This document provides guidelines for pediatric advanced life support (PALS). It outlines the systematic approach algorithm which begins with checking responsiveness, calling for help, and checking for a pulse. The BLS assessment evaluates consciousness, breathing, and skin color to determine if the child is unresponsive with no breathing. For infants and children under 8, CPR should be provided first before calling for help, while those over 8 receive phone assistance first before CPR. The guidelines describe performing CPR, providing oxygen, inserting airways, monitoring the child, establishing IV/IO access, administering adrenaline, and considering reversible causes and an advanced airway. The primary and secondary assessment evaluates the child's airway, breathing, circulation, and

1. PEDIATRIC ADVANCED LIFE SUPPORT

2. PALS Systematic Approach Algorithm
1. Check
responsiveness
2. Call for help
3. Check for a
pulse
4. PALS Cardiac
Arrest Algorithm
1
2
3
4
E-I-T

3. • The BLS Assessment is the first step that you
will take when treating any emergency
situation
• This initial impression of consciousness,
breathing, and color helps to answer the
following question:

4. “Is the child unresponsive with no
breathing or only gasping?”
• Consciousness:
– Unresponsive
– Irritable
– Alert
• Breathing
– Abnormal breath sounds
– Abnormal breathing patterns
– Accessory muscle use
• Color
– Cyanosis
– Pallor
– Mottling

5. Phone First vs Phone Fast
• Infants and Children < 8 years:
– CPR first, then
– Phone fast
– Exeption: apparent sudden cardiac collapse
• Children > 8 years and Adults:
– Phone first, then
– Provide CPR
– Exception: unresponsiveness w/t respiratory
compromise (submersion, trauma, drug overdose)

6. Check for a pulse
• Check the pulse in the infant using the
brachial artery on the inside of the upper arm
between the infant’s elbow and shoulder
• Check for pulse in child using the carotid
artery on the side of the neck or femoral pulse
on the inner thigh in the crease between the
leg and groin.

7. Position the victim
Head Tilt – Chin Lift Maneuver
Jaw – Thrust Maneuver
Open Airway

9. Ventilation and Oxygen

11. PALS Cardiac Arrest
Algorithm

12. Start CPR
5 components of high-quality CPR
• Adequate depth: ≥ 1/3 diameter of chest – 6cm
• Adequate rate: 100-120 beats/minute
• Full chest recoil
• Minimize interuptions
• Avoid excess ventilation
– One cycle CPR:
• 15:2 (no advanced airway)
• 5 cycles = 2 minutes
– If advanced airway
• 10 breaths per minute (1 breath every 6 secs)
Check rhythm every 2 minutes
– Rotate compressors every 2 minutes, rhythm checked

13. Give Oxygen
• Open the airway
• Provide basic ventilation
– Bag-mask ventilation
– ± Use of artificial airways (OPA and NPA)
Only use an OPA in unresponsive patients with NO cough or gag reflex
– Avoid hyperventilation
• Suction to maintain a clear airway
– 10 seconds or less

15. Inserting An Oropharyngeal Airway
1. Clear the mouth of blood or secretions with suction, if
possible.
2. Select an airway device that is the correct size for the
patient.
3. Place the device at the side of the patient’s face.
Choose the device that extends from the corner of
the mouth to the earlobe
4. Insert the device into the mouth so the point is
toward the roof of the mouth or parallel to the teeth
5. Once the device is almost fully inserted, turn it until
the tongue is cupped by the interior curve of the
device

16. Monitor

17. IV/IO access

18. Adrenaline
• Dose:
– IV/IO access:
• 0.1 mL/kg of 1:10.000 concentration
– Endotracheal dose:
• 0.1 mL/kg of 1:1.000 concentration
• Repeat every 3 – 5 minutes

19. Advanced Airway

20. Reversible Causes
• 5 H’s:
– Hypoxia
– Hypovolemia
– Hyper/Hypokalemia
– Hypothermia
– Hypoglycemia
• 5 T’s:
– Thrombosis
– Tension pneumothorax
– Tamponade
– Toxic
– Trauma

21. Part 1-Sequence: Evaluate
Primary Assessment
Maintainable
Unmaintainable
R Distress
R Failure
Compensated
Uncompensated
Alert
Voice
Pain
Unreponsive

22. A - Airway
• Is the airway open?
– This means open and unobstructed
– If yes, proceed to B (Breathing)
• Can the airway be kept open manually?
– Jaw Lift/ Chin Thrust
– Nasopharygeal or oropharygeal airway
• In an advanced airway required?
– Endotracheal intubation
– Cricothyrotomy, if necessary

23. B - Breathing
1. Respiratory Rate
2. Respiratory Effort and Mechanics
3. Air entry/Tidal volume
4. Skin color
Respiratory Distress: increased WOB
Respiratory Failure: Inadequate gas exchange
resulting in inadequate oxygenation and/or
ventilation (distress ±)

24. C – Circulation
• Cardiovascular function
– Responsiveness: AVPU
– Heart reat
– Pulse
– Blood pressure
• End-organ perfusion
– Brain
– Skin: temperature, capillary refill, color
– Kidney: 1 – 2 mL/kg/hr

25. Secondary assessment
• A search for underlying causes
- 4 H’s
- 4 T’s
• If possible a focused medical history
- SAMPLE: (S) Signs and symptoms
(A) Allergies
(M) Medications
(P) Past illnesses
(L) Last Oral Intake
(E) Events Leading Up To Present illness

26. Part 2-Sequence: Identify
• STABLE
• RESPIRATORY DISTRESS
• RESPIRATORY FAILURE
• SHOCK
• CARDIOPULMONARY FAILURE