PALS algorithm is a specialized training program and set of clinical guidelines designed for healthcare providers who respond to emergencies involving infants and children. The goal of PALS is to improve the quality of care provided to seriously ill or injured pediatric patients, both in and out of the hospital, and to increase survival rates. The PALS Algorithm Guide plays a crucial role in guiding healthcare providers through the structured, step-by-step management of life-threatening emergencies in infants and children. It provides clear, evidence-based decision pathways for quickly assessing, identifying, and treating pediatric patients in critical situations like cardiac arrest, respiratory failure, or shock.
The Pediatric Post-Resuscitation Care Algorithm helps you know what to do after a child’s heart starts pounding again. It guides you step by step to keep them stable and safe. It’s like a care plan for their body and brain after CPR.
The Pediatric Cardiac Arrest Algorithm walks you through what to do when a child’s heart stops. It helps you quickly start CPR, give shocks if required, and use meds the right way. It’s your step-by-step guide in a life-threatening emergency.
The PALS Tachycardia Algorithm helps you handle a fast heart rate in a child. It directs you through checking if it's serious and what steps to take next. It’s your go-to technique for keeping calm and treating it the right way.
The Pediatric Post-Resuscitation Care Algorithm helps you know what to do after a child’s heart starts pounding again. It guides you step by step to keep them stable and safe. It’s like a care plan for their body and brain after CPR.
The Pediatric Septic Shock Algorithm shows you what to do when a child is in septic shock. It allows you to quickly assess, give fluids, and use medications to stabilize them. It’s a step-by-step plan to treat a serious infection and prevent it from getting worse.
The PALS Algorithm Guide is a lifesaver when every second counts in pediatric emergencies. It is important because of the following reasons:
To ensure healthcare providers deliver fast, consistent, and effective care during pediatric emergencies, the PALS protocols are followed. Here are key considerations while following the algorithm:
01.
The sooner you identify signs of distress, shock, or cardiac arrest in a child, the better the chances of a positive outcome. This includes watching for subtle signs like changes in breathing patterns, skin color, or level of consciousness. Early recognition allows for quicker intervention, potentially preventing the child’s condition from worsening into a more critical state.
02.
The PALS protocol follows a clear, organized sequence to ensure no important steps are overlooked. Start by assessing the initial impression (how the child looks and behaves), then move on to a primary assessment (using the ABCDE approach to check Airway, Breathing, Circulation, Disability, and Exposure). Afterward, conduct a secondary assessment, which involves gathering a more detailed history and performing a physical exam to look for specific causes of the child's condition. After that diagnostic assessment, which involves tests like ECG, Oxygen Saturation, Measurement of BP, and Sugar Level. Finally, Ongoing Assessment and Post-Resuscitation Care ensure continuous monitoring and recovery management. This systematic approach guarantees thorough evaluation and care at every stage.
03.
During pediatric resuscitation, high-quality CPR is vital. This means providing chest compressions at the right rate and depth (about 100-120 compressions per minute at a depth of 1/3 of the chest diameter), with minimal interruptions. Adjust compression techniques based on the child’s age,proper hand placement and ensuring full chest recoil between compressions.
04.
Effective communication within the team is crucial in any resuscitation effort. Use closed-loop communication (where instructions are repeated back and confirmed) to ensure everyone understands. This reduces mistakes and confusion, helping the team act swiftly and cohesively, which is especially important in high-stress situations like pediatric resuscitation.
05.
In the case of pediatric patients, dosages of medications, equipment sizes, and defibrillation energy need to be tailored to the child’s size. Since children come in many different sizes, it’s essential to adjust interventions based on age or weight to ensure safety and effectiveness. This includes calculating the correct medication doses and selecting the right-sized equipment for airway management and defibrillation.
06.
In the case of pediatric patients, dosages of medications, equipment sizes, and defibrillation energy need to be tailored to the child’s size. Since children come in many different sizes, it’s essential to adjust interventions based on age or weight to ensure safety and effectiveness. This includes calculating the correct medication doses and selecting the right-sized equipment for airway management and defibrillation.
07.
After successful resuscitation, the work isn’t over. Focus on stabilizing the child’s condition by optimizing factors like oxygen levels, blood pressure, glucose levels, and body temperature. Additionally, monitoring neurological status closely is essential to assess any potential brain injury or other complications. The aim is to prevent further deterioration and provide the best possible outcome in recovery.
08.
Ensure you have the correct pediatric-sized equipment and tools available for the procedure. This includes airway devices, defibrillator pads, and vascular access supplies. Using adult-sized equipment on children can be ineffective or even harmful, so it’s crucial to have the right tools for the right size of patient.
These PALS vital signs serve as a guideline to assess the child’s condition during an emergency or routine check-up and can help healthcare providers quickly identify any deviations from the norm that may indicate a medical issue.
| Age | Heart Rate | Respiratory Rate | Normal Blood Pressure |
| Neonatal (0-28 Days) | 70-190 bpm | 30-60 | Systolic 60-80 mmHg Diastolic 30-45 mmHg |
| Infant (1-12 Months) | 80-160 bpm | 30-60 | Systolic 72-104 mmHg Diastolic 37-56 mmHg |
| Toddler (1-2 Years) | 80-130 bpm | 24-40 | Systolic 90-105 mmHg Diastolic 55-70 mmHg |
| Preschool (3-5 Years) | 80-120 bpm | 22-34 | Systolic 95-110 mmHg Diastolic 56-70 mmHg |
| School Age (6-11 Years) | 70-120 bpm | 18-30 | Systolic 97 to 120 mmHg Diastolic 57 to 80 mmHg |
| Adolescents (12+ Years) | 60-100 bpm | 12-16 | Systolic Less than 120 mmHg Diastolic Less than 80 mmHg |
Notes:
Oxygen saturation, or SpO2 (%), indicates the percentage of hemoglobin in the arterial blood that is bound to oxygen. A normal SpO2 level is above 94% in children of all ages when breathing room air. Cyanosis ( bluish color in the skin,lips and nails) may occur when the saturation falls below 90%. Hypoxemia, or inadequate oxygen levels, is reflected by lower SpO2 readings.
The body temperature in children is kept within a narrow range, with a normal temperature ranging from 36-38°C (96.8-100.4°F). Hypothermia, defined as a temperature below 36°C, can increase the risk of mortality and make resuscitation more challenging. The PALS algorithm includes an evaluation for temperature abnormalities to quickly identify and manage these issues. On the other hand, hyperthermia (a temperature above 38.5°C) could indicate infection, neurological problems, or heat-related conditions.
The reversible causes (H’s and T’s) include:
