EPALS COMPREHENSIVE ASSESSMENT 2026
COMPLETE SOLUTIONS GRADED A+
⫸ PaO2 aim . Answer: 10-14 kPa
⫸ PaCO2 aim . Answer: 4.5-6 kPa
⫸ oxygen mask preferred method for ill children breathing spontaneously . Answer: Non
rebreather oxygen mask with reservoir. The flow of oxygen must be sufficiently high to
ensure the reservoir bag fills adequately. It is possible to give an oxygen concentration up to
90% with an oxygen delivery flow of 12-15L min, depending on the child's minute volume.
⫸ Flows of oxygen starting rate . Answer: Flows of 2L/kg are commonly used up to 12kg,
then 0.5L/kg for each kg thereafter to a maximum of 70L/kg
⫸ HFNC brands . Answer: OPTIFLOW, VAPOTHERM, AIRVO 2
⫸ Equipment for intubation . Answer: - Medications
- Self-inflating bag system and oxygen supply
- Oropharyngeal/nasopharyngeal airway
- Laryngoscope handles and blades
- Tracheal tubes of the appropriate sizes
- Bougie
- End-tidal CO2 monitoring
- Stylet and Magill forceps
- Suction apparatus with the appropriate size of the suckers
- Tapes or ties to secure the tube
- Nasogastric tubes
,⫸ Verification of TT placement . Answer: Sustained exhaled carbon dioxide, CO2 will be
detected if the tracheal tube is correctly placed after four to six ventilations.
⫸ Causes of Sudden deterioration of the intubated patient . Answer: DOPES
D- displacement of the tracheal tube (oesophagus, right main bronchus)
O- obstruction of artificial airway (accumulated secretions eg. bronchiolitis),kinking of the
tracheal tube
P- pneumothorax (from excessive BMV pressure, rib fractures)
E- equipment failure (Eg. disconnected oxygen supply)
S- stomach distension (following expired air or bag-mask)
TT too small with significant air leak
Tidal volume given is too small (aim for tidal volumes of 5-7ml Kg)
Pressure limiting valve active with non-compliant lungs (eg. in near drowning)
⫸ what should we always do prior to intubation . Answer: Pre-oxygenation is important to
prevent hypoxia, with at least 3 minutes of oxgen delivered by BMV or an anaesthetic circuit
to increase the amount of oxygen reserve.
Emergency drugs, including atropine, should be immediately available.
⫸ Types of drugs for emergency anaesthesia
Analgesia: . Answer: Alfentanil, Fentanyl
⫸ Anaesthetic agent for emergency intubation . Answer: Ketamine
Propofol
Sevoflurane
Thiopentone
⫸ Types of drugs for emergency anaesthesia, Neuromuscular blocking drug: . Answer:
Rocuronium
Suxamethonium
,⫸ Heart rate range for 1 month old . Answer: 110-180
⫸ HR range for 1 year old . Answer: 100-170
⫸ HR range for 2 year old . Answer: 90-160
⫸ HR range for 5 year old . Answer: 70-140
⫸ HR range for 10 year old . Answer: 60-120
⫸ HR range for 18 year old . Answer: 60-100
⫸ RR for 1 month old . Answer: 25-60
⫸ RR for 1 year old . Answer: 20-50
⫸ RR for 2 year old . Answer: 18-40
⫸ RR for 5 year old . Answer: 17-30
⫸ RR for 10 year old . Answer: 14- 25
⫸ RR for 18 year old . Answer: 12 to 20
⫸ Most common cause of arrest . Answer: Resp failure then shock
⫸ Most common arrhythmias in children . Answer: ventricular fibrillation or pulseless
ventricular tachycardia
, ⫸ Poiseuille's law shows what for radius . Answer: - the effect of different factors on
resistance of gas (eg. oxygen or CO2) flowing through a tube.
A decrease in airway radius, results in a large increase of resistance to flow of gases through
the airway.
⫸ Do infants prefer breathing through the nose . Answer: nose, hence anything that causes
nasal obstruction can lead to iWOB and resp compromise
⫸ Epiglottis in infants . Answer: Larger and floppier than adults, it is more vulnerable to
damage by airway devices and manipulation of the epiglottis can lead to vagal stimulation.
⫸ Difference of larynx in adults and children . Answer: In adults, larynx is placed at C5 - C6
In preterm infant, around C3, in full term, C3
Shape of larynx in children is - Ellipsoid shaped airways
The vocal cords at the apex of the ellipsoid.
⫸ Blind finger sweeps in children . Answer: - Do not perform Blind finger sweeps in
children with partial airway obstruction as it may be converted to complete obstruction.
⫸ Minute ventilation . Answer: total volume of air inhaled or exhaled from the lungs in one
minute, calculated by multiplying the tidal volume (air per breath) by the respiratory rate
(breaths per minute
⫸ Minute ventilation equation . Answer: tidal volume x respiratory rate, Spontaneous tidal
volume stays constant throughout life- at 4-6ml Kg
⫸ What is the circulating volume in neonates . Answer: The circulating volume of the
newborn is 80mls/kg, and decreased with age to 60-70mls/kg in adulthood.
⫸ Arterial oxygen content is Hb x 1.34, x SaO2 . Answer: Hb x 1.34, x SaO2
COMPLETE SOLUTIONS GRADED A+
⫸ PaO2 aim . Answer: 10-14 kPa
⫸ PaCO2 aim . Answer: 4.5-6 kPa
⫸ oxygen mask preferred method for ill children breathing spontaneously . Answer: Non
rebreather oxygen mask with reservoir. The flow of oxygen must be sufficiently high to
ensure the reservoir bag fills adequately. It is possible to give an oxygen concentration up to
90% with an oxygen delivery flow of 12-15L min, depending on the child's minute volume.
⫸ Flows of oxygen starting rate . Answer: Flows of 2L/kg are commonly used up to 12kg,
then 0.5L/kg for each kg thereafter to a maximum of 70L/kg
⫸ HFNC brands . Answer: OPTIFLOW, VAPOTHERM, AIRVO 2
⫸ Equipment for intubation . Answer: - Medications
- Self-inflating bag system and oxygen supply
- Oropharyngeal/nasopharyngeal airway
- Laryngoscope handles and blades
- Tracheal tubes of the appropriate sizes
- Bougie
- End-tidal CO2 monitoring
- Stylet and Magill forceps
- Suction apparatus with the appropriate size of the suckers
- Tapes or ties to secure the tube
- Nasogastric tubes
,⫸ Verification of TT placement . Answer: Sustained exhaled carbon dioxide, CO2 will be
detected if the tracheal tube is correctly placed after four to six ventilations.
⫸ Causes of Sudden deterioration of the intubated patient . Answer: DOPES
D- displacement of the tracheal tube (oesophagus, right main bronchus)
O- obstruction of artificial airway (accumulated secretions eg. bronchiolitis),kinking of the
tracheal tube
P- pneumothorax (from excessive BMV pressure, rib fractures)
E- equipment failure (Eg. disconnected oxygen supply)
S- stomach distension (following expired air or bag-mask)
TT too small with significant air leak
Tidal volume given is too small (aim for tidal volumes of 5-7ml Kg)
Pressure limiting valve active with non-compliant lungs (eg. in near drowning)
⫸ what should we always do prior to intubation . Answer: Pre-oxygenation is important to
prevent hypoxia, with at least 3 minutes of oxgen delivered by BMV or an anaesthetic circuit
to increase the amount of oxygen reserve.
Emergency drugs, including atropine, should be immediately available.
⫸ Types of drugs for emergency anaesthesia
Analgesia: . Answer: Alfentanil, Fentanyl
⫸ Anaesthetic agent for emergency intubation . Answer: Ketamine
Propofol
Sevoflurane
Thiopentone
⫸ Types of drugs for emergency anaesthesia, Neuromuscular blocking drug: . Answer:
Rocuronium
Suxamethonium
,⫸ Heart rate range for 1 month old . Answer: 110-180
⫸ HR range for 1 year old . Answer: 100-170
⫸ HR range for 2 year old . Answer: 90-160
⫸ HR range for 5 year old . Answer: 70-140
⫸ HR range for 10 year old . Answer: 60-120
⫸ HR range for 18 year old . Answer: 60-100
⫸ RR for 1 month old . Answer: 25-60
⫸ RR for 1 year old . Answer: 20-50
⫸ RR for 2 year old . Answer: 18-40
⫸ RR for 5 year old . Answer: 17-30
⫸ RR for 10 year old . Answer: 14- 25
⫸ RR for 18 year old . Answer: 12 to 20
⫸ Most common cause of arrest . Answer: Resp failure then shock
⫸ Most common arrhythmias in children . Answer: ventricular fibrillation or pulseless
ventricular tachycardia
, ⫸ Poiseuille's law shows what for radius . Answer: - the effect of different factors on
resistance of gas (eg. oxygen or CO2) flowing through a tube.
A decrease in airway radius, results in a large increase of resistance to flow of gases through
the airway.
⫸ Do infants prefer breathing through the nose . Answer: nose, hence anything that causes
nasal obstruction can lead to iWOB and resp compromise
⫸ Epiglottis in infants . Answer: Larger and floppier than adults, it is more vulnerable to
damage by airway devices and manipulation of the epiglottis can lead to vagal stimulation.
⫸ Difference of larynx in adults and children . Answer: In adults, larynx is placed at C5 - C6
In preterm infant, around C3, in full term, C3
Shape of larynx in children is - Ellipsoid shaped airways
The vocal cords at the apex of the ellipsoid.
⫸ Blind finger sweeps in children . Answer: - Do not perform Blind finger sweeps in
children with partial airway obstruction as it may be converted to complete obstruction.
⫸ Minute ventilation . Answer: total volume of air inhaled or exhaled from the lungs in one
minute, calculated by multiplying the tidal volume (air per breath) by the respiratory rate
(breaths per minute
⫸ Minute ventilation equation . Answer: tidal volume x respiratory rate, Spontaneous tidal
volume stays constant throughout life- at 4-6ml Kg
⫸ What is the circulating volume in neonates . Answer: The circulating volume of the
newborn is 80mls/kg, and decreased with age to 60-70mls/kg in adulthood.
⫸ Arterial oxygen content is Hb x 1.34, x SaO2 . Answer: Hb x 1.34, x SaO2
