Pediatrics

Pediatric Cardiac Arrest (PALS) Algorithm

Weight-based shocks and drugs

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Each step lists what to do, then the choices that lead on. In the app the algorithm is tapped through one decision at a time.

1 Start CPR

Compressions 100–120/min, one-third of chest depth; 15:2 with two rescuers
Oxygen, monitor/defibrillator, IV/IO

Shockable (VF/pVT) → step 2 Asystole/PEA → step 3

2 Shock 2 J/kg, CPR 2 minutes

Second shock 4 J/kg; later shocks 4–10 J/kg (max 10 J/kg or adult dose)
Epinephrine 0.01 mg/kg IV/IO (0.1 mL/kg of 0.1 mg/mL) every 3–5 minutes
Amiodarone 5 mg/kg (repeat up to 3 times) or lidocaine 1 mg/kg

Rhythm not shockable → step 3 ROSC → step 4

3 CPR, epinephrine as soon as possible

Epinephrine 0.01 mg/kg every 3–5 minutes
Treat causes: hypoxia is the most common in children
Advanced airway: 1 breath every 2–3 seconds (20–30/min)

Rhythm shockable → step 2 ROSC → step 4

4 After ROSC

SpO₂ 94–99%; normal PaCO₂
Treat hypotension (below 5th percentile for age)
Avoid fever; continuous EEG if comatose

End of this path.

Drugs in this algorithm

Amiodarone

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