lOMoAR cPSD| 5079866
PALS
Pediatric Advanced Life Support Provider
Handbook
By Dr. Karl Disque
, lOMoAR cPSD| 5079866
TABLE of CONTENTS
Introduction to PALS............. 5
Chapter 1
The Resuscitation Team ............. 6
2
Basic Life Support ............. 8
3 BLS for Children (One year to puberty) – 9
One-Rescuer BLS for Children
Two-Rescuer BLS for Children
BLS for Infants (0 to 12 months) – 10
One-Rescuer BLS for Infants
Two-Rescuer BLS for Infants
Self-Assessment for BLS – 13
Pediatric Advanced Life Support ............. 14
4 Normal Heart Anatomy and Physiology – 14
PALS—A Systematic Approach – 15
Initial Diagnosis and Treatment – 16
Airway
Breathing
Circulation
Disability
Secondary Diagnosis and Treatment – 19
Life-Threatening Issues – 20
Self-Assessment for PALS – 21
Resuscitation Tools............... 22
5 Medical Devices – 22
Intraosseous Access
Bag-Mask Ventilation
Endotracheal Intubation
Basic Airway Adjuncts
Basic Airway Technique
Automated External Defibrillator (AED)
Pharmacological Tools – 28
Self-Assessment for Resuscitation Tools – 29
Respiratory Distress/Failure .............30
6 Recognizing Respiratory Distress/Failure – 30
Causes of Respiratory Distress/Failure
Responding to Respiratory Distress/Failure – 32
Self-Assessment for Respiratory Distress/Failure – 34
Bradycardia ............ 35
7 Recognizing Bradycardia – 35
Responding to Bradycardia – 36
Self-Assessment for Bradycardia – 38
, lOMoAR cPSD| 5079866
TABLE of CONTENTS
Chapter 8 Tachycardia .......... 39
Recognizing Tachycardia – 39
Narrow QRS Complex
Wide QRS Complex
Responding to Tachycardia – 42
Self-Assessment for Tachycardia – 43
9 Shock............. 44
Recognizing to Shock – 44
Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock
Responding to Shock – 47
Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock
Self-Assessment for Shock – 49
10 Cardiac Arrest ............. 50
Recognizing Cardiac Arrest – 50
Pulseless Electrical Activity and Asystole
Ventricular Fibrillation and Pulseless Ventricular Tachycardia
Responding to Cardiac Arrest – 52
11 Pediatric Post-Resuscitation Care ............. 55
Respiratory System – 55
Cardiovascular System – 56
Neurological System – 56
Renal System – 57
Gastrointestinal System – 57
Hematological System – 57
Self-Assessment for Pediatric Post Resuscitation Care – 59
12 PALS Essential ............. 60
13 Additional Tools ............. 61
MediCode – 61
CertAlert+ – 61
14 Review Questions .............. 62
, lOMoAR cPSD| 5079866
1 INTRODUCTION
TO PALS
The goal of Pediatric Advanced Life Support (PALS) is to save a life. For a child or infant experiencing
serious injury or illness, your action can be the difference between life and death. PALS is a series of
protocols to guide responses to life-threatening clinical events. These responses are designed to be
simple enough to be committed to memory and recalled under moments of stress. PALS guidelines
have been developed from thorough review of available protocols, patient case studies, and clinical
research; and they reflect the consensus opinion of experts in the field. The gold standard in the
United States and many other countries is the course curriculum published by the International
Liaison Committee on Resuscitation (ILCOR). Approximately every five years the ILCOR updates the
guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).
This handbook is based on the most recent ILCOR publication of PALS and will periodically compare
the previous and the new recommendations for a more comprehensive review.
Take Note
Any provider attempting to perform PALS is assumed to have developed
and maintained competence with not only the materials presented in this
handbook, but also certain physical skills, including Basic Life Support
(BLS) interventions. Since PALS is performed on children and infants,
PALS providers should be proficient in BLS for these age groups. While we
review the basic concepts of pediatric CPR, providers are encouraged to
keep their physical skills in practice and seek additional training if needed.
Proper utilization of PALS requires rapid and accurate assessment of the child or infant’s clinical
condition and selection and delivery of the appropriate intervention for the given situation. This not
only applies to the provider’s initial assessment of a child or an infant in distress, but also to the
reassessment throughout the course of treatment utilizing PALS guidelines.
PALS protocols assume that the provider may not have all of the information needed from the child
or the infant or all of the resources needed to properly use PALS in all cases. For example, if a
provider is utilizing PALS on the side of the road, they will not have access to sophisticated devices to
measure breathing or arterial blood pressure. Nevertheless, in such situations, PALS providers have
the framework to provide the best possible care in the given circumstances. PALS algorithms are
based on current understanding of best practice to deliver positive results in life-threatening cases
and are intended to achieve the best possible outcome for the child or the infant during
an emergency.
>> Next: The Resuscitation Team
PALS – Pediatric Advanced Life Support 5
PALS
Pediatric Advanced Life Support Provider
Handbook
By Dr. Karl Disque
, lOMoAR cPSD| 5079866
TABLE of CONTENTS
Introduction to PALS............. 5
Chapter 1
The Resuscitation Team ............. 6
2
Basic Life Support ............. 8
3 BLS for Children (One year to puberty) – 9
One-Rescuer BLS for Children
Two-Rescuer BLS for Children
BLS for Infants (0 to 12 months) – 10
One-Rescuer BLS for Infants
Two-Rescuer BLS for Infants
Self-Assessment for BLS – 13
Pediatric Advanced Life Support ............. 14
4 Normal Heart Anatomy and Physiology – 14
PALS—A Systematic Approach – 15
Initial Diagnosis and Treatment – 16
Airway
Breathing
Circulation
Disability
Secondary Diagnosis and Treatment – 19
Life-Threatening Issues – 20
Self-Assessment for PALS – 21
Resuscitation Tools............... 22
5 Medical Devices – 22
Intraosseous Access
Bag-Mask Ventilation
Endotracheal Intubation
Basic Airway Adjuncts
Basic Airway Technique
Automated External Defibrillator (AED)
Pharmacological Tools – 28
Self-Assessment for Resuscitation Tools – 29
Respiratory Distress/Failure .............30
6 Recognizing Respiratory Distress/Failure – 30
Causes of Respiratory Distress/Failure
Responding to Respiratory Distress/Failure – 32
Self-Assessment for Respiratory Distress/Failure – 34
Bradycardia ............ 35
7 Recognizing Bradycardia – 35
Responding to Bradycardia – 36
Self-Assessment for Bradycardia – 38
, lOMoAR cPSD| 5079866
TABLE of CONTENTS
Chapter 8 Tachycardia .......... 39
Recognizing Tachycardia – 39
Narrow QRS Complex
Wide QRS Complex
Responding to Tachycardia – 42
Self-Assessment for Tachycardia – 43
9 Shock............. 44
Recognizing to Shock – 44
Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock
Responding to Shock – 47
Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock
Self-Assessment for Shock – 49
10 Cardiac Arrest ............. 50
Recognizing Cardiac Arrest – 50
Pulseless Electrical Activity and Asystole
Ventricular Fibrillation and Pulseless Ventricular Tachycardia
Responding to Cardiac Arrest – 52
11 Pediatric Post-Resuscitation Care ............. 55
Respiratory System – 55
Cardiovascular System – 56
Neurological System – 56
Renal System – 57
Gastrointestinal System – 57
Hematological System – 57
Self-Assessment for Pediatric Post Resuscitation Care – 59
12 PALS Essential ............. 60
13 Additional Tools ............. 61
MediCode – 61
CertAlert+ – 61
14 Review Questions .............. 62
, lOMoAR cPSD| 5079866
1 INTRODUCTION
TO PALS
The goal of Pediatric Advanced Life Support (PALS) is to save a life. For a child or infant experiencing
serious injury or illness, your action can be the difference between life and death. PALS is a series of
protocols to guide responses to life-threatening clinical events. These responses are designed to be
simple enough to be committed to memory and recalled under moments of stress. PALS guidelines
have been developed from thorough review of available protocols, patient case studies, and clinical
research; and they reflect the consensus opinion of experts in the field. The gold standard in the
United States and many other countries is the course curriculum published by the International
Liaison Committee on Resuscitation (ILCOR). Approximately every five years the ILCOR updates the
guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).
This handbook is based on the most recent ILCOR publication of PALS and will periodically compare
the previous and the new recommendations for a more comprehensive review.
Take Note
Any provider attempting to perform PALS is assumed to have developed
and maintained competence with not only the materials presented in this
handbook, but also certain physical skills, including Basic Life Support
(BLS) interventions. Since PALS is performed on children and infants,
PALS providers should be proficient in BLS for these age groups. While we
review the basic concepts of pediatric CPR, providers are encouraged to
keep their physical skills in practice and seek additional training if needed.
Proper utilization of PALS requires rapid and accurate assessment of the child or infant’s clinical
condition and selection and delivery of the appropriate intervention for the given situation. This not
only applies to the provider’s initial assessment of a child or an infant in distress, but also to the
reassessment throughout the course of treatment utilizing PALS guidelines.
PALS protocols assume that the provider may not have all of the information needed from the child
or the infant or all of the resources needed to properly use PALS in all cases. For example, if a
provider is utilizing PALS on the side of the road, they will not have access to sophisticated devices to
measure breathing or arterial blood pressure. Nevertheless, in such situations, PALS providers have
the framework to provide the best possible care in the given circumstances. PALS algorithms are
based on current understanding of best practice to deliver positive results in life-threatening cases
and are intended to achieve the best possible outcome for the child or the infant during
an emergency.
>> Next: The Resuscitation Team
PALS – Pediatric Advanced Life Support 5
