PALS Megacode Scenario 1
By Gina Maria Jansheski, MD | Medically reviewed by Lisa Wright, MHA, RRT-NPS on March 17, 2025
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Question 1 of 9
1. Question
You are an emergency department physician trained in Pediatric Advanced Life Support (PALS). You are working in the pediatric emergency department when a mother brings her 4-year-old son into the ED.She reports that the child was playing with toys on the floor when the symptoms began. The child’s breathing is rapid and shallow.
You take vital signs and note that the child’s HR is 124 bpm, his respiratory rate is 32 breaths per minute, and his SpO2 is 88%.
1. The correct order of assessment for this child is:
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Question 2 of 9
2. Question
2. Based on your training in PALS, the subsequent intervention for this child should be:
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Question 3 of 9
3. Question
After several minutes of supplementary oxygen at 3 LPM via nasal cannula, the child’s SpO2 has increased to 100%.3. At this point, you should:
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Question 4 of 9
4. Question
During your assessment, you note that the child has inspiratory stridor, use of accessory muscles, and nasal flaring, particularly on inspiration.You also notice that the child has a harsh barking cough.
4. You suspect:
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Question 5 of 9
5. Question
You continue to monitor the child. He is awake and crying. He is afebrile. The cardiac monitor shows this rhythm:
5. You recognize this rhythm as:CorrectIncorrect -
Question 6 of 9
6. Question
You get a soft tissue X-ray of the neck to rule out foreign body aspiration. The X-ray is negative for a foreign body.6. The next intervention appropriate for this child is:
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Question 7 of 9
7. Question
As you continue to monitor the child, his breathing slows to 8 breaths per minute. His breath sounds are diminished.The SpO2 decreases to 88%.
7. Your next intervention is to:
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Question 8 of 9
8. Question
You decide to intubate the child using a cuffed tube.8. The correct size of ET tube for this 4-year-old child would be:
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Question 9 of 9
9. Question
9. The correct depth of insertion of an ET tube for a 4-year-old child would likely be:
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PALS Megacode Scenario 1 Video
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