PALS

What is the normal awake heart rate for a neonate?

100–205 beats per minute.

What is the normal respiratory rate for a neonate?

40–60 breaths per minute.

What is the normal awake heart rate for an infant?

100–180 beats per minute.

What is the normal respiratory rate for an infant?

30–53 breaths per minute.

What is the normal awake heart rate for a toddler?

98–140 beats per minute.

What is the normal respiratory rate for a toddler?

22–37 breaths per minute.

What is the normal awake heart rate for a preschooler?

80–120 beats per minute.

What is the normal respiratory rate for a preschooler?

20–28 breaths per minute.

What is the normal awake heart rate for a school‑aged child?

75–118 beats per minute.

What is the normal respiratory rate for a school‑aged child?

18–25 breaths per minute.

What is the normal awake heart rate for an adolescent?

60–100 beats per minute.

What is the normal respiratory rate for an adolescent?

12–20 breaths per minute.

What is the number‑one cause of bradycardia in pediatric patients?

Hypoxia.

What is the initial management for symptomatic bradycardia in children?

Provide oxygenation and ventilation

What is the epinephrine dose for pediatric bradycardia?

0.01 mg/kg (0.1 mL/kg of 1:10 000 solution) every 3–5 minutes.

What dose of atropine is used for pediatric bradycardia due to increased vagal tone or primary AV block?

0.02 mg/kg with a minimum dose of 0.1 mg.

What intervention should be considered if medications fail to treat pediatric bradycardia?

Transcutaneous pacing.

In SVT, what heart‑rate threshold signals treatment for infants versus children?

An infant heart rate >220 bpm or a child heart rate >180 bpm requires treatment.

What non‑pharmacologic maneuver is first used for stable SVT?

Vagal maneuvers such as bearing down, blowing through a straw or applying ice to the face.

What is the initial adenosine dose for pediatric SVT?

0.1 mg/kg rapid IV push (maximum 6 mg) followed by a 10–20 mL saline flush.

What is the second adenosine dose for persistent SVT?

0.2 mg/kg rapid IV push (maximum 12 mg)

How is unstable SVT treated?

Synchronized cardioversion beginning at 0.5–1 J/kg and increasing to 2 J/kg

What symptoms differentiate stable from unstable SVT?

Stable SVT may present with lightheadedness, dizziness or palpitations, whereas unstable SVT includes chest pain, difficulty breathing, decreased consciousness or hemodynamic instability.

What medication is used for stable monomorphic ventricular tachycardia with a pulse?

Amiodarone 5 mg/kg IV over 20–60 minutes (procainamide 15 mg/kg over 30–60 minutes may also be considered).

How is unstable ventricular tachycardia with a pulse managed?

Synchronized cardioversion at 0.5–1 J/kg, followed by 2 J/kg for subsequent shocks

When is ventricular tachycardia with a pulse generally treated?

When the heart rate is greater than 150 beats per minute.

What is the immediate action for pulseless ventricular tachycardia or ventricular fibrillation?

Begin CPR immediately.

What compression ratio is recommended for pediatric CPR with one rescuer versus two?

Use 30:2 for a single rescuer and 15:2 for two or more rescuers

What is the initial defibrillation energy for pediatric VF/pVT?

Deliver 2 J/kg followed by 4 J/kg, and subsequent shocks may remain at 4 J/kg or be escalated to 6–10 J/kg.

What is the epinephrine dose during pediatric cardiac arrest?

0.01 mg/kg (0.1 mL/kg of 1:10 000 solution) every 3–5 minutes.

When should amiodarone be given in VF/pulseless VT?

During the second round of CPR after epinephrine, at a dose of 5 mg/kg (repeatable up to two more times).

Which pediatric arrest rhythms are not defibrillated?

Asystole and pulseless electrical activity (PEA).

What are the key actions for pediatric asystole/PEA?

Immediately start CPR, give epinephrine 0.01 mg/kg every 3–5 minutes, consider an early advanced airway and search for reversible causes (H’s & T’s).

How is hypovolemia treated during cardiac arrest?

With fluid resuscitation.

What treatment corrects hypoxia as a reversible cause of arrest?

Oxygenation and ventilation.

How is acidosis (hydrogen‑ion excess) corrected during resuscitation?

Administration of sodium bicarbonate.

How is hyperkalemia addressed in cardiac arrest?

By giving calcium while managing electrolyte disturbances.

How is hypoglycemia corrected during a code?

Give intravenous dextrose.

How do you treat hypo‑ or hyperthermia during arrest?

By warming or cooling the patient as appropriate.

Which antidote is used for opiate toxicity causing arrest?

Naloxone (Narcan).

How is cardiac tamponade treated during arrest?

Pericardiocentesis.

What intervention treats tension pneumothorax as a reversible cause?

Needle decompression.

How is thrombosis treated when it causes cardiac arrest?

Administer fibrinolytics or perform clot removal.

How should trauma be managed as a cause of cardiac arrest?

By controlling bleeding and addressing injuries.

What signs suggest cardiogenic shock in children?

Tachycardia, hypotension, jugular venous distension and hepatomegaly.

What fluid bolus is used for cardiogenic shock?

5–10 mL/kg over 10–20 minutes.

Which medications are recommended for cardiogenic shock?

Dopamine at 10 mcg/kg/min and epinephrine at >0.3 mcg/kg/min.

What are the initial steps in managing cardiogenic shock?

Early recognition and oxygenation/ventilation.

What is the fluid strategy for hypovolemic shock in children?

Give 20 mL/kg boluses over 5–10 minutes, repeated up to three times (total 60 mL/kg).

What should be considered if a child doesn’t improve after three fluid boluses for hypovolemic shock?

Ongoing fluid loss or bleeding—consider switching to colloids or whole blood and evaluate for other causes of shock.

What is the most common cause of pediatric shock?

Hypovolemic shock, usually due to dehydration.

How is tension pneumothorax managed in obstructive shock?

With needle decompression.

How is cardiac tamponade managed in obstructive shock?

By performing pericardiocentesis and administering a 20 mL/kg fluid bolus over 5–10 minutes.

How is pulmonary embolism treated in obstructive shock?

Provide a 20 mL/kg fluid bolus over 5–10 minutes and consider thrombolytics or anticoagulants.

What is the first step in managing obstructive shock?

Identify and correct the underlying problem while ensuring oxygenation and ventilation.

What signs indicate anaphylactic shock?

Tachycardia, hypotension, bronchoconstriction, wheezing or stridor, hives and flushed skin.

What is the IM epinephrine dose for pediatric anaphylaxis?

0.15 mg via autoinjector or syringe.

When might a continuous epinephrine infusion be required for anaphylaxis?

In severe cases where symptoms persist after 10–15 minutes—start >0.05 mcg/kg/min.

What fluid bolus is recommended for anaphylactic shock?

20 mL/kg over 5–10 minutes.

What adjunct medications are used in anaphylactic shock?

Nebulized albuterol 2.5 mg, diphenhydramine 1 mg/kg (up to 25 mg) and corticosteroids like Solu‑Medrol or Decadron.

What are the first steps in managing anaphylactic shock?

Early detection and prompt oxygenation/ventilation.

What injury mechanism should raise concern for neurogenic shock?

A significant spinal cord injury.

What fluid bolus is recommended for neurogenic shock?

20 mL/kg over 5–10 minutes.

Which medications may be used for neurogenic shock?

Dopamine 10 mcg/kg/min and epinephrine <0.3 mcg/kg/min.

What are the initial management steps for neurogenic shock?

Early recognition, oxygenation and ventilation.

What clinical signs suggest septic shock in children?

Altered mental status, tachycardia, fever, low end‑tidal CO₂ and hypotension.

What is the fluid resuscitation range for septic shock?

10–20 mL/kg boluses (10 mL/kg for neonates or children with cardiovascular compromise).

What medications are used when fluids fail to stabilize septic shock?

Epinephrine or norepinephrine infusions and appropriate antibiotics.

What is the initial management for septic shock?

Early detection, oxygenation, ventilation and fluid resuscitation.

What signs suggest an upper airway obstruction?

Difficulty breathing, tachypnea, stridor, pale cool skin, cyanosis and anxiety.

How is croup managed?

With corticosteroids (Solu‑Medrol or Decadron), humidified oxygen, nebulized racemic epinephrine and high‑concentration oxygen or airway management.

How is anaphylactic upper airway obstruction treated?

Administer IM epinephrine 0.15 mg, nebulized albuterol 2.5 mg, corticosteroids, a 20 mL/kg fluid bolus and provide high‑concentration oxygen or airway management.

How is a foreign‑body airway obstruction managed in a responsive child?

Deliver five back blows followed by five chest thrusts

What signs indicate a lower airway obstruction?

Difficulty breathing, wheezing, prolonged expiratory phase, tachycardia, pale cool skin, cyanosis and anxiety.

What medication is used for bronchiolitis with wheezing?

Nebulized albuterol 2.5 mg in 3 mL.

What medications are given for an asthma exacerbation?

Albuterol (with or without ipratropium), corticosteroids, magnesium sulfate, intramuscular epinephrine for severe cases and terbutaline.

What is the overall management approach for lower airway obstruction?

Early detection, oxygenation, ventilation and appropriate medication therapy.

What signs suggest lung tissue disease in children?

Grunting, crackles, decreased breath sounds, tachypnea, pale cool skin and anxiety.

What ventilatory support is used for lung tissue disease?

Noninvasive or invasive ventilation with positive end‑expiratory pressure (PEEP).

What medications treat pneumonia and pulmonary edema?

Pneumonia is treated with albuterol and antibiotics

What presentation suggests disordered control of breathing?

Normal breath sounds with variable breathing rate or effort, cyanosis and anxiety.

How is ventilatory support provided for disordered control of breathing?

Use noninvasive or invasive ventilation with PEEP.

How is increased intracranial pressure managed during respiratory failure?

By avoiding hypoxemia, hypercarbia, hyperthermia and hypotension.

How should poisoning or overdose affecting breathing be managed?

Administer the appropriate antidote if available and contact poison control.

How are neuromuscular diseases affecting breathing managed?

With noninvasive or invasive ventilatory support.