Pediatric Assessment
Not publishedof exam
Respiratory Emergencies
Not publishedof exam
Pediatric Shock
Not publishedof exam
BLS, Arrest and Rhythms
Not publishedof exam
Post-Arrest Care
Not publishedof exam
Access and Medications
Not publishedof exam
Team and Course Skills
Not publishedof exam
Quick Facts
- Course
- AHA PALS Provider
- Science
- 2025 AHA/AAP guidelines
- Written
- Open-resource; minimum 84%
- Skills
- Child and infant BLS tests
- Cases
- One cardiac; one respiratory/shock
- Role
- Team member or team leader
- Card
- Two-year completion eCard
- Topic weights
- Not published by AHA
- Written length
- Current public count not specified
Pediatric Assessment Triangle
PAT: appearance, breathing, skin circulation
AppearanceBreathing workSkin circulation
Initial Pediatric Response
- Unsafe scene→Protect team and child(Call for help)
- Unresponsive; no normal breathing→Check pulse ≤10 seconds(Activate emergency response)
- No pulse felt→Start high-quality CPR(Attach AED/monitor)
- Pulse; inadequate breathing→Ventilate every 2–3 seconds(Reassess pulse)
- Threat detected during PAT→Treat immediately(Continue primary assessment)
Assessment Loop
- PAT
- Appearance, breathing, skin circulation
- Appearance
- Tone and interaction clues
- Breathing work
- Effort, sounds, posture
- Skin circulation
- Pallor, mottling, cyanosis
- Primary assessment
- Airway, breathing, circulation, disability, exposure
- Secondary assessment
- Focused history and examination
- Reassessment
- Evaluate after each intervention
- Immediate threat
- Treat before exhaustive diagnosis
Distress vs Respiratory Failure
Distress
- Work increased
- Effort maintained
- Watch progression
Failure
- Exchange inadequate
- Effort may fall
- Ventilation support urgent
Quiet can mean worse
Respiratory Problem Picker
- Stridor; croup pattern→Give corticosteroid(Assess severity)
- Moderate/severe croup→Consider nebulized epinephrine(Monitor response)
- Wheeze; lower-airway pattern→Assess airflow and oxygenation(Treat cause)
- Quiet effort; poor appearance→Support ventilation urgently(Possible respiratory failure)
- Severe responsive infant FBAO→Five back blows/thrusts(Heel-of-hand chest thrusts)
Respiratory Clues
- Distress
- Increased effort; compensation remains
- Failure
- Poor exchange or exhausted effort
- Stridor
- Consider upper-airway obstruction
- Wheeze
- Consider lower-airway obstruction
- Quiet chest
- May signal severe airflow failure
- Croup steroid
- Use corticosteroid treatment
- Moderate/severe croup
- Consider nebulized epinephrine
- Humidified mist
- Not evidence-based croup treatment
Airway and FBAO
- Pulse; inadequate breathing
- Ventilate every 2–3 seconds
- Bag-mask ventilation
- Visible chest rise, avoid overventilation
- Advanced airway
- Confirm ETT with exhaled CO₂
- Severe infant FBAO
- Five back blows, five chest thrusts
- Infant chest thrust
- Heel of one hand
- Unresponsive infant FBAO
- Start CPR; inspect visible object
- Severe child FBAO
- Five back blows, five abdominal thrusts
Shock Loop
BOLUS: begin, observe, look, update, stop
Begin indicated aliquotObserve perfusionLook for overloadUpdate planStop if harm
Compensated vs Hypotensive Shock
Compensated
- Poor perfusion
- Pressure may remain
- Treat before collapse
Hypotensive
- Pressure falls
- Late decompensation
- Immediate escalation
Normal pressure cannot exclude shock
Shock Type Picker
- Perfusion poor; pressure preserved→Recognize compensated shock(Treat early)
- Septic shock→Give 10 or 20mL/kg(Reassess each aliquot)
- Fluid-refractory septic shock→Consider vasoactive infusion(Epinephrine or norepinephrine)
- Cardiogenic signs→Use fluid caution(Assess pump function)
- Hemorrhage suspected→Control bleeding(Tailor resuscitation)
Shock Clues
- Compensated shock
- Perfusion impaired; pressure may persist
- Hypotensive shock
- Late decompensation
- Hypovolemic
- Suspect volume loss
- Distributive
- Vasodilation; consider sepsis
- Cardiogenic
- Pump dysfunction; fluid caution
- Obstructive
- Relieve mechanical cause
- Perfusion markers
- Mentation, pulses, capillary refill
- Trend
- Recheck after each action
Septic Fluids
- Septic shock
- 10 or 20 mL/kg aliquots
- Each aliquot
- Reassess response and overload
- Fluid choice
- Isotonic crystalloid or colloid
- Fluid-refractory sepsis
- Epinephrine or norepinephrine infusion
- Cardiogenic physiology
- Avoid automatic large boluses
- Hemorrhagic shock
- Control bleeding; tailored resuscitation
- Fluid overload
- Watch worsening oxygenation
CPR Quality
RATE: recoil, airway, tempo, exchange
Recoil fullyAirway supportTempo 100–120Exchange compressors
VF/pVT vs PEA/Asystole
VF/pVT
- Shockable
- Defibrillate
- Resume CPR
PEA/asystole
- Nonshockable
- CPR plus epinephrine
- Treat reversible causes
Rhythm determines shock
Rhythm Decision
- VF or pulseless VT→Defibrillate 2 J/kg first(4 second; later capped)
- PEA or asystole→CPR plus epinephrine(No defibrillation)
- HR <60 with compromise→CPR after effective ventilation(Treat cause)
- Unstable tachycardia with pulse→Synchronized cardioversion(0.5–1 then 2 J/kg)
- Stable probable SVT→Vagal manoeuvre; adenosine(Rapid push and flush)
CPR Ratios
- One rescuer
- 30:2 before advanced airway
- Two; prepuberty
- 15:2 before advanced airway
- Two; postpuberty
- 30:2 before advanced airway
- Compression rate
- 100–120/min
- Compression depth
- At least one-third AP chest diameter
- Pause
- Keep under 10 seconds
- Advanced airway CPR
- Continuous compressions; breath every 2–3s
- Compressor switch
- About every two minutes
Prepuberty vs Postpuberty CPR
Two rescuers; prepuberty
- 15:2
- No advanced airway
- Pediatric ratio
Two rescuers; postpuberty
- 30:2
- No advanced airway
- Adult ratio
Puberty changes ratio
Arrest and Rhythms
- VF/pVT
- Shockable arrest
- Asystole/PEA
- Nonshockable arrest
- First shock
- 2 J/kg teaching dose
- Second shock
- 4 J/kg
- Later shock
- ≥4 J/kg; cap applies
- Shock ceiling
- 10 J/kg or adult maximum
- Shock action
- Resume CPR immediately
- Rhythm reassessment
- About every two minutes
Defibrillation vs Cardioversion
Defibrillation
- Pulseless VF/pVT
- Unsynchronized shock
- 2 then 4 J/kg
Synchronized cardioversion
- Unstable tachycardia; pulse
- Synchronized shock
- 0.5–1 then 2 J/kg
Pulse and rhythm determine mode
Bradycardia and Tachyarrhythmia
- Bradycardia first
- Support airway and ventilation
- HR <60; compromise persists
- CPR after effective oxygenation/ventilation
- Atropine indication
- Vagal tone or primary AV block
- Stable probable SVT
- Consider vagal maneuvers
- Unstable tachycardia
- Synchronized cardioversion
- Cardioversion initial
- 0.5–1 J/kg
- Cardioversion repeat
- 2 J/kg if ineffective
- Regular monomorphic wide
- Adenosine only with expert context
Post-ROSC Oxygen Sources
2025 AHA guideline
- May target 94–99%
- Underlying condition matters
- Wean from hyperoxia
2025 AHA checklist
- 94–98% or normal baseline
- Practical care target
- Separate source document
Do not conflate ranges
After ROSC
- Reliable oximetry available→Titrate oxygen appropriately(Guideline 94–99%)
- Known lower baseline→Use child-specific target(Checklist permits baseline)
- Blood pressure low→Support perfusion(SBP/MAP >10th percentile)
- Comatose post-arrest child→Prevent temperature >37.5°C(Central monitoring)
- Seizure suspected→Evaluate and treat(Avoid early single-test prognosis)
Post-ROSC Targets
- 2025 oxygen guideline
- 94–99% if appropriate; titrate
- 2025 care checklist
- 94–98% or child baseline
- Ventilation
- Target condition-appropriate normocapnia
- Systolic and MAP
- Above age tenth percentile
- Comatose child
- Monitor central temperature continuously
- Temperature
- Avoid central >37.5°C
- Seizures
- Monitor and treat
- Prognosis
- Use multimodal, serial assessment
Drug Doses
- Arrest epinephrine IV/IO
- 0.01 mg/kg; 0.1 mg/mL
- Epinephrine maximum
- 1 mg per dose
- Epinephrine interval
- Every 3–5 minutes
- Adenosine first IV/IO
- 0.1 mg/kg; maximum 6 mg
- Adenosine repeat IV/IO
- 0.2 mg/kg; maximum 12 mg
- Adenosine delivery
- Rapid push, then flush
- Arrest amiodarone first IV/IO
- 5 mg/kg; maximum 300 mg
- Arrest amiodarone repeats
- 5mg/kg; maximum 150mg per repeat
- Arrest lidocaine IV/IO
- 1 mg/kg alternative
- Drug calculation
- Verify weight and concentration
Team Communication
LOOP: lead, order, observe, playback
Lead rolesOrder clearlyObserve completionPlayback confirmation
Written vs Hands-On Completion
Written
- Open-resource
- Minimum 84%
- Cognitive component
Hands-on
- Child/infant BLS
- Two core scenarios
- Team member or leader
Both components required
Team Actions
- Leader
- Assign roles; maintain overview
- Closed loop
- Order, repeat, perform, confirm
- Dose readback
- Weight, dose, route, timing
- Recorder
- Track shocks, drugs, times
- Constructive intervention
- State specific safety concern
- Two-minute rhythm check
- Pause <10s; summarize during CPR
- Debrief
- Identify improvements without blame
Course Checklist
- Learning stations
- Participate as required
- Written assessment
- Open-resource; at least 84%
- Child BLS
- One- and two-rescuer skills
- Infant BLS
- One- and two-rescuer skills
- Cardiac case
- Pass team scenario
- Respiratory/shock case
- Pass team scenario
- Case role
- Leader or member accepted
- Completion card
- Valid two years
Common Traps
Puberty changes ratio
Two rescuers prepuberty: 15:2 ≠ Two rescuers postpuberty: 30:2
Epinephrine cap
Arrest dose: 0.01mg/kg IV/IO ≠ Maximum: 1mg per dose
Shock escalation
First: 2; second: 4J/kg ≠ Later: ≥4; capped 10J/kg/adult
Sepsis bolus scope
Septic shock: 10 or 20mL/kg ≠ Not every shock: automatic 20mL/kg
Croup therapy
Corticosteroid; nebulized epinephrine if moderate/severe ≠ Humidified mist lacks evidence
Infant choking
Five back blows/chest thrusts ≠ No infant abdominal thrusts
Post-ROSC oxygen
Guideline: 94–99% if appropriate ≠ Checklist: 94–98% or baseline
Course completion
84% written is one component ≠ Skills and two cases also required
Last Minute
- 1.No official PALS topic weights
- 2.ILT written: open-resource, minimum 84%
- 3.Pass child and infant BLS skills
- 4.Pass cardiac plus respiratory/shock cases
- 5.Prepuberty two-rescuer CPR: 15:2
- 6.Postpuberty two-rescuer CPR: 30:2
- 7.Shock: 2→4→≥4J/kg; max10J/kg-or-adult
- 8.Arrest epinephrine: 0.01mg/kg; max 1mg
- 9.Adenosine: 0.1→0.2 mg/kg; caps 6→12mg
- 10.Septic bolus: 10 or 20mL/kg
- 11.Reassess after every septic bolus
- 12.Infant FBAO: 5back-blows; 5chest-thrusts
- 13.Croup: steroid; neb epi for moderate–severe
- 14.Post-ROSC oxygen: check source range
Third-party resources · We may earn a commission from purchases.
Pediatric Advanced Life Support (PALS)Updated exam MANUAL Study Guide: All-in-One Test Prep with 3,500 Practice Questions and Prep for the Certification Course (The Complete Guide to Life Support)
By Ashley, Martin McDonough
$35.99 · 
Same family resources
Explore More AHA CPR & Resuscitation
Continue into nearby exams from the same family. Each card keeps practice questions, study guides, flashcards, videos, and articles in one place.
More From This Family
Videos and articles for deeper review.