👶 Pediatric Advanced Life Support (PALS)

SHA PALS Guidelines - Interactive Pediatric CPR Algorithm

Source: SHA PALS Provider Manual 2022

This resource follows the official Saudi Heart Association PALS guidelines for pediatric resuscitation.

📏 Pediatric Age Groups & Vital Signs

Infant (0-1 year)

HR: 100-190 bpm

RR: 30-60/min

SBP: 70-100 mmHg

Weight: 3-10 kg

Child (1-8 years)

HR: 80-150 bpm

RR: 20-30/min

SBP: 80-110 mmHg

Weight: 10-25 kg

Adolescent (8-18 years)

HR: 60-100 bpm

RR: 12-20/min

SBP: 90-140 mmHg

Weight: 25-70 kg

🎯 Key Pediatric Differences

Cardiac arrest is usually secondary to respiratory failure or trauma
Quality compressions are crucial - deliver for ≥60% of resuscitation time
Two-person CPR ratio: 15:2 (not 30:2 like adults)
All medications are weight-based dosages
Defibrillation energy: 2 J/kg, then 4 J/kg

🔄 Pediatric CPR Algorithm

1

Scene Safety & Pediatric Assessment Triangle (PAT)
Check scene safety, assess Appearance, Work of Breathing, Circulation

2

Primary Assessment (ABCDE)
Airway, Breathing, Circulation, Disability, Exposure

3

Begin CPR Immediately
15:2 ratio (2 rescuers), 30:2 (1 rescuer), 100-120 compressions/min

4

Attach Monitor/Defibrillator
Check for shockable rhythm as soon as possible

5

Establish IV/IO Access
Give epinephrine 0.01 mg/kg every 3-5 minutes

⚡ Pediatric Rhythm Analysis & Treatment

Shockable Rhythms (VF/pVT)

⏱️ Every 2 minutes

Energy: 2 J/kg → 4 J/kg → 4-10 J/kg (max 10 J/kg)

Shock → CPR 2 min → Rhythm check → Epinephrine → Amiodarone

Non-Shockable Rhythms (PEA/Asystole)

⏱️ Every 2 minutes

CPR 2 min → Rhythm check → Epinephrine → Treat reversible causes

💊 Pediatric Medications (Weight-Based)

Epinephrine

0.01 mg/kg IV/IO every 3-5 minutes

First-line vasopressor for all pediatric cardiac arrest rhythms. Give as soon as IV/IO access established.

Amiodarone

5 mg/kg IV/IO bolus (may repeat up to 2 times)

For VF/pVT unresponsive to defibrillation. Give after 3rd shock.

Atropine

0.02 mg/kg IV/IO (min 0.1 mg, max 0.5 mg)

For symptomatic bradycardia with increased vagal tone. Repeat once if needed.

✅ Pediatric Critical Checkpoints

🎯 Pediatric Compression Quality

Rate: 100-120 compressions per minute
Depth: 1/3 anterior-posterior diameter of chest
Ratio (2 rescuers): 15:2 (without definitive airway)
Ratio (1 rescuer): 30:2
Minimize interruptions: <10 seconds
Allow full recoil: Complete chest release

🫁 Pediatric Ventilation Quality

15:2 compression-to-ventilation ratio (2-rescuer pediatric CPR)
30:2 ratio for single rescuer
Each breath: 1 second, visible chest rise
Avoid hyperventilation - can decrease cardiac output
Consider advanced airway after failed initial attempts

⏰ Pediatric Time-Critical Actions

0-2 min: Begin CPR, attach monitor/AED

2-4 min: First rhythm check, shock if indicated (2 J/kg)

4-6 min: Epinephrine 0.01 mg/kg, advanced airway consideration

6-8 min: Second rhythm check, amiodarone if VF/pVT

Every 2 min: Rhythm check, medication timing

🔍 Pediatric Reversible Causes (H's and T's)

H's

Hypovolemia
IV fluids 20 mL/kg bolus, blood products if hemorrhagic

Hypoxia
Oxygenation, ventilation, treat underlying cause

Hydrogen ions (Acidosis)
Sodium bicarbonate 1 mEq/kg if prolonged arrest

Hyperkalemia/Hypokalemia
Calcium 20 mg/kg, insulin, albuterol

Hypothermia
Warming measures, avoid hyperthermia

T's

Toxins
Specific antidotes, naloxone for opioids

Tamponade (Cardiac)
Pericardiocentesis, emergency consultation

Tension Pneumothorax
Needle decompression, chest tube placement

Thrombosis (Coronary)
Fibrinolytics, PCI if available

Thrombosis (Pulmonary)
Anticoagulation, embolectomy

🏥 Pediatric Post-Cardiac Arrest Care

🎯 Immediate Goals

Optimize cardiopulmonary function and perfusion
Transport to appropriate pediatric facility
Identify and treat precipitating causes
Control temperature (avoid hyperthermia)
Optimize ventilation and oxygenation
Monitor and treat seizures

Targeted Temperature Management

32-36°C for 12-24 hours

For comatose pediatric patients after ROSC from VF/pVT or other rhythms.

✓

Continuous Pediatric Monitoring
12-lead ECG, arterial blood gas, chest X-ray, laboratory studies, glucose monitoring

SHA PALS Key Principles

• Quality compressions are the cornerstone of successful resuscitation (≥60% time)
• Respiratory emergencies are most frequent life-threatening pediatric emergencies
• Bradycardia is almost always symptomatic in pediatrics
• Cardiac arrest is secondary to respiratory failure or trauma in children
• All medications and interventions are weight-based