressure is 90/64 mm Hg, and
SpO2 is 96% in room air. Capillary refill is 5 seconds and peripheral pulses are weak. After placing the child on a
nonrebreathing face mask (10 L/min flow) with 100% oxygen and obtaining vascular access, which of the following is the
most appropriate immediate treatment for this child?
A. Administer a dopamine infusion at 2 to 5 mcg/kg
per minute
C. Administer a bolus of 20 mL/kg isotonic
crystalloid
B. Obtain a chest x-ray
D. Begin a maintenance crystalloid infusion
Question 12 of 19
A 4-year-old male is in a pulseless arrest in the pediatric intensive care unit. A code is in progress. As the on-call
physician you quickly review the chart and find that his baseline corrected QT interval on a 12-lead ECG is prolonged. A
glance at the monitor shows recurrent episodes of the above rhythm. The boy has received one dose of epinephrine 0.01
mg/kg (0.1 mL/kg if 1:10,000 dilution) but continues to demonstrate the rhythm illustrated above. If this rhythm persists at
the next rhythm check, which medication would be the most appropriate to administer at this time?
A. Lidocaine 1 mg/kg IV
C. Magnesium sulfate 25 to 50 mg/kg IV
B. Epinephrine 0.1 mg/kg (0.1 mL/kg if 1:1,000
dilution) IV
D. Adenosine 0.1 mg/kg IV
Question 13 of 19
You are caring for a 3-year-old with vomiting and diarrhea. You have established IV access. When you place an
orogastric tube, the child begins gagging and continues to gag after the tube is placed. The child’s color has deteriorated;
pulses are palpable but faint and the child is now lethargic. The heart rate is variable (range 44/min to 62/min). You begin
bag-mask ventilations with 100% oxygen. When the heart rate does not improve, you begin chest compressions. The
cardiac monitor shows the above rhythm. Which of the following would be the most appropriate therapy to consider next?
A. Attempt synchronized cardioversion at 0.5 J/kg
C. Atropine 0.02 mg/kg IV
B. Cardiology consult for transcutaneous pacing
D. Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000
dilution) IV
Page 13 of 15
Question 14 of 19
You are preparing to use a manual defibrillator and paddles in the pediatric setting. When would it be most appropriate to
use the smaller “pediatric” sized paddles for shock delivery?
A. If the patient weighs less than approximately 10 kg or is less than 1 year of age
B. To attempt synchronized cardioversion but not defibrillation
C. Whenever you can compress the victim’s chest using only the heel of one hand
D. If the patient weighs less than approximately 25 kg or is less than 8 years of age
Question 15 of 19
A 7-year-old boy is found unresponsive, apneic, and pulseless. CPR is ongoing. The child in intubated and vascular
access is established. The ECG monitor reveals an organized rhythm, but a pulse check reveals no palpable pulses.
Effective ventilations and compressions are resumed, and an initial IV dose of epinephrine is administered. Which of the
following therapies should you perform next?
A. Administer epinephrine 0.1 mg/kg IV (0.1 mL/kg of 1:1,000 dilution)
B. Administer synchronized cardioversion at 1 J/kg
C. Attempt defibrillation at 4 J/kg
D. Attempt to identify and treat reversible causes (using the H’s and the T’s as a memory aid)
Question 16 of 19
Initial impression of a 10-year-old male shows him to be unresponsive. You shout for help, check breathing or only
gasping. After finding that he is pulseless, you begin cycles of compressions and ventilations with a compression rate of at
least 100/min and compression-to-ventilation ratio of 30:2. A colleague arrives and places the child on a cardiac monitor,
revealing the above rhythm. The two of you attempt defibrillation at 2 J/kg and give 2 minutes of CPR. The rhythm persists
at the second rhythm check, at which point you attempt defibrillation using 4 J/kg. A third colleague establishes IO access
and administers one does of epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) during the compressions following
the second shock. If VF or pulseless VT persists after 2 minutes of CPR, what is the next drug/dose to administer?
A. Adenosine 0.1 mg/Kg IV
C. Epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000
dilution) IV
B. Amiodarone 5 mg/kg IV
D. Atropine 0.02 mg/kg IV
Page 14 of 15
Question 17 of 19
An 8-month-old male is brought to the emergency department (ED) for evaluation of severe diarrhea and dehydration. In
the ED the child becomes unresponsive and pulseless. You shout for help and start CPR at a compression rate of at least
100/min and a compression-to-ventilation ratio of 30:2. Another provider arrives, at which point you switch to 2-rescuer
CPR with a compression-to-ventilation ratio of 15:2. The cardiac monitor shows the above rhythm. The infant is intubated
and ventilated with 100% oxygen. An IO line is rapidly established and a dose of epinephrine is given. Of the following
choices for management, which would be most appropriate to give next?
A. Normal saline 20 mL/kg IV rapidly
C. Amiodarone 5 mg/kg IO
B. High-dose epinephrine, 0.1 mg/kg (0.1 mL/kg of
1:1,000 dilution), IO
D. Defibrillation 2 J/kg
Question 18 of 19
Initial impression of a 10-month-old male in the emergency department reveals a lethargic pale infant with slow
respirations. You begin assisted ventilation with a bag-mask device using 100% oxygen. On primary assessment heart
rate is 38/min, central pulses 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 child on a cardiac monitor and you observe the rhythm
above. The rhythm remains unchanged despite ventilation with 100% oxygen. What are your next management steps?
A. Start chest compressions and give epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV/IO
B. Administer adenosine 0.1 mg/kg rapidly IV/IO and prepare for synchronized cardioversion
C. Start chest compressions and give epinephrine 0.1 mg/kg (0.1 mL/kg of 1:1,000 dilution) IV/IO
D. Administer 20 mL/kg isotonic crystalloid and epinephrine 0.1 mg/kg (0.1 mL/kg of 1:10,000 dilution) IV/IO
Question 19 of 19
You are evaluating an irritable 6-year-old girl with mottled color. On primary assessment she is febrile (temperature 40C
[104F]), and her extremities are cold (despite a warm ambient temperature in the room) with capillary refill of 5 seconds.
Distal pulses are absent and central pulses are weak. Heart rate is 180/min, respiratory rate is 45/min, and blood pressure
is 98/56 mm Hg. Which of the following most accurately describes the categorization of this child’s condition using the
terminology taught in the PALS Provider Course?
A. Compensated shock associated with tachycardia and inadequate tissue perfusion
B. Compensated shock requiring no intervention
C. Hypotensive shock associated with inadequate tissue perfusion
D. Hypotensive shock associated with inadequate tissue perfusion and significant hypotension
Page 15 of 15