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PALS Self-Assessment ECG Rhythm Identification
Exam With Rationale 2023-2024 GRADED A+
PALS Self-Assessment
ECG Rhythm Identification Answer Sheet
Pediatric Rhythms (core PALS rhythms A to H; non-core rhythms I to M):
A. Normal sinus rhythm
B. Sinus tachycardia
C. Sinus bradycardia
D. Supraventricular tachycardia (SVT)
E. Wide-complex tachycardia; presumed ventricular tachycardia (monomorphic)
F. Ventricular fibrillation (VF)
G. Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine administration
J. Wide-complex tachycardia (in a child with known aberrant intraventricular conduction;
this is SVT with aberrant conduction)
K. First-degree AV block
L. Torsades de pointes (polymorphic ventricular tachycardia)
M. VF converted to organized rhythm after successful shock delivery (defibrillation)
Rhythms 1 to 8: Core PALS Rhythms (select single best answer from rhythms A to H)
Rhythm 1 (clinical clue: heart rate 214/min)
Correct answer is E: Wide-complex tachycardia; presumed ventricular tachycardia
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(monomorphic)
Pediatric ECG tip: Ventricular tachycardia is a sustained series of wide QRS complexes
(ie, ventricular depolarizations) typically at a rate of at least 120/min. This VT can be
further classified as monomorphic because all complexes have the same appearance. If
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this rhythm is observed in a child with no history of aberrant intraventricular conduction
and no aberrant conduction apparent on 12-lead ECG, the rhythm should be presumed
to be ventricular tachycardia.
For further information: see the PALS Provider Manual Chapter 6: Recognition
and Management of Bradyarrhythmias and Tachyarrhythmias and Chapter 7:
Recognition and Management of Cardiac Arrest.
Rhythm 2 (clinical clues: heart rate 44/min; no detectable pulses)
Correct answer is H: Pulseless electrical activity (PEA)
Pediatric ECG tip: In the absence of detectable pulses, this organized rhythm is one of
the cardiac arrest rhythms—Pulseless electrical activity (PEA) (PEA). It is treated using
the asystole/PEA portion of the PALS Pulseless Arrest algorithm. This particular rhythm
may be described as an idioventricular escape rhythm (an escape rhythm originating
from a slow ventricular pacemaker during periods of significant sinus bradycardia or
high-grade AV block). It is characterized by wide QRS complexes, and it is often seen in
the setting of a severely hypoxic-ischemic myocardium.
For further information: see the PALS Provider Manual Chapter 6: Recognition
and Management of Bradyarrhythmias and Tachyarrhythmias.
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Rhythm 3 (clinical clues: age 8 years; heart rate 50/min)
Correct answer is C: Sinus bradycardia.
Pediatric ECG tip: Sinus bradycardia is characterized by a sinus rhythm with a rate that
is slower than normal for the patient’s age. P waves and QRS complexes are usually
normal in appearance; the QRS is narrow.
For further information: see the PALS Provider Manual Chapter 6: Recognition
and Management of Bradyarrhythmias and Tachyarrhythmias.
Rhythm 4 (clinical clue: no detectable pulses)
Correct answer is G: Asystole
Pediatric ECG tip: Asystole is the absence of ventricular depolarization (ie, cardiac
standstill). It may be preceded by an agonal (usually wide-complex) bradyarrhythmia
(see an example of this in Rhythm 2). When you observe this rhythm in a child who is
unresponsive, apneic, and pulseless, you should begin compressions and ventilations
(CPR) immediately. Of course, if you are uncertain whether the rhythm is asystole,
confirm the flat-line rhythm in 2 perpendicular leads but do not delay CPR for an
unresponsive, apneic child.
PALS Self-Assessment ECG Rhythm Identification
Exam With Rationale 2023-2024 GRADED A+
PALS Self-Assessment
ECG Rhythm Identification Answer Sheet
Pediatric Rhythms (core PALS rhythms A to H; non-core rhythms I to M):
A. Normal sinus rhythm
B. Sinus tachycardia
C. Sinus bradycardia
D. Supraventricular tachycardia (SVT)
E. Wide-complex tachycardia; presumed ventricular tachycardia (monomorphic)
F. Ventricular fibrillation (VF)
G. Asystole
H. Pulseless electrical activity (PEA)
I. SVT converting to sinus rhythm with adenosine administration
J. Wide-complex tachycardia (in a child with known aberrant intraventricular conduction;
this is SVT with aberrant conduction)
K. First-degree AV block
L. Torsades de pointes (polymorphic ventricular tachycardia)
M. VF converted to organized rhythm after successful shock delivery (defibrillation)
Rhythms 1 to 8: Core PALS Rhythms (select single best answer from rhythms A to H)
Rhythm 1 (clinical clue: heart rate 214/min)
Correct answer is E: Wide-complex tachycardia; presumed ventricular tachycardia
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(monomorphic)
Pediatric ECG tip: Ventricular tachycardia is a sustained series of wide QRS complexes
(ie, ventricular depolarizations) typically at a rate of at least 120/min. This VT can be
further classified as monomorphic because all complexes have the same appearance. If
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this rhythm is observed in a child with no history of aberrant intraventricular conduction
and no aberrant conduction apparent on 12-lead ECG, the rhythm should be presumed
to be ventricular tachycardia.
For further information: see the PALS Provider Manual Chapter 6: Recognition
and Management of Bradyarrhythmias and Tachyarrhythmias and Chapter 7:
Recognition and Management of Cardiac Arrest.
Rhythm 2 (clinical clues: heart rate 44/min; no detectable pulses)
Correct answer is H: Pulseless electrical activity (PEA)
Pediatric ECG tip: In the absence of detectable pulses, this organized rhythm is one of
the cardiac arrest rhythms—Pulseless electrical activity (PEA) (PEA). It is treated using
the asystole/PEA portion of the PALS Pulseless Arrest algorithm. This particular rhythm
may be described as an idioventricular escape rhythm (an escape rhythm originating
from a slow ventricular pacemaker during periods of significant sinus bradycardia or
high-grade AV block). It is characterized by wide QRS complexes, and it is often seen in
the setting of a severely hypoxic-ischemic myocardium.
For further information: see the PALS Provider Manual Chapter 6: Recognition
and Management of Bradyarrhythmias and Tachyarrhythmias.
, @ 2023-2024
Rhythm 3 (clinical clues: age 8 years; heart rate 50/min)
Correct answer is C: Sinus bradycardia.
Pediatric ECG tip: Sinus bradycardia is characterized by a sinus rhythm with a rate that
is slower than normal for the patient’s age. P waves and QRS complexes are usually
normal in appearance; the QRS is narrow.
For further information: see the PALS Provider Manual Chapter 6: Recognition
and Management of Bradyarrhythmias and Tachyarrhythmias.
Rhythm 4 (clinical clue: no detectable pulses)
Correct answer is G: Asystole
Pediatric ECG tip: Asystole is the absence of ventricular depolarization (ie, cardiac
standstill). It may be preceded by an agonal (usually wide-complex) bradyarrhythmia
(see an example of this in Rhythm 2). When you observe this rhythm in a child who is
unresponsive, apneic, and pulseless, you should begin compressions and ventilations
(CPR) immediately. Of course, if you are uncertain whether the rhythm is asystole,
confirm the flat-line rhythm in 2 perpendicular leads but do not delay CPR for an
unresponsive, apneic child.
