AHA PALS EXAMINATION SCRIPT 2025/2026 QUESTIONS
WITH SOLUTIONS GRADED A+
✔✔Epinephrine Dosage & Indications - ✔✔Symptomatic Bradycardia - Pulseless Arrest:
0.01mg/kg IV/IO q3-5min
0.1mg/kg if ETT (no IV/IO)
Hypotensive Shock:
0.1-1mcg/kg/min IV/IO gtt
IM Anaphylaxis:
IM Autoinjector 0.15mg <30kg, 0.30mg if >30kg
✔✔Dextrose Dosage & Indications - ✔✔Hypoglycemia
0.5-1g/kg IV/IO (D25W 2-4ml/kg, D10W 5-10ml/kg)
✔✔Lidocaine Dosage & Indications - ✔✔VF/VT (w/o pulse), wide tachycardia w/ pulse
1mg/kg IV/IO bolus
20-50mcg/kg/min IV/IO gtt
2-3mg/kg ETT (no IV/IO)
✔✔Norepinephrine Dosage & Indications - ✔✔Hypotensive (distributive shock)
0.1-2mcg/kg/min IV/IO gtt, titratable
✔✔Naloxone Dosage & Indications - ✔✔Narcotic (opiate) reversal
Total reversal: 0.1mg/kg IV/IO/IM/Subq q 2min, max 2mg
Partial reversal: 1-5mcg/kg IV/IO/IM/Subq
Maintain reversal: 0.002-0.16mg/kg/hour IV/IO gtt
✔✔Tachycardia Wide QRS - ✔✔>0.09 sec is wide complex QRS for PALS
✔✔Sinus Tachycardia Limits/Characteristics/Treatment if Stable - ✔✔<200 for infants
<180 children
Rate Variability, identified cause (fever, hypovolemia)
Treat the cause
✔✔SVT Limits/Characteristics/Treatment if Stable - ✔✔>= 220 infants
>= 180 children
No P waves, abrupt onset, no rate variability
Vagal Maneuvers
IV/IO Adenosine
, ✔✔SVT (w/ QRS aberrancy) Wide QRS - ✔✔Rare in PALS
R-R regular
Uniform QRS
Tough to tell from VT
IV/IO Adenosine
✔✔Ventricular Tachycardia (VT) Wide QRS - ✔✔Underlying heart disease
Expert consultation
Treat Cause
Consider Amiodarone, Procainimide, Adenosine, Electrical cardioversion
✔✔Electrical Synchronized (SYNC) Cardioversion PALS - ✔✔0.5-1J/kg, if not effective,
2J/kg
Sedate if possible
✔✔If QRS Normal, Unstable, Pulse, Poor Perfusion - ✔✔IV/IO adenosine
Sync cardioversion if no access, or adenosine ineffective
✔✔If QRS Wide, Unstable, Pulse, Poor Perfusion - ✔✔Presume VT
Unstable? Hypotension, AMS, Shock
YES - Sync Cardioversion
NO - Adenosine if rhythm regular and uniform QRS & Then experts, amiodarone,
procainimide
✔✔A Fib or A Flutter PALS - ✔✔Procainimide may be helpful
Always get expert consultation
Consider sync cardioversion if acutely unstable, only definitive treatment for A Flutter
✔✔Lowest Acceptable SBP Ages 1-10 - ✔✔(Agex2)+70
✔✔Signs/Symptoms Worsening Pediatric Shock - ✔✔Worsening Tachycardia
Narrowing Pulse Pressure
Decreased LOC
Weakening Central Pulses
✔✔Early Shock Pulse Pressure Changes - ✔✔Increase SVR (vasoconstriction)
WITH SOLUTIONS GRADED A+
✔✔Epinephrine Dosage & Indications - ✔✔Symptomatic Bradycardia - Pulseless Arrest:
0.01mg/kg IV/IO q3-5min
0.1mg/kg if ETT (no IV/IO)
Hypotensive Shock:
0.1-1mcg/kg/min IV/IO gtt
IM Anaphylaxis:
IM Autoinjector 0.15mg <30kg, 0.30mg if >30kg
✔✔Dextrose Dosage & Indications - ✔✔Hypoglycemia
0.5-1g/kg IV/IO (D25W 2-4ml/kg, D10W 5-10ml/kg)
✔✔Lidocaine Dosage & Indications - ✔✔VF/VT (w/o pulse), wide tachycardia w/ pulse
1mg/kg IV/IO bolus
20-50mcg/kg/min IV/IO gtt
2-3mg/kg ETT (no IV/IO)
✔✔Norepinephrine Dosage & Indications - ✔✔Hypotensive (distributive shock)
0.1-2mcg/kg/min IV/IO gtt, titratable
✔✔Naloxone Dosage & Indications - ✔✔Narcotic (opiate) reversal
Total reversal: 0.1mg/kg IV/IO/IM/Subq q 2min, max 2mg
Partial reversal: 1-5mcg/kg IV/IO/IM/Subq
Maintain reversal: 0.002-0.16mg/kg/hour IV/IO gtt
✔✔Tachycardia Wide QRS - ✔✔>0.09 sec is wide complex QRS for PALS
✔✔Sinus Tachycardia Limits/Characteristics/Treatment if Stable - ✔✔<200 for infants
<180 children
Rate Variability, identified cause (fever, hypovolemia)
Treat the cause
✔✔SVT Limits/Characteristics/Treatment if Stable - ✔✔>= 220 infants
>= 180 children
No P waves, abrupt onset, no rate variability
Vagal Maneuvers
IV/IO Adenosine
, ✔✔SVT (w/ QRS aberrancy) Wide QRS - ✔✔Rare in PALS
R-R regular
Uniform QRS
Tough to tell from VT
IV/IO Adenosine
✔✔Ventricular Tachycardia (VT) Wide QRS - ✔✔Underlying heart disease
Expert consultation
Treat Cause
Consider Amiodarone, Procainimide, Adenosine, Electrical cardioversion
✔✔Electrical Synchronized (SYNC) Cardioversion PALS - ✔✔0.5-1J/kg, if not effective,
2J/kg
Sedate if possible
✔✔If QRS Normal, Unstable, Pulse, Poor Perfusion - ✔✔IV/IO adenosine
Sync cardioversion if no access, or adenosine ineffective
✔✔If QRS Wide, Unstable, Pulse, Poor Perfusion - ✔✔Presume VT
Unstable? Hypotension, AMS, Shock
YES - Sync Cardioversion
NO - Adenosine if rhythm regular and uniform QRS & Then experts, amiodarone,
procainimide
✔✔A Fib or A Flutter PALS - ✔✔Procainimide may be helpful
Always get expert consultation
Consider sync cardioversion if acutely unstable, only definitive treatment for A Flutter
✔✔Lowest Acceptable SBP Ages 1-10 - ✔✔(Agex2)+70
✔✔Signs/Symptoms Worsening Pediatric Shock - ✔✔Worsening Tachycardia
Narrowing Pulse Pressure
Decreased LOC
Weakening Central Pulses
✔✔Early Shock Pulse Pressure Changes - ✔✔Increase SVR (vasoconstriction)
