Overview
Pediatric Advanced Life Support (PALS) is a systematic approach to managing pediatric cardiac arrest and other life-threatening emergencies. It provides structured algorithms for resuscitation based on the child's condition and response to interventions.
PALS is essential for managing pediatric emergencies including cardiac arrest, respiratory failure, and shock. Proper PALS implementation can significantly improve outcomes in critically ill children. This systematic approach ensures all team members work cohesively.
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Indications
Pediatric cardiac arrest requiring advanced life support
Severe respiratory distress not responding to basic interventions
Hypovolemic, cardiogenic, or distributive shock
Symptomatic bradycardia with poor perfusion
Symptomatic tachycardia with poor perfusion
Management after return of spontaneous circulation
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes assembling the resuscitation team, ensuring all PALS equipment is available and functional, preparing medications, and establishing clear communication protocols. All team members should understand their roles and the PALS algorithms.Step-by-Step Procedure
Step 1: Initial Assessment
Assess responsiveness, breathing, and circulation. Activate emergency response system. Begin CPR if needed. Assess for signs of life.
⚠️ Common Mistakes to Avoid:
- Delayed activation of emergency response
- Inadequate assessment of ABCs
- Poor quality CPR
💡 Pro Tip:
Remember CAB (Circulation, Airway, Breathing) for pediatric cardiac arrest.
Step 2: Basic Life Support
Provide high-quality chest compressions (100-120/min, depth 1/3 AP diameter). Give rescue breaths (15:2 ratio for 2 rescuers, 30:2 for single rescuer).
⚠️ Common Mistakes to Avoid:
- Inadequate compression depth
- Incorrect compression rate
- Poor ventilation technique
💡 Pro Tip:
Push hard and fast - allow full chest recoil between compressions.
Step 3: Advanced Airway
Establish advanced airway (endotracheal tube or supraglottic airway). Confirm placement. Secure airway. Continue compressions without interruption.
⚠️ Common Mistakes to Avoid:
- Interrupting compressions for airway
- Failure to confirm placement
- Poor airway securing
💡 Pro Tip:
Once advanced airway is in place, give breaths every 6 seconds without interrupting compressions.
Step 4: Vascular Access
Establish IV or IO access. Give medications as per PALS algorithms. Monitor for response to interventions.
⚠️ Common Mistakes to Avoid:
- Delayed vascular access
- Wrong medication doses
- Poor medication timing
💡 Pro Tip:
IO access is preferred if IV access is not immediately available.
Step 5: Rhythm Analysis
Analyze rhythm every 2 minutes. Shock if shockable rhythm (VF/pVT). Continue CPR between shocks. Administer medications as indicated.
⚠️ Common Mistakes to Avoid:
- Inadequate rhythm analysis
- Delayed defibrillation
- Poor post-shock CPR
💡 Pro Tip:
Minimize interruptions in chest compressions during rhythm analysis.
Step 6: Medication Administration
Give epinephrine every 3-5 minutes. Consider amiodarone for refractory VF/pVT. Treat reversible causes (Hs and Ts).
⚠️ Common Mistakes to Avoid:
- Wrong medication timing
- Incorrect doses
- Failure to address reversible causes
💡 Pro Tip:
Epinephrine is the primary medication for pediatric cardiac arrest.
Step 7: Post-Arrest Care
Once ROSC achieved, maintain airway, support circulation, control temperature, and address underlying cause. Monitor for complications.
⚠️ Common Mistakes to Avoid:
- Inadequate post-arrest monitoring
- Failure to address underlying cause
- Poor temperature management
💡 Pro Tip:
Post-arrest care is crucial for good neurological outcomes.
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Post-procedure Care
Post-resuscitation care involves stabilizing the patient, monitoring vital signs, addressing underlying causes, and providing appropriate intensive care. Documentation and debriefing are essential for quality improvement.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Failure to achieve ROSC | 60-70% | No return of spontaneous circulation | Continue PALS, consider termination criteria | High-quality CPR, early defibrillation |
| Hypoxic brain injury | 20-30% | Neurological deficits, coma | Therapeutic hypothermia, neuroprotective measures | Early CPR, good quality compressions |
| Myocardial dysfunction | 15-25% | Low cardiac output, hypotension | Inotropic support, fluid management | Minimize interruptions in CPR |
| Multi-organ failure | 10-20% | Organ dysfunction, poor perfusion | Supportive care, address underlying cause | Early recognition and treatment |
Clinical Pearls
Remember CAB (Circulation, Airway, Breathing) for pediatric cardiac arrest.
Push hard and fast - allow full chest recoil between compressions.
IO access is preferred if IV access is not immediately available.
Minimize interruptions in chest compressions during rhythm analysis.
Epinephrine is the primary medication for pediatric cardiac arrest.
Post-arrest care is crucial for good neurological outcomes.
Once advanced airway is in place, give breaths every 6 seconds without interrupting compressions.