AHA PALS Provider cheat sheet

Pediatric Assessment Triangle: appearance, work of breathing, and circulation to skin; abnormal appearance is a key early indicator of serious illness.

Respiratory distress: increased work of breathing with preserved ventilation; respiratory failure: inadequate oxygenation or ventilation with apnea, bradycardia, cyanosis, or altered mentation.

Hypotension thresholds: systolic <60 mm Hg in neonates, <70 mm Hg in infants 1-12 months, <70 + (2 × age) mm Hg in children 1-10 years, and <90 mm Hg in children >10 years.

Compensated shock: tachycardia, cool skin, delayed capillary refill, weak pulses, narrow pulse pressure, and normal blood pressure; hypotension is a late sign.

Fluid bolus for shock: isotonic crystalloid 10-20 mL/kg over 5-20 minutes, reassess after each bolus, and use caution in cardiogenic shock with pulmonary edema.

Anaphylaxis: IM epinephrine 0.01 mg/kg of 1 mg/mL (max 0.3 mg child, 0.5 mg adolescent) into the anterolateral thigh, repeat every 5-15 minutes as needed.

Foreign body obstruction with ineffective cough: start CPR; conscious infant <1 year gets 5 back slaps then 5 chest thrusts; conscious child gets abdominal thrusts.

Severe croup: nebulized epinephrine plus dexamethasone; observe after epinephrine because stridor can recur as the drug wears off.

Bronchiolitis: supportive care with oxygenation and hydration; routine bronchodilators, corticosteroids, and antibiotics are not recommended.

Two-person bag-mask technique: one rescuer seals the mask with two hands and lifts the jaw; the second squeezes the bag to visible chest rise.

CPR without an advanced airway: 30:2 for one rescuer and 15:2 for two rescuers; rotate the compressor about every 2 minutes.

CPR with an advanced airway: 1 breath every 2-3 seconds (20-30/min) for infants and children, with continuous compressions.

Uncuffed ETT size for children >1 year: (age in years/4) + 4 mm; cuffed ETT size: (age/4) + 3.5 mm.

Uncuffed oral ETT depth: approximately 3 × internal diameter in cm; confirm with chest radiograph and clinical assessment.

Confirm ETT placement with continuous waveform capnography plus clinical assessment; loss of waveform suggests dislodgment, obstruction, or no pulmonary blood flow.

Advanced airway tidal volume: 6-7 mL/kg per breath, adjusted to visible chest rise; avoid excessive volume.

Hyperventilation lowers PaCO2, raises intrathoracic pressure, reduces venous return, and can worsen cerebral perfusion.

Cricoid pressure is not recommended routinely during bag-mask ventilation or intubation.

VF/pVT: immediate defibrillation, then CPR for 2 minutes; epinephrine after the second shock; amiodarone or lidocaine for refractory VF/pVT.

Asystole/PEA: CPR, epinephrine every 3-5 minutes, and search for reversible causes (H's and T's).

Defibrillation: first shock 2 J/kg, second 4 J/kg, subsequent shocks at least 4 J/kg, maximum 10 J/kg or adult dose.

Synchronized cardioversion for unstable tachycardia with a pulse: 0.5-1 J/kg first, 2 J/kg second; sedate if awake and time permits.

Bradycardia with poor perfusion and HR <60/min despite oxygenation and ventilation: start CPR; give epinephrine; consider atropine for vagal tone or primary AV block.

SVT: adenosine 0.1 mg/kg rapid IV/IO (max 6 mg), then 0.2 mg/kg (max 12 mg); synchronized cardioversion if unstable.

Torsades de pointes: magnesium 25-50 mg/kg IV/IO (max 2 g); correct electrolytes and remove QT-prolonging drugs.

AED in children <8 years or <25 kg: use a pediatric attenuator if available; otherwise use standard adult pads.

PEA reversible causes: hypovolemia, hypoxia, hydrogen ion acidosis, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, and thrombosis.

Cardiac arrest epinephrine: 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO, max 1 mg, every 3-5 minutes.

Amiodarone for VF/pVT: 5 mg/kg IV/IO bolus, max 300 mg; may repeat for refractory arrhythmia.

Lidocaine for VF/pVT: 1 mg/kg IV/IO bolus, then infusion 20-50 mcg/kg/min.

Adenosine: 0.1 mg/kg rapid IV/IO push (max 6 mg), then 0.2 mg/kg (max 12 mg).

Atropine: 0.02 mg/kg IV/IO, minimum 0.1 mg, maximum 0.5 mg child or 1 mg adolescent; repeat once.

Naloxone: 0.1 mg/kg IV/IO/IM/SC (max 2 mg) for opioid-induced respiratory depression; repeat every 2-3 minutes.

Hypoglycemia: dextrose 0.5-1 g/kg; D10 5-10 mL/kg in children; recheck glucose and avoid concentrated dextrose extravasation.

Magnesium for torsades: 25-50 mg/kg IV/IO, max 2 g.

Fluid-refractory shock: start a vasoactive infusion; epinephrine for cold shock, norepinephrine for warm shock, and milrinone for myocardial dysfunction with adequate blood pressure.

Post-arrest oxygen: titrate to SpO2 94-99%, avoiding hypoxemia and hyperoxia.

Post-arrest ventilation: target normocapnia; avoid excessive ventilation and monitor with capnography when an advanced airway is present.

Comatose post-arrest child: consider targeted temperature management at 32-34°C for 24 hours, then slow rewarming; prevent fever.

Post-arrest blood pressure: maintain systolic pressure at least the 5th percentile for age and treat hypotension with fluids and vasoactive drugs.

Post-arrest labs: check glucose, electrolytes, calcium, blood gas, lactate, and renal/hepatic function; treat hypoglycemia and electrolyte abnormalities.

Post-arrest neurologic care: treat seizures, consider EEG monitoring, and avoid fever, hyperoxia, hypocapnia, and hypotension.

Team dynamics: closed-loop communication, clear role assignment, mutual respect, constructive intervention, and knowledge sharing.

Debrief after resuscitation: review CPR quality, timing of interventions, and team performance to improve future care.

High-quality CPR: rate 100-120/min, depth at least one third AP diameter (about 4 cm infant, 5 cm child), full recoil, interruptions <10 seconds.