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Excellent — the Harriet Lane Handbook gives definitive drug doses. Now I have everything needed to answer all four options.

Answer: Option 2 — Chest compression depth must be at least 1/3rd of the child's chest AP diameter ✅

Analysis of Each Option

Option 1 — Chest compressions at 30:2 with 2 rescuers ❌ FALSE

The 30:2 ratio applies to single rescuers (or when performing CPR on an infant/child without an advanced airway). With 2 or more healthcare providers, the ratio changes to 15:2 in paediatric patients. The 30:2 ratio in a 2-rescuer scenario applies only to adult CPR.
"The 2020 AHA Guidelines on pediatric BLS algorithms separated one-person from two-person or more health care provider CPR" — Miller's Anesthesia, 10e

Option 2 — Compression depth at least 1/3rd of AP chest diameter ✅ TRUE

This is the correct answer. The 2020 AHA guidelines explicitly state that for paediatric patients (birth to onset of puberty), chest compression depth should be at least one-third the anterior–posterior diameter of the chest — approximately:
  • ~4 cm (1.5 inches) in infants
  • ~5 cm (2 inches) in children
Compression rate: 100–120/min (same as adults).
"The pediatric chest compression depth recommendation of at least one-third of anterior–posterior chest depth (approximately 4 cm in infants and 5 cm in children) is based largely upon expert clinical consensus." — Miller's Anesthesia, 10e
"For both infants and children, compressions should be at least one-third the depth of the chest at a rate of 100 to 120/min." — Barash's Clinical Anesthesia, 9e

Option 3 — Adenosine via intraosseous (IO) is preferred over other methods ❌ FALSE

Adenosine should be administered via central IV or the most proximal IV access (closest to the heart), followed by rapid flush. This is because adenosine has an extremely short half-life (~10 seconds) and is rapidly degraded; peripheral IV or IO routes result in the drug being metabolised before reaching the heart.
  • Preferred route: Central venous or proximal/large peripheral IV with rapid bolus + flush
  • IO route is acceptable for many ACLS drugs, but not the preferred route for adenosine due to its ultrashort half-life
The Harriet Lane Handbook specifies adenosine administration: "0.1 mg/kg IV (max 6 mg) — administer with three-way stopcock rapid push/flush technique" — The Harriet Lane Handbook, 23rd ed.
IO is listed as a valid vascular access route generally, but adenosine specifically requires rapid central/proximal delivery.

Option 4 — Adrenaline (epinephrine) 0.01 mg/kg IV/IO in 1:1000 concentration ❌ FALSE

The dose is correct (0.01 mg/kg IV/IO), but the concentration is wrong. Epinephrine for IV/IO use in paediatric cardiac arrest is given as 1:10,000 concentration (0.1 mg/mL), NOT 1:1000 (1 mg/mL).
RouteConcentrationDose
IV/IO1:10,000 (0.1 mg/mL)0.01 mg/kg (max 1 mg)
Endotracheal (ET)1:1000 (1 mg/mL)0.1 mg/kg (max 2.5 mg)
"Epinephrine — Bolus: 0.01 mg/kg IV/IO (0.1 mg/mL, max 1 mg) or 0.1 mg/kg ET (1 mg/mL, max 2.5 mg). Repeat every 3–5 min as needed." — The Harriet Lane Handbook, 23rd ed.
The 1:1000 concentration is used for the endotracheal or IM/SC route (e.g., anaphylaxis). Using 1:1000 IV/IO would result in a 10× overdose and is dangerous.

Summary Table

OptionStatementVerdict
130:2 with 2 rescuers❌ 30:2 is for single rescuer; 2 rescuers use 15:2
2Depth ≥ 1/3 AP diameter✅ CORRECT
3Adenosine preferred via IO❌ Adenosine preferred via central/proximal IV
4Adrenaline 0.01 mg/kg in 1:1000❌ Correct dose, wrong concentration — should be 1:10,000
Sources: Miller's Anesthesia 10e; Barash's Clinical Anesthesia 9e; The Harriet Lane Handbook 23rd ed. (Johns Hopkins Hospital)
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