📋 PALS Algorithms (AHA 2020) · Nelson Pediatrics Ch 79

BLS for Healthcare Providers (Single & Two Rescuer) | Bradycardia with a Pulse | Tachycardia with a Pulse | Cardiac Arrest Algorithm

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🫀 Fig 79.1 & 79.2 · BLS (Single & Two Rescuer)

1. Verify scene safety
2. Check responsiveness
└─ No response → shout for help, activate EMS
3. Check breathing & pulse (≤10 sec)
└─ No normal breathing, has pulse → Rescue breathing: 1 breath q3-5 sec (12-20/min)
└─ No normal breathing, no pulse → Start CPR
   ▸ Single rescuer: 30:2 compressions:ventilations
   ▸ Two rescuers (infant/child): 15:2 ratio
   ▸ Compression rate: 100-120/min | Depth: 1/3 AP diameter (~4 cm infant, 5 cm child)
4. After 2 minutes of CPR → Activate EMS (if not already), get AED
5. Use AED as soon as available (pediatric attenuator for <8 years)

🫀 Fig 79.11 · Bradycardia with a Pulse Algorithm

1. Identify: HR <60/min AND poor perfusion (hypotension, AMS, shock)
2. Support airway, breathing, oxygenation (100% O2), ventilation
└─ Persistent bradycardia with poor perfusion → Start CPR
   ▸ Epinephrine 0.01 mg/kg IV/IO q3-5 min
└─ If increased vagal tone or primary AV block → Atropine 0.02 mg/kg (min 0.1 mg, max 0.5 mg child / 1 mg adolescent)
└─ If refractory → Consider cardiac pacing
3. Identify and treat underlying cause (hypoxia, hypothermia, acidosis, toxins)

🫀 Fig 79.12 · Tachycardia with a Pulse Algorithm

1. Assess cardiopulmonary compromise (hypotension, AMS, shock)
└─ YES (unstable)
   ▸ Narrow QRS (≤0.09 sec): Synchronized cardioversion 0.5-1 J/kg
   ▸ Wide QRS (>0.09 sec): Synchronized cardioversion 0.5-1 J/kg
└─ NO (stable)
   ▸ Narrow QRS: Sinus tachycardia (treat cause) vs SVT → Vagal maneuvers, Adenosine 0.1 mg/kg (max 6 mg) rapid IV; second dose 0.2 mg/kg (max 12 mg)
   ▸ Wide QRS: Expert consult, consider adenosine (if monomorphic), amiodarone 5 mg/kg over 20-60 min

🫀 Fig 79.16 · Cardiac Arrest Algorithm

1. Start CPR (30:2 or 15:2) · Activate EMS · Get AED/Defibrillator
2. Rhythm check q2 min (≤10 sec pause)
└─ Shockable (VF/pVT) → Defibrillate 2 J/kg → Resume CPR → 2nd shock 4 J/kg → Epinephrine 0.01 mg/kg → 3rd shock → Amiodarone 5 mg/kg or Lidocaine 1 mg/kg
└─ Non-shockable (Asystole/PEA) → Continue CPR, Epinephrine q3-5 min → Identify/treat reversible causes (Hs & Ts)
3. Post-ROSC: maintain BP, SpO2 94-99%, normothermia (36-37.5°C), treat seizures

📋 30 MCQs — PALS Algorithms (BLS, Bradycardia, Tachycardia, Cardiac Arrest)

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