AHA PALS Algorithm

The AHA Pediatric Advanced Life Support (PALS) Algorithm is a step-by-step guide used by healthcare providers to recognize and treat serious heart- and breathing-related emergencies in infants and children. The PALS guidelines are updated regularly every 5 years by the American Heart Association by conducting evidence-based research on infants and children critical situation.

It helps medical teams quickly assess the patient’s condition, provide life-saving interventions, and make the right treatment decisions to improve outcomes. By following the PALS code algorithm, healthcare providers can respond in a clear, organized, and effective way during critical situations.

What is the Pediatric Advanced Life Support Algorithm?

The PALS algorithm is a systematic approach to providing pediatric life support. The Pediatric Algorithm is a guide from the American Heart Association (AHA) that helps healthcare providers treat serious emergencies in infants and children. Instead of being just one chart, PALS is made up of different algorithms, each focusing on a specific life-threatening condition.

Here’s a more detailed look at some of the core PALS algorithms:

PALS Tachycardia Algorithm
PALS Bradycardia Algorithm
Pediatric Septic Shock Algorithm
Pediatric Cardiac Arrest Algorithm
Pediatric Post-Resuscitation Care Algorithm: Return of Spontaneous Circulation (ROSC)

Breakdown of PALS Algorithm

PALS Tachycardia Algorithm

Pediatric tachycardia refers to the condition of a faster heartbeat rate, exceeding the upper limit of the normal rate for a child’s specific age group. This makes it essential to know the normal heart rate for children at first to determine if the child is tachycardic or not.

PALS Bradycardia Algorithm

Pediatric bradycardia refers to a heart rate that is slower than the normal range for a child’s age, differing among infants, younger children, to adolescents. It results from several causes that may be heart-related or other underlying issues, such as low oxygen level (hypoxia), hypothermia, hypotension, or electrolyte imbalance.

Pediatric Septic Shock Algorithm

Pediatric Cardiac Arrest Algorithm

The Pediatric Cardiac Arrest Algorithm is a clear, step-by-step guide to help healthcare providers treat children whose hearts have stopped or are beating dangerously. It focuses on checking the child’s airway, breathing, and circulation, performing high-quality CPR, using an AED when needed, and giving medicines to improve chances of survival.

Pediatric Post-Resuscitation Care Algorithm

Return of spontaneous circulation (ROSC) in the pediatric patient, a phase called post-resuscitation care starts, which requires more intensive and integrated care. A systematic and coordinated approach, called the Pediatric post-resuscitation care algorithm, has been introduced to facilitate this care.

Clinical Considerations in the PALS Protocol

In Pediatric Advanced Life Support (PALS), certain clinical considerations are vital for recognizing problems early, guiding treatment, and improving survival in critically ill or injured children. These include:

1. Hypotension (Low Blood Pressure): A major sign of shock and poor organ blood flow.

Infants: Systolic BP < 70 mmHg
Children (1–10 years): Systolic BP < 70 + (2 × age in years)
Treat by giving a 20 mL/kg fluid bolus over 5–10 minutes, reassess, and repeat as needed. If BP stays low, start vasoactive medications like dopamine or epinephrine.

2. Hemodynamic Monitoring: Continuously check heart rate, blood pressure, capillary refill, mental status, pulses, and extremity temperature.

Normal HR: 60–200 bpm (infants), 60–180 bpm (children)
Watch for dangerous arrhythmias and treat as necessary.

3. Airway, Breathing, and Circulation (ABCs): Always keep the airway clear and open, provide oxygen to support breathing, and assist with ventilation when necessary. If blood flow is weak or inadequate, support circulation by giving fluids and appropriate medications.

4. Differential Diagnosis: Identify all possible causes (e.g., sepsis, trauma, heart problems, metabolic disorders) so treatment addresses the root problem.

5. Advanced Airway Management: If basic airway methods are not enough, use advanced techniques such as intubation to secure the airway and ensure effective oxygen delivery and ventilation.

6. Defibrillation: For shockable heart rhythms, deliver electrical therapy promptly.

Ventricular fibrillation or pulseless VT: Defibrillate at 2 J/kg, increasing as needed.
Unstable SVT: Use synchronized cardioversion at 0.5–1 J/kg, then escalate if required.

PALS Vital Sign

Vital signs are key measurements that help healthcare providers quickly assess a child’s condition during Pediatric Advanced Life Support (PALS). Monitoring these signs closely guides treatment decisions and helps detect life-threatening problems early. The most important vital signs in PALS include:

1. Heart Rate (Pulse): Normal ranges vary by age.

Infants: 60–200 beats per minute (bpm)
Children: 60–180 bpm
Abnormal heart rates may indicate bradycardia (too slow) or tachycardia (too fast), which need prompt evaluation.

2. Blood Pressure: Normal BP varies substantially based on a child’s height and age. Hypotension risk thresholds correlate with patient age, weight, and clinical context, as outlined in the PALS guidelines.

A 6-month-old with an SBP < 70 mm Hg would be considered hypotensive.
The treatment target would be to achieve an SBP >60 mm Hg through the administration of fluid boluses and/or vasoactive medications.
An 8-year-old child will be considered hypotensive if their SBP drops below 86 mm Hg (70 + (2 x 8) years).
The post-resuscitation BP goal for this 8-year-old would be ≥ 90 mm Hg systolic.

3. Oxygen Saturation (SpO2): Measures how much oxygen the blood is carrying. Normal levels are usually above 94%. Lower values indicate the need for oxygen therapy or advanced airway support.

4. Temperature: Core body temperature is carefully regulated within a narrow range to support vital functions. In children, the normal temperature is 36–38°C (96.8–100.4°F). Hypothermia (temperature below 36°C) can increase the risk of mortality and make resuscitation efforts more challenging. The AHA PALS Algorithm emphasizes assessing and correcting temperature abnormalities early to improve outcomes. Hyperthermia (temperature above 38.5°C) may indicate infection, neurological issues, or excessive heat exposure, requiring prompt evaluation and management.

Final Thoughts on the PALS Algorithm

The PALS Algorithm serves as a vital tool for managing life-threatening conditions in children, guiding healthcare providers to make quick and accurate decisions in critical moments. Its structured, step-by-step approach helps identify the problem, choose the right intervention, and increase the chances of survival. From airway management to circulation and temperature control, every component of the algorithm works together to ensure that care is delivered promptly and effectively.

If you are a healthcare professional or an individual who wants to be prepared to save a child’s life, consider enrolling in the CPRVAM PALS course. Our expert-led training provides practical skills, hands-on practice, and in-depth knowledge to build your confidence in real emergencies. By joining CPRVAM, you’ll not only learn the algorithm but also gain the ability to apply it effectively when every second counts.

FAQs of PALS Algorithm

1. Does the age of the child affect how I assess cardiac arrest?

Yes. A child’s age plays an important role in how you assess and respond to cardiac arrest. Infants, children, and adolescents have different normal heart rates, breathing patterns, and causes of arrest. For example, infants often experience cardiac arrest due to breathing problems, while older children may have heart-related causes. The AHA PALS Algorithm adjusts assessment and treatment steps based on the child’s age to make sure care is safe and effective.

2. What are the doses for the pediatric cardiac arrest algorithm?

In the PALS Pediatric Cardiac Arrest Algorithm, common medication doses include:

Epinephrine: 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO, given every 3–5 minutes during CPR.
Amiodarone: 5 mg/kg IV/IO bolus, may repeat up to 2 times for refractory ventricular fibrillation or pulseless ventricular tachycardia.
Lidocaine (alternative to amiodarone): 1 mg/kg IV/IO loading dose, then 20–50 mcg/kg/min infusion if needed.
Always double-check doses based on the child’s exact weight and follow current AHA PALS guidelines.

3. What is the ABCDE approach in the PALS algorithm?

The ABCDE approach in the PALS Algorithm is a step-by-step method to quickly check and treat a sick or injured infant and child. It stands for:

A – Airway: Make sure the child’s airway is open and clear.
B – Breathing: Check if they are breathing well and give oxygen if needed.
C – Circulation: Look at their pulse, skin color, and blood pressure.
D – Disability: Assess their level of consciousness and check for signs of brain injury.
E – Exposure: Fully examine the child for injuries, rashes, or other problems while keeping them warm.

This approach helps healthcare providers find and treat life-threatening issues in the right order.

4. What is the PALS Algorithm?

The PALS Algorithm is a step-by-step set of guidelines created by the American Heart Association to help healthcare providers assess and treat critically ill or injured children. It focuses on quickly identifying problems with the airway, breathing, circulation, and other vital signs to provide timely and effective emergency care