PALS QUESTIONS & ANSWERS
Core Case Cardiac 1: SVT with pulses present ✔️✔️Admin high-flow O2, re-assess
AED, Vitals (cardiac rhythm = SVT with adequate perfusion)
S/sx resp distress, SVT, adequate perfusion
Vascular access, labs, ABGs, chest x-ray
TX: Vagal (ice on face), admin Adenosine (0.1 mg/kg) plus second dose (0.2 mg/kg) if needed,
sync cardioversion (0.5-1 j/kg) if needed
Monitor for heart failure
Not Shockable Rhythms ✔️✔️PEA
Asystole
Core Case Cardiac 3: Asystole/PEA ✔️✔️CPR, re-assess every 2 mins
Bag-mask ventilation with 100% O2, consider oropharyngeal airway
AED/Vitals (cardiac rhythm = asystole) NO SHOCK
S/sx cardiac arrest
Vascular access, labs, ABGs
TX: CPR, Admin Epi (0.01 mg/kg) during CPR every 3-5 mins, consider reversible H&T's
Prepare for death if cause not identified/rhythm stabilized
Core Case Cardiac 4: VF/Pulseless VT ✔️✔️CPR, re-assess every 2 min
Bag-mask 100% O2, consider oropharyngeal airway
, AED/Vitals (cardiac rhythm = VF)
S/sx cardiac arrest, VF, pulseless VT
Defib/shock (2 j/kg), re-assess
If VF continues, defib/shock again (4 j/kg)
Vascular access (IO may be best route), labs, ABGs
TX: CPR, Defib/shock, admin Epi (0.01 mg/kg) anytime after 2nd rhythm check repeating every
3-5 mins, admin Amiodarone (5 mg/kg) for persistent VF/pulseless VT up to 2 doses
Titrate O2 to maintain 94-99%
Post resuscitation care
Algorithm: Pediatric Tachycardia, Pulse Present, Poor Perfusion ✔️✔️Airway, assess with
breathing if needed, oxygen
Cardiac monitor, BP, oximetry, IV access
ECG, evaluate QRS
--Wide:
Possible VT
If Cardiopulmonary Compromise: Sync Cardioversion
If not: Adenosine, Amiodarone
--Narrow:
If Sinus Tachy: search for and treat cause
If SVT: Vagal, Adenosine, Sync Cardioversion
Atropine (increases HR) ✔️✔️Bradycardia
Core Case Cardiac 1: SVT with pulses present ✔️✔️Admin high-flow O2, re-assess
AED, Vitals (cardiac rhythm = SVT with adequate perfusion)
S/sx resp distress, SVT, adequate perfusion
Vascular access, labs, ABGs, chest x-ray
TX: Vagal (ice on face), admin Adenosine (0.1 mg/kg) plus second dose (0.2 mg/kg) if needed,
sync cardioversion (0.5-1 j/kg) if needed
Monitor for heart failure
Not Shockable Rhythms ✔️✔️PEA
Asystole
Core Case Cardiac 3: Asystole/PEA ✔️✔️CPR, re-assess every 2 mins
Bag-mask ventilation with 100% O2, consider oropharyngeal airway
AED/Vitals (cardiac rhythm = asystole) NO SHOCK
S/sx cardiac arrest
Vascular access, labs, ABGs
TX: CPR, Admin Epi (0.01 mg/kg) during CPR every 3-5 mins, consider reversible H&T's
Prepare for death if cause not identified/rhythm stabilized
Core Case Cardiac 4: VF/Pulseless VT ✔️✔️CPR, re-assess every 2 min
Bag-mask 100% O2, consider oropharyngeal airway
, AED/Vitals (cardiac rhythm = VF)
S/sx cardiac arrest, VF, pulseless VT
Defib/shock (2 j/kg), re-assess
If VF continues, defib/shock again (4 j/kg)
Vascular access (IO may be best route), labs, ABGs
TX: CPR, Defib/shock, admin Epi (0.01 mg/kg) anytime after 2nd rhythm check repeating every
3-5 mins, admin Amiodarone (5 mg/kg) for persistent VF/pulseless VT up to 2 doses
Titrate O2 to maintain 94-99%
Post resuscitation care
Algorithm: Pediatric Tachycardia, Pulse Present, Poor Perfusion ✔️✔️Airway, assess with
breathing if needed, oxygen
Cardiac monitor, BP, oximetry, IV access
ECG, evaluate QRS
--Wide:
Possible VT
If Cardiopulmonary Compromise: Sync Cardioversion
If not: Adenosine, Amiodarone
--Narrow:
If Sinus Tachy: search for and treat cause
If SVT: Vagal, Adenosine, Sync Cardioversion
Atropine (increases HR) ✔️✔️Bradycardia
