EPALS Test Bank Study Guide Exam Prep
Practice Questions Answer Key with
Solution 2026/ 2027 Edition
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
Cardiac output - ANSWER -CO is the product of stroke volume and heart rate,
and so the high cardiac outputs in infants and young children are primarily
achieved by rapid heart rates.
MAP - ANSWER -MAP = CO X SVR
Mean arterial pressure (MAP) is influenced by both cardiac output and systemic
vascular resistance. Because of this, changes in SVR can make MAP an unreliable
indicator of cardiac output alone.
MAP calclation in acute settings - ANSWER -MAP (mmHg) = [(2 × diastolic) +
systolic] / 3
Disability - what things to assess - ANSWER -AVPU score or the Glasgow coma
scale
Assess pupils, size and reaction, posture, muscle tone and any focal signs to
determine neurological status
Estimating weight in children with normal BMI - ANSWER -actual body weight
should be used- as it will closely align with ideal body weight.
Estimating weight in children with HIGH BMI - ANSWER -ideal body weight
should be used, as using actual body weight may result in overdose and toxicity,
,particularly when using hydrphillic drugs (which do not distribute into excess fat
tissue). This is because Drugs used in resuscitation are mostly hydrophilic
(adrenaline, calcium, potassium, salbutamol, magnesium, adenosine), with fewer
beng lipophilic (amiodarone). Therefore, it is important to adjust doses of most
resuscitation drugs in obesity.
The ABCDE assessment - ANSWER -Behaviour: appearance, abnormal tone,
reduced interactions, abnormal look/gaze, anormal speech/cry, apnoea/gasping
Body: circulation to skin, pallor, mottling, cyanosis
Breathing: work of breathing, abnormal sounds, abnormal position,
recession/retraction, nasal flaring, apnoea/gasping
· If unresponsive, use tactile stimulation. If they respond by speaking or crying,
this means they have a patent airway, are breathing and have cerebral perfusion
Causes of airway obstruction - ANSWER -- Congenital abnormality (eg. choanal
atresia, Pierre-Robin syndrome)
- Secretions (eg. vomit, blood)
- Respiratory tract infections (swelling or mucus secretions)
- Pharyngeal swelling (eg. oedema, infection)
- Epiglottitis
- Laryngotracheobronchitis (croup)
- Nasal feeding tubes
- Oxygen delivery devices (eg. nasal cannulae)
- Foreign body (eg. food, toy, orthodontic appliances)
- CNS depression (loss of muscle tone): head trauma, metabolic disorders eg,
hypoglycaemia, hypercapnia, alcohol and medications eg. opiates, benzodiazepines
- Trauma (facial or throat)
Recognition of upper airway obstruction - ANSWER -Look for visible
obstruction, listening and feeling for air entry and/or added sounds
There may also be signs indicating difficulty in breathing and/or increased
respiratory effort
,Management of upper airway obstruction - ANSWER -Basic, airway opening
manoeuvres (eg. head tilt, chin lift, or jaw thrust)
Nasopharyngeal or oropharyngeal arway
Tracheal tube insertion, supraglottic airway, or cricothyroidotomy.
A cricothyroidotomy will provide temporary oxygenation until a definitive airway
can be achieved.
- Feeding should be avoided, and any fever should be treated to reduce increased
metabolic demand.
Recognition of respiratory failure - ANSWER -RF is defined as the failure of the
respiratory system to maintain an arterial oxygen level (PaO2) >9 kPa, with 21%
inspired O2 (room air) and/or an arterial CO2 level of <6.5 kPa.
PaO2 of 9 kPa corresponds to a peripheral oxygen saturation of 90%
Warning signs of respiratory failure: - ANSWER -Decreased level of
consciousness
Hypotonia (floppiness)
Decreased respiratory effort
Cyanosis or extreme pallor despite supplemental oxugen
Sweating
Bradycardia
pulse oximetry error - ANSWER -Presence of other haemoglobins
carboxyhaemoglobin (carbon monoxide poisoning) and methaemoglobin
(congenital or acquired).
Surgical and imaging dyes: methylene blue, indocyanine green, and indigo can
cause falsely low saturation readings.
Nail varnish high-ambient light levels (fluorescent and xenon lamps)
Motion artefact
Reduced pulse volume:
, What do we aim for once oxygen therapy has started - ANSWER -aim for sats
between 94-98% (or 3% below the known SpO2 baseline of infants with pre-
existing chronic conditions).
When giving supplemental oxygen, sustained SpO2 readings of 100% should
generally be avoided (except in specific circumstances such a carbon monoxide
poisoning).
Central cyanosis ((lips, mouth, mucosal membranes - ANSWER -Appears when
the SpO2 is <80%, A LATE SIGN // PRE-TERMINAL SIGN
Compensated circulatory failure
Signs - ANSWER -(may have a normal blood pressure)
Tachycardia (heart rate rises to maintain cardiac output)
Poor skin perfusion (prolonged cap refill)
Weak peripheral pulse
Tachyonoea
Reduced urine output
Decompensated circulatory failure, Present when hypotension develops
Warm shock= - ANSWER -child appears to be well perfused but there is shock
present
cardiac output - ANSWER -HR x SV
Recognition of circulatory failure - ANSWER -Heart rate
Pulse volume
Capillary refill time
Blood pressure
Filling pressure (liver size in infants or jugular vein filling in older children)
End organ perfusion status
How much of an infants total circulating volume is lost before hypovolaemia
occurs - ANSWER -40% of the infant/child's total circulating volume can be lost
before hypotension occurs
Practice Questions Answer Key with
Solution 2026/ 2027 Edition
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
Cardiac output - ANSWER -CO is the product of stroke volume and heart rate,
and so the high cardiac outputs in infants and young children are primarily
achieved by rapid heart rates.
MAP - ANSWER -MAP = CO X SVR
Mean arterial pressure (MAP) is influenced by both cardiac output and systemic
vascular resistance. Because of this, changes in SVR can make MAP an unreliable
indicator of cardiac output alone.
MAP calclation in acute settings - ANSWER -MAP (mmHg) = [(2 × diastolic) +
systolic] / 3
Disability - what things to assess - ANSWER -AVPU score or the Glasgow coma
scale
Assess pupils, size and reaction, posture, muscle tone and any focal signs to
determine neurological status
Estimating weight in children with normal BMI - ANSWER -actual body weight
should be used- as it will closely align with ideal body weight.
Estimating weight in children with HIGH BMI - ANSWER -ideal body weight
should be used, as using actual body weight may result in overdose and toxicity,
,particularly when using hydrphillic drugs (which do not distribute into excess fat
tissue). This is because Drugs used in resuscitation are mostly hydrophilic
(adrenaline, calcium, potassium, salbutamol, magnesium, adenosine), with fewer
beng lipophilic (amiodarone). Therefore, it is important to adjust doses of most
resuscitation drugs in obesity.
The ABCDE assessment - ANSWER -Behaviour: appearance, abnormal tone,
reduced interactions, abnormal look/gaze, anormal speech/cry, apnoea/gasping
Body: circulation to skin, pallor, mottling, cyanosis
Breathing: work of breathing, abnormal sounds, abnormal position,
recession/retraction, nasal flaring, apnoea/gasping
· If unresponsive, use tactile stimulation. If they respond by speaking or crying,
this means they have a patent airway, are breathing and have cerebral perfusion
Causes of airway obstruction - ANSWER -- Congenital abnormality (eg. choanal
atresia, Pierre-Robin syndrome)
- Secretions (eg. vomit, blood)
- Respiratory tract infections (swelling or mucus secretions)
- Pharyngeal swelling (eg. oedema, infection)
- Epiglottitis
- Laryngotracheobronchitis (croup)
- Nasal feeding tubes
- Oxygen delivery devices (eg. nasal cannulae)
- Foreign body (eg. food, toy, orthodontic appliances)
- CNS depression (loss of muscle tone): head trauma, metabolic disorders eg,
hypoglycaemia, hypercapnia, alcohol and medications eg. opiates, benzodiazepines
- Trauma (facial or throat)
Recognition of upper airway obstruction - ANSWER -Look for visible
obstruction, listening and feeling for air entry and/or added sounds
There may also be signs indicating difficulty in breathing and/or increased
respiratory effort
,Management of upper airway obstruction - ANSWER -Basic, airway opening
manoeuvres (eg. head tilt, chin lift, or jaw thrust)
Nasopharyngeal or oropharyngeal arway
Tracheal tube insertion, supraglottic airway, or cricothyroidotomy.
A cricothyroidotomy will provide temporary oxygenation until a definitive airway
can be achieved.
- Feeding should be avoided, and any fever should be treated to reduce increased
metabolic demand.
Recognition of respiratory failure - ANSWER -RF is defined as the failure of the
respiratory system to maintain an arterial oxygen level (PaO2) >9 kPa, with 21%
inspired O2 (room air) and/or an arterial CO2 level of <6.5 kPa.
PaO2 of 9 kPa corresponds to a peripheral oxygen saturation of 90%
Warning signs of respiratory failure: - ANSWER -Decreased level of
consciousness
Hypotonia (floppiness)
Decreased respiratory effort
Cyanosis or extreme pallor despite supplemental oxugen
Sweating
Bradycardia
pulse oximetry error - ANSWER -Presence of other haemoglobins
carboxyhaemoglobin (carbon monoxide poisoning) and methaemoglobin
(congenital or acquired).
Surgical and imaging dyes: methylene blue, indocyanine green, and indigo can
cause falsely low saturation readings.
Nail varnish high-ambient light levels (fluorescent and xenon lamps)
Motion artefact
Reduced pulse volume:
, What do we aim for once oxygen therapy has started - ANSWER -aim for sats
between 94-98% (or 3% below the known SpO2 baseline of infants with pre-
existing chronic conditions).
When giving supplemental oxygen, sustained SpO2 readings of 100% should
generally be avoided (except in specific circumstances such a carbon monoxide
poisoning).
Central cyanosis ((lips, mouth, mucosal membranes - ANSWER -Appears when
the SpO2 is <80%, A LATE SIGN // PRE-TERMINAL SIGN
Compensated circulatory failure
Signs - ANSWER -(may have a normal blood pressure)
Tachycardia (heart rate rises to maintain cardiac output)
Poor skin perfusion (prolonged cap refill)
Weak peripheral pulse
Tachyonoea
Reduced urine output
Decompensated circulatory failure, Present when hypotension develops
Warm shock= - ANSWER -child appears to be well perfused but there is shock
present
cardiac output - ANSWER -HR x SV
Recognition of circulatory failure - ANSWER -Heart rate
Pulse volume
Capillary refill time
Blood pressure
Filling pressure (liver size in infants or jugular vein filling in older children)
End organ perfusion status
How much of an infants total circulating volume is lost before hypovolaemia
occurs - ANSWER -40% of the infant/child's total circulating volume can be lost
before hypotension occurs
