EPALS COMPREHENSIVE STUDY
GUIDE 2026 FULL QUESTIONS AND
SOLUTIONS GRADED A+
◍ Active rewarming techniques to use below 32 degrees.
Answer: Warmed IV fluids up to 40 degrees C (monitor electrolytes closely)
Gastric or bladder lavage with 0.9% saline up to 40 degrees CVentilation
with humidified gas up to 42 degrees C Bair hugger / arctic sun (external
warmers)
◍ GCS - CHILDREN < 5yo.
Answer: EYE4 - VERBAL5 - MOTOR6- E4 - SPONTANT- E3 - VOICE-
E2 - PAIN- E1 - NONE- V5 - ORIENTED - alert/babble, coos- V4 -
IRRATIBLE CRY- V3- CRIES TO PAIN- V2 - MOANS TO PAIN- V1 -
NO RESPONSE TO PAIN- M6 - NORMAL SPONANT MOVEMENT-
M5 - Localizes to supraorbital pain- M4 - Withdraws from pain- M3 -
FLEXION (DECORTICATE)- M2 - EXTENSION (DECEREBRATE)- M1
- NOTHING (FLACCID)
◍ Fluid bolus.
Answer: 10ml/kg plasmalyte If not improvement after 40-60ml/kg indicates
hypovolaemic shock If cardiac failure - use only 5-10ml/kg In trauma -
10ml/kg but constantly reassess to prevent de-establishing blood clots If 2x
fluid bolus does not improve circulation, give group O negative blood If >
40ml/kg required, activate major haemorrhage
◍ When to expect ETCO2 (end tidal CO2) trace.
Answer: The presence of an ETCO2 trace after 4-6 ventilated breaths
indicates that the TT is in the tracheobronchial tree, both in the presence of a
perfusing rhythm and during cardiorespiratory arrest.
, ◍ causes of Sudden deterioration of the intubated patient.
Answer: DOPESD- displacement of the tracheal tube (oesophagus, right
main bronchus)O- obstruction of artificial airway (accumulated secretions
eg. bronchiolitis),kinking of the tracheal tubeP- 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 leakTidal 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)
◍ IO Proximal tibia landmark in small children.
Answer: 1cm below the tibial tuberosity and 1cm medial to the tibial
tuberosity.
◍ Paediatric breathing differences.
Answer: - small resting lung volume so low o2 reserve -relies on diaphragm
more than muscles
◍ Dissociative shock.
Answer: Insufficient oxygen carrying capacity of blood e.g. anaemia or CO
poisoning
◍ Signs of fluid overload.
Answer: Distended jugular veins Increasing Liver span Crepitations at the
lung bases
◍ Indication of Vasoactive drugs.
Answer: After 30-40mls/kg of fluid boluses
◍ IO Proximal tibia landmark in older children.
Answer: 3cm proximal to the most prominent aspect of the medial malleolus
on the flat centre aspect of the bone.
◍ End tidal CO2 devices.
Answer: Side stream - connector in breathing system usually at end of
tracheal tube Main stream - placed directly in breathing system
GUIDE 2026 FULL QUESTIONS AND
SOLUTIONS GRADED A+
◍ Active rewarming techniques to use below 32 degrees.
Answer: Warmed IV fluids up to 40 degrees C (monitor electrolytes closely)
Gastric or bladder lavage with 0.9% saline up to 40 degrees CVentilation
with humidified gas up to 42 degrees C Bair hugger / arctic sun (external
warmers)
◍ GCS - CHILDREN < 5yo.
Answer: EYE4 - VERBAL5 - MOTOR6- E4 - SPONTANT- E3 - VOICE-
E2 - PAIN- E1 - NONE- V5 - ORIENTED - alert/babble, coos- V4 -
IRRATIBLE CRY- V3- CRIES TO PAIN- V2 - MOANS TO PAIN- V1 -
NO RESPONSE TO PAIN- M6 - NORMAL SPONANT MOVEMENT-
M5 - Localizes to supraorbital pain- M4 - Withdraws from pain- M3 -
FLEXION (DECORTICATE)- M2 - EXTENSION (DECEREBRATE)- M1
- NOTHING (FLACCID)
◍ Fluid bolus.
Answer: 10ml/kg plasmalyte If not improvement after 40-60ml/kg indicates
hypovolaemic shock If cardiac failure - use only 5-10ml/kg In trauma -
10ml/kg but constantly reassess to prevent de-establishing blood clots If 2x
fluid bolus does not improve circulation, give group O negative blood If >
40ml/kg required, activate major haemorrhage
◍ When to expect ETCO2 (end tidal CO2) trace.
Answer: The presence of an ETCO2 trace after 4-6 ventilated breaths
indicates that the TT is in the tracheobronchial tree, both in the presence of a
perfusing rhythm and during cardiorespiratory arrest.
, ◍ causes of Sudden deterioration of the intubated patient.
Answer: DOPESD- displacement of the tracheal tube (oesophagus, right
main bronchus)O- obstruction of artificial airway (accumulated secretions
eg. bronchiolitis),kinking of the tracheal tubeP- 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 leakTidal 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)
◍ IO Proximal tibia landmark in small children.
Answer: 1cm below the tibial tuberosity and 1cm medial to the tibial
tuberosity.
◍ Paediatric breathing differences.
Answer: - small resting lung volume so low o2 reserve -relies on diaphragm
more than muscles
◍ Dissociative shock.
Answer: Insufficient oxygen carrying capacity of blood e.g. anaemia or CO
poisoning
◍ Signs of fluid overload.
Answer: Distended jugular veins Increasing Liver span Crepitations at the
lung bases
◍ Indication of Vasoactive drugs.
Answer: After 30-40mls/kg of fluid boluses
◍ IO Proximal tibia landmark in older children.
Answer: 3cm proximal to the most prominent aspect of the medial malleolus
on the flat centre aspect of the bone.
◍ End tidal CO2 devices.
Answer: Side stream - connector in breathing system usually at end of
tracheal tube Main stream - placed directly in breathing system
