PALS Questions & Answers: Updated A Plus Score
Guide Solution
pulses in kiddos - ANSWERcheck brachial in infant
carotid or femoral in child
position infant - ANSWERexternal ear canal level with top of infants shoulder
PAT ABC - ANSWERappearance, work of breathing, and circulation
TiCLS - ANSWERtone, interactiveness, consolability, look/gaze, speech/cry
Primary survey - ANSWERAirway, Breathing, Circulation, Disability, Exposure
Tidal volume - ANSWER5-7 mL/kg throughout life
Tachycardia - ANSWERHeart rate that is greater than 180/min in an infant or toddler
and greater than 160/min in a child older than 2 years of ae warrants further
assessment and may be a serious condition.
normal cap refill - ANSWER2 seconds or less
cuff size - ANSWER40% mid upper arm circumference
50-75% of length of upper arm
bp - ANSWERhypotension neonate <60
1-12 months <70
1-10 yo <70+agex2
AVPU - ANSWERAlert (15)
Responsive to Voice (13)
Responsive to pain (8)
Unresponsive (6)
Unilaterally dilated pupils with AMS - ANSWERIpsilateral (same side) uncle
herniation (lateral herniation of the temporal love, caused by increased intracranial
pressure)
hypoglycemia - ANSWERBS <45 in newly born
BS <60 in child
capillary blood gas - ANSWERarterialization of the capillary bed yields pH and PaCo2
comparable to arterial blood. A CBG analysis is useful for estimating arterial
oxygenation.
Normal SVo2 - ANSWER70-75%, assuming arterial O2 saturation is 100%
,Depth of chest compression - ANSWERAt least 2 inches in adults
Children 1 year to puberty at least 1/3 AP diameter of chest, about 2 inches
Infants At least 1/3, 1.5 inches
PETCO2 - ANSWERShould be greater than 10-15 mm Hg
ROSC over 40 mm hg
What meds can be administered by ET? - ANSWERLipid-soluble drugs-lidocaine,
epinephrine, atropine, and naloxone (LEAN) and vasopressin
ET dose of Epi is 10 times the IV/IO dose
ET dose of other drugs is 2-3 times the IV/IO
Technique for ET drug admin - ANSWERInstill the drug into the ET tube
Follow with a minimum of 5mL NS
Provide rapid positive pressure breaths after drug is instilled
Shock and VF - ANSWERIF shock eliminates VF, continue CPR because most have PEA
or systole after shock delivery
Wt and pads - ANSWER>10 kg use large adult paddles (8-13 cm)
<10 kg (<1 yr) small infant paddles (4.5 cm)
Cold? - ANSWERRewarm to at least 30 degrees C
Pulm HTN - ANSWERCorrect hypercarbia and acidosis
Bolus isotonic crystalloid
If pt receiving pulm vasodilators such as NO or prostacyclin immediately before the
arrest, be sure drug admin continues
Consider admin of inhaled NO or prostacyclin to reduce pulm vascular resistance
ECPR if instituted early during resuscitation
Single ventricle heart failure consideration - ANSWERHeparin admin for pts with
aortopulm or RV-pulm art shunt if shunt potency is concern
Titrate O2 to optimum puls to systemic blood flow ratio
Petco may not be reliable
Consider permissive hypoventilation or even negative pressure vent in periarrest
state to improve CO
Extracorporeal life support or extracoporeal membrane oxygenation may be
considered for pts in cardiac arrest who have undergone stage I palliation (Norwood)
or Fontan-type procedures
algorithm for septic shock - ANSWER
tx anaphylactic shock - ANSWER
, Bradycardia with a pulse algorithm - ANSWER
drug table for tachy - ANSWER
tachycardia with adequate perfusion algorithm - ANSWER
tachy with pulse and poor perfusion algorithm - ANSWER
ROSC Respiratory Failure - ANSWER
ROSC algorithm - ANSWER
Giving fluids in ROSC - ANSWER
Rhythm disturbance check - ANSWER
Vascular access check - ANSWER
Upper airway check - ANSWER
Lower airway check - ANSWER
Lung tissue disease check - ANSWER
Disordered control of breathing check - ANSWER
Hypovolemic shock check - ANSWER
Obstructive shock check - ANSWER
Distributive shock check - ANSWER
Cardiogenic shock check - ANSWER
SVT check - ANSWER
Bradycardia check - ANSWER
Asystole/PEA check - ANSWER
VF/Pulseless VT check - ANSWER
airway management check - ANSWER
Pals management of shock after ROSC algorithm - ANSWER
PALS vitals - ANSWER
Guide Solution
pulses in kiddos - ANSWERcheck brachial in infant
carotid or femoral in child
position infant - ANSWERexternal ear canal level with top of infants shoulder
PAT ABC - ANSWERappearance, work of breathing, and circulation
TiCLS - ANSWERtone, interactiveness, consolability, look/gaze, speech/cry
Primary survey - ANSWERAirway, Breathing, Circulation, Disability, Exposure
Tidal volume - ANSWER5-7 mL/kg throughout life
Tachycardia - ANSWERHeart rate that is greater than 180/min in an infant or toddler
and greater than 160/min in a child older than 2 years of ae warrants further
assessment and may be a serious condition.
normal cap refill - ANSWER2 seconds or less
cuff size - ANSWER40% mid upper arm circumference
50-75% of length of upper arm
bp - ANSWERhypotension neonate <60
1-12 months <70
1-10 yo <70+agex2
AVPU - ANSWERAlert (15)
Responsive to Voice (13)
Responsive to pain (8)
Unresponsive (6)
Unilaterally dilated pupils with AMS - ANSWERIpsilateral (same side) uncle
herniation (lateral herniation of the temporal love, caused by increased intracranial
pressure)
hypoglycemia - ANSWERBS <45 in newly born
BS <60 in child
capillary blood gas - ANSWERarterialization of the capillary bed yields pH and PaCo2
comparable to arterial blood. A CBG analysis is useful for estimating arterial
oxygenation.
Normal SVo2 - ANSWER70-75%, assuming arterial O2 saturation is 100%
,Depth of chest compression - ANSWERAt least 2 inches in adults
Children 1 year to puberty at least 1/3 AP diameter of chest, about 2 inches
Infants At least 1/3, 1.5 inches
PETCO2 - ANSWERShould be greater than 10-15 mm Hg
ROSC over 40 mm hg
What meds can be administered by ET? - ANSWERLipid-soluble drugs-lidocaine,
epinephrine, atropine, and naloxone (LEAN) and vasopressin
ET dose of Epi is 10 times the IV/IO dose
ET dose of other drugs is 2-3 times the IV/IO
Technique for ET drug admin - ANSWERInstill the drug into the ET tube
Follow with a minimum of 5mL NS
Provide rapid positive pressure breaths after drug is instilled
Shock and VF - ANSWERIF shock eliminates VF, continue CPR because most have PEA
or systole after shock delivery
Wt and pads - ANSWER>10 kg use large adult paddles (8-13 cm)
<10 kg (<1 yr) small infant paddles (4.5 cm)
Cold? - ANSWERRewarm to at least 30 degrees C
Pulm HTN - ANSWERCorrect hypercarbia and acidosis
Bolus isotonic crystalloid
If pt receiving pulm vasodilators such as NO or prostacyclin immediately before the
arrest, be sure drug admin continues
Consider admin of inhaled NO or prostacyclin to reduce pulm vascular resistance
ECPR if instituted early during resuscitation
Single ventricle heart failure consideration - ANSWERHeparin admin for pts with
aortopulm or RV-pulm art shunt if shunt potency is concern
Titrate O2 to optimum puls to systemic blood flow ratio
Petco may not be reliable
Consider permissive hypoventilation or even negative pressure vent in periarrest
state to improve CO
Extracorporeal life support or extracoporeal membrane oxygenation may be
considered for pts in cardiac arrest who have undergone stage I palliation (Norwood)
or Fontan-type procedures
algorithm for septic shock - ANSWER
tx anaphylactic shock - ANSWER
, Bradycardia with a pulse algorithm - ANSWER
drug table for tachy - ANSWER
tachycardia with adequate perfusion algorithm - ANSWER
tachy with pulse and poor perfusion algorithm - ANSWER
ROSC Respiratory Failure - ANSWER
ROSC algorithm - ANSWER
Giving fluids in ROSC - ANSWER
Rhythm disturbance check - ANSWER
Vascular access check - ANSWER
Upper airway check - ANSWER
Lower airway check - ANSWER
Lung tissue disease check - ANSWER
Disordered control of breathing check - ANSWER
Hypovolemic shock check - ANSWER
Obstructive shock check - ANSWER
Distributive shock check - ANSWER
Cardiogenic shock check - ANSWER
SVT check - ANSWER
Bradycardia check - ANSWER
Asystole/PEA check - ANSWER
VF/Pulseless VT check - ANSWER
airway management check - ANSWER
Pals management of shock after ROSC algorithm - ANSWER
PALS vitals - ANSWER
