© 2019 United Medical Education 1

INSTRUCTIONSforSkillsTesting:TheExamineristoreadthecasescenariosaloudtotheexaminee.Astheexamineeworksthrougheachstepinascenario,theexamineristomarkeachcorrespondingsteponthechecklistasCompleteorIncomplete.ItemsmarkedasCompletearetobeperformedcorrectlywithoutguidance.Iftheexamineeneedsguidancethroughastep,thestepmustbemarkedasIncompleteandtheskillstestshouldberepeated.Noadditionalguidanceshouldbegiventotheexamineebeyondtheinformationprovidedinitalics.Areasneedingimprovementshouldbereviewedbeforeretesting.Takeapproximately10minutestocompleteeachscenario.*HaveaPALSproviderwithcurrentcertificationadministerthetest.*RandomlyselectoneBLSscenariofortesting,andonerespiratoryarrestormegacodescenariofortesting.

© 2019 United Medical Education 2

BLSSCENARIO-Childover1yearSingleRescuerYouareadaycareprovidercaringforchildrenthatareplayingatapark.Suddenly,youwitnessa4-year-oldcollapsetotheground.

1. Examineesecuresthescene.(Sceneissafe)

2. Assessespatientresponsiveness.(Nopulsepresent,nobreathsobserved)

3. CallsforhelpandgetsAEDfirst,thenbeginsCPR.

4. DemonstratescorrectCPRhandplacement,onepalmorbothpalmsoneovertheother,on

lowersternumbetweenthenipples.

5. PerformssinglerescuerCPR:30compressions/2breathsfor5cycles(2min).

6. Demonstratescorrectcompressionrate,depthandcompletechestrecoil.

7. Opensairway,giveseffectivebreaths,andobservesvisiblechestrise.(Helparriveswithan

AED.)

8. DemonstratescorrectplacementofAEDpads.

9. Clearofthepatientduringrhythmanalysis/shock.

10. ContinuesCPRimmediatelyaftershockdelivery.

© 2019 United Medical Education 3

BLS - Skills Verification Checklist Skill Tested

Completed

Yes No

Establishesscenesafety.

Assessespatientresponsiveness(stimulate/speaktochild,check

breathing/pulse)

Collapsewitnessed:Callsemergencyresponse,getsAED,thenstartsCPR.

Demonstratescorrecthandplacement(oneorbothpalmsoneoverthe

other,onlowersternumbetweenthenipples.)

Delivers30compressions/2breathsover,5cycles(2min).

DemonstratescorrectCPRrate:(100-120/min.)anddepth(2inches).

Allowscompleterecoilofchestbetweencompressions.

Opensairwayappropriately(headtilt/chinlift,jawthrust).

Delivers2breathswithvisiblechestrise.

PerformscorrectAEDplacement.

Staysclearofpatientforrhythmanalysisandshock.

ImmediatelyresumesCPRaftershock.

© 2019 United Medical Education 4

BLSSCENARIO-Childover1yearTwoRescuersYouandafriendarewatchingchildrenplayinapublicpool.Thepoolisverybusywithseveralfamiliesswimming.Suddenlyyounoticea3-year-oldlyingfacedowninthepoolmotionless.

1. Establishesscenesafety.(Sceneissafe.)

2. Assesseschild’sresponsiveness.(Nopulsedetected.patientisnotbreathing.Thereare

severaladultstherereadytohelp.)

3. ExamineedirectsbystandertocallforhelpandgetAED,whileexamineebegins2provider

CPR.

4. DemonstratescorrectCPRhandplacement:onepalmorbothpalmsoneovertheother,on

lowersternumbetweenthenipples.

5. Provides15compressions/2breaths,for10cycles(2min).

6. Demonstratescorrectcompressionrate,depth,andallowsforcompletechestrecoil.

7. Opensairwayappropriately,andobservesvisiblechestrisewithbreaths.(Bystanderhas

returnedwithAED.)

8. Examineeswitchesrolewithsecondprovider.Secondprovidernowperformsopposite

role(compressionsorbreaths).

9. ExamineedemonstratescorrectplacementofAEDwithoutinterruption.

10. Examineedirectseveryonetobeclearofpatientduringrhythmanalysisandshock.

11. ContinuesCPRimmediatelyaftershockdelivered.

© 2019 United Medical Education 5

BLS - Skills Verification Checklist Skill Tested

Completed

Yes No

Establishesscenesafety.

Assessespatientresponsiveness.(Stimulatesandspeakstochild.Checksfor

breathingandapulse.)

DirectsbystandertocallemergencyresponseandgetAED,andbeginstwo-

providerCPR.

Demonstratescorrecthandplacement:oneorbothpalmsoneovertheother,

onlowersternumbetweenthenipples.

Performs15compressionsto2breathesfor10cycles(2min).

DemonstratescorrectCPRrate(100-120/min.)anddepth(2inches).

Allowscompleterecoilofchestbetweencompressions.

Opensairwayappropriately.(headtilt/chinliftorjawthrust-ifcervical

injuryisnotruledout)

Delivers2breathswhilewatchingforvisiblechestrise.

Providersswitchat2minutes.

CorrectlyplacesAEDwithoutdisruptingcompressions.

Staysclearofpatientforrhythmanalysisandshock.

ImmediatelyresumesCPRaftershock.

© 2019 United Medical Education 6

BLSSCENARIO-Infant0to1yearSingleRescuerYouarebabysittinga4-month-oldinfantthatislyinginhiscrib.Yougotoprepareabottleofmilkandwhenyoureturntheinfantappearstobeunresponsive.

1. Theexamineeshouldsecurethescene.(Sceneissafe)

2. Assessespatientresponsiveness.(Nopulsepresent,nobreathsobserved)

3. Commences2minCPRfirst,thencallsforhelp/getsAED.

4. DemonstratescorrectCPRhandplacement-twofingersoversternumofchest.

5. PerformssinglerescuerCPR:30compressions/2breathsfor5cycles.

6. Demonstratescorrectcompressionrate,depthandcompletechestrecoil.

7. Opensairway,giveseffectivebreaths,andobservesvisiblechestrise.(Helparriveswithan

AED)

8. DemonstratescorrectplacementofAEDpads.

9. Staysclearofthepatientduringtherhythmanalysisandshock.

10. ContinuesCPRimmediatelyaftershockdelivery.

© 2019 United Medical Education 7

BLS - Skills Verification Checklist Skill Tested

Completed

Yes No

Establishesscenesafety.

Assesspatientresponsiveness.(stimulatesandspeakstoinfant,check

breathingandpulse)

Collapseun-witnessed:Perform2minutesofCPRfirst,thencallsemergency

responseandretrievestheAED.

Demonstratescorrecthandplacement.(twofingersonsternumoflower

chest)

Delivers30compressionsto2breathsover5cycles(2minutes).

DemonstratescorrectCPRrate(100-120/min.)anddepth(1.5in.or1/3of

chest).

Allowscompleterecoilofchestbetweencompressions.

Airwayopenedappropriately(headtilt/chinlift,jawthrust).

Delivers2breathswithvisiblechestrise.

CorrectAEDplacementwithoutdisruptingcompressions.

Staysclearofpatientforrhythmanalysisandshock.

CPRimmediatelyresumedaftershock.

© 2019 United Medical Education 8

BLSSCENARIO-Infant0to1yearTwoProviderRescueYouandanothernursearegettingdinnerafterashiftwhenawomanyellsforhelp.Her3-montholdinfanthasbecomeunresponsive.

1. Establishesscenesafety.(Sceneissafe)

2. Assessesinfant’sresponsiveness.(Nopulsedetected,notbreathing)

3. ExamineedirectsmothertocallforhelpandgetAED,andproceedstoperformtwo-

providerCPR.

4. DemonstratescorrectCPRhandplacement,havingthehandsencircletheinfant’storso

withthumbsmidlineoversternum,1cmbelownippleline.

5. Gives15compressionsto2breathsfor10cycles.

6. Demonstratescorrectcompressionrate,depth,andallowsforcompletechestrecoil.

7. Opensairway,andobservesforvisiblechestrisewithbreathsgiven.(motherhasreturned

withAED).

8. Examineeswitchesroleswithsecondprovider.SecondprovidernowperformsCPR

compressions.

9. ExamineedemonstratescorrectplacementofAEDpads,withoutdisruptingcompressions.

10. Examineedirectseveryonetobeclearofpatientduringrhythmanalysisandshock.

11. ContinuesCPRimmediatelyaftershockdelivered.

© 2019 United Medical Education 9

BLS - Skills Verification Checklist Skill Tested

Completed

Yes No

Establishesscenesafety.

Assessespatientresponsiveness.(Stimulatesandspeakstoinfant.Checksfor

breathingandpulse.)

Startstwo-providerCPR.

Demonstratescorrecthandplacement(handsencircleinfant’storsowith

boththumbspositionedmidlineoverthesternum,1cmbelownipples.)

Performs15compressionsto2breathesfor10cycles(2min).

DemonstratescorrectCPRrate(100-120/min.)anddepth(1.5in.or1/3of

chest).

Allowsforcompleterecoilofthechestbetweencompressions.

Openstheairwayappropriately(headtilt/chinlift,jawthrust).

Delivers2breathswithvisiblechestrise.

ProvidersswitchCPRrolesat2minutes(10cycles).

PlacestheAEDpadsonthepatientcorrectly,withoutdisrupting

compressions.

Staysclearofpatientforrhythmanalysisandshock.

ResumesCPRimmediatelyaftershock.

© 2019 United Medical Education 10

RESPIRATORYARRESTSCENARIOYouarewatchinga2-year-oldthatissittingatthetableeatinggrapes.Afewmomentslateryounoticeheissilent,andappearscyanotic.

1. Assessesairway,breathing,andcirculation.(Patientunabletomakenoise,notbreathing,pulsepresent)

2. Distinguishesbetweencompleteandpartialairwayobstruction.3. Initiatesemergencyresponseandcallsforhelp.4. Recognizesneedforintervention:Heimlichmaneuver5. DemonstratesHeimlichmaneuvercorrectlybyplacingarmsaroundthepatient’swaist,

havingtheirhandoverfist,withthumbsideoffistabovenaval,andthenprovidesfastupwardabdominalthrusts.

YouareperformingtheHeimlichmaneuverbutthechildsuddenlybecomesunresponsive

6. BeginsCPRimmediately:singlerescuerCPR30:2ratio7. Priortorescuebreaths,checksforobstructioninpatient’smouth(After2cycles:You

noticethegrapeisnowvisibleinthemouth.)8. Removestheobstructionfromthepatient’smouth.9. ContinuesCPR.(Patientnowbreathingspontaneously,strongpulsepresent).10. Monitorspatientconditionuntilparamedicsarrive.

© 2019 United Medical Education 11

PALS Skills Verification Checklist - Airway Management Skill Tested

Completed

Yes No

Assessairway,breathing,andcirculation.

Identifiescompleteairwayobstruction.(abletodistinguishbetweenpartial

andcomplete)

Activatesemergencyresponseandcallsforhelp.

Identifiescorrectintervention:Heimlichmaneuver.

PerformsHeimlichmaneuvercorrectly:armsaroundwaist,handoverfist,

thumbsideoffistabovenaval,fastupwardabdominalthrusts.

BeginsCPRoncepatientbecomesunresponsive.

Checksforobstructioninmouthpriortogivingrescuebreaths.

Removesobstructiononceitisvisible.

ContinuesCPR.

Monitorspatientconditionuntilhelparrives.

© 2019 United Medical Education 12

PALSMEGACODE-TachyarrhythmiaAn11-year-oldboyisbroughtintotheERforheartpalpitations,shortnessofbreathandfeelingfatigued.

1. Evaluates/assessesairway,breathing,andcirculation.(Patientappearssluggishbutanswersquestions,increasedrespiratoryeffortandnasalflaring,coolskin.)

2. Performsimmediateinterventions:maintainairway,placecardiacmonitor,BPcuff,pulseox,givesupplementaloxygen,startIV,ECG.

Patient’svitalsigns:HR-210bpm,BP-84/62,RR-30/min,spO2-91%.Therhythmonthecardiacmonitorshowsthefollowing:

3. ShowexamineerhythmstripforSVT;AskexamineetoidentifybetweenwideornarrowQRS.

4. HaveexamineeidentifybetweensinustachycardiaandSVT.5. Haveexamineeidentifybetweenstableorunstable.

PatientisinSVTwithpoorperfusion.Cardioversionisnotimmediatelyavailable.Whatinterventionswillyouattemptfirst?

6. Attemptvagalmaneuversfirst.(Vagalmaneuversunsuccessful)7. Administersadenosine.Verbalizescorrectinitialdose-0.1mg/kg,max6mg.(Nochangein

patientconditionafterinitialdose)8. Administersseconddoseadenosine,verbalizes0.2mg/kg,max12mg.(Adenosineis

ineffective)9. Performssynchronizedcardioversion.Verbalizescorrectdose0.5-1J/Kg

Patienthasconvertedbacktonormalsinusrhythm

10. Reassesses/monitorspatientcardiopulmonarystatus.Evaluateforsignsofheartfailure,ECG,orderslabtests,etc.

© 2019 United Medical Education 13

PALS Skills Verification Checklist - Tachyarrhythmia Skill Tested

Completed

Yes No

Initialassessment:airway,breathingandcirculation

Initiatesappropriateinterventionsfortachyarrhythmia:

Maintainsairway,providessupplementaloxygen,placescardiacmonitor,

pulseox,BPcuff,initiatesIV,ECG

CorrectlyidentifiesnarrowQRS

CorrectlydistinguishesbetweensinustachycardiaandSVT

CorrectlydistinguishesbetweenstableorunstableSVT

Performsvagalmaneuvers

Administersadenosine,verbalizescorrectdoses.1stdose:.01mg/kg(6mg

max)2nddose:0.2mg/kg(12mgmax)

Performscardioversion,verbalizescorrectdose0.5-1J/Kg

Reassesses/monitorspatientstatuspost-conversion.

© 2019 United Medical Education 14

PALSMEGACODE-BradyarrhythmiaYourparamedicteamiscalledtothesceneofa7yea-oldgirlhavingaseizure.

1. Assessesairway,breathing,andcirculation.(Patientexhibitsdecreasedrespiratoryeffort,weakpulse,nonresponsive.)

2. Performsimmediateinterventions:maintainairway,givesupplementaloxygen,placecardiacmonitor,BPcuff,pulseox,startIV,placedefibpads.

Patient’svitalsigns:HR-44bpm,BP-84/52,RR-8/min,spO2-75%,Temp-99.9F.Cardiacmonitorshowsfollowingrhythm(showrhythmstripforsinusbradycardia)

3. Examineecorrectlyidentifiescardiacrhythmandpatientstateofhypoxemia.4. Identifiescorrectintervention:needforoxygenation/ventilationwithnon-rebreather

mask.

Despiteoxygenationandventilationpatientcontinuestohavepoorperfusion.Newvitals:HR-58,spO2-85%,BP-84/56.

5. IdentifiesCPRneededtotreatbradycardia,beginsCPR(Bradycardiapersists)6. PerformscorrectCPRratio15:2for10cycles(2min)7. Givesepinephrine.Verbalizescorrectdose-0.01mg/kg,every3-5min

Atrhythmcheckthereisnopulse,themonitorshowsthefollowingrhythm(showrhythmstripforVT)

8. Recognizespulselessarrestandidentifiesshockablerhythm.9. Deliversshock,verbalizescorrectdose-firstshock2J/kg10. Makessureeveryoneisclearofpatient.11. Continues2minCPR,immediatelyaftershock.(Whatinterventionmayyouconsider

duringCPR?Advancedairway)AtnextrhythmcheckpatienthasachievedROSC.

12. Identifiespost-arrestcare:optimizeventilation/oxygenation,identify/treatreversiblecausesH&T’s,considersfluidbolus,monitor/treatseizures.

© 2019 United Medical Education 15

PALS Skills Verification Checklist - Bradyarrhythmia Skill Tested

Completed

Yes No

Assessesairway,breathingandcirculation

Initiatesappropriateinterventions:Maintainsairway,providessupplemental

oxygen,placescardiacmonitor,pulseox,BPcuff,IV,defibpads

Correctlyidentifiessymptomaticbradycardia

Identifiescorrectimmediateintervention:oxygenation/ventilation

IdentifieswhenCPRisneededtotreatbradycardia

PerformscorrectCPRratio15:2for10cycles(2min)

GivesEpinephrine.Verbalizescorrectdose-0.01mg/kg

Recognizespulselessarrestandidentifiesshockablerhythm

Deliversshock,verbalizescorrectdose.Firstshock2J/kg

Ensuresclearofpatientbeforeadministeringshock

ContinuesCPRimmediatelyaftershock.Considersadvancedairway?

Identifiespost-arrestcare:optimizeventilation/oxygenation,identify/treatreversiblecausesH&T’s,considersfluidbolus,monitor/treatseizures.

© 2019 United Medical Education 16

MEGACODE RHYTHM STRIPS (Key is on the next page.) 1.

2.

3.

© 2019 United Medical Education 17

MEGACODE RHYTHM STRIPS KEY:

1. Supraventricular Tachycardia (SVT) 2. Ventricular Tachycardia – Monomorphic (VT) 3. Sinus Bradycardia

© 2019 United Medical Education 18

I, __________________________, the examiner, attest that I am currently certified in Pediatric Advanced Life support (PALS), and that the examinee has successfully completed all aspects of the PALS live skills test as provided by United Medical Education, in accordance with the current international CPR and ECC guidelines. Examinee Name: _______________________ Examinee Signature: __________________________ Date Signed: ______________ Examiner Name: ________________________ Examiner Signature: __________________________ Date Signed: ______________ Corresponding Provider Card Verification Number (VN): _____________________ This sheet is to be kept with the corresponding PALS provider card of the examinee.