AHA PALS Provider key terms

A rapid visual and auditory first impression made from across the room using three elements: appearance, work of breathing, and circulation to skin. It helps decide whether a child is sick or not sick before you touch the patient.

A clinical state in which increased work of breathing, such as retractions, nasal flaring, grunting, or tachypnea, keeps oxygenation and ventilation adequate. The child is still compensating and needs prompt support to prevent progression to respiratory failure.

Inadequate oxygenation or ventilation despite effort, marked by decreasing respiratory effort, weak cry, cyanosis, altered mental status, or poor chest rise. Compensation has failed, so assisted ventilation is needed immediately.

A state in which cardiac output is reduced but blood pressure remains normal because of increased heart rate and vasoconstriction. Perfusion signs such as delayed capillary refill, cool extremities, or weak pulses appear before blood pressure falls.

Shock in which the child's blood pressure has fallen below the normal range for age. It is a late and dangerous sign in children, showing that compensatory mechanisms have failed and that cardiac arrest may be imminent.

Delivery of breaths with a self-inflating bag and a tightly sealed mask. Effective technique needs an open airway, a correctly sized mask, a good seal, and only enough volume to make the chest rise in infants and children.

A rigid curved device inserted over the tongue to hold the upper airway open in an unresponsive child who has no gag reflex. Correct sizing runs from the corner of the mouth to the angle of the jaw.

A soft, lubricated tube passed through the nose into the pharynx to keep the airway open when an oral airway cannot be used, such as in a child who has a gag reflex or jaw trismus.

Removal of secretions, blood, or vomit from the airway with a catheter or bulb device. It should be brief, limited to the time needed, and preceded by adequate oxygen because it can cause hypoxemia and bradycardia.

A noninvasive estimate of arterial oxygen saturation using light absorption through a pulsatile vascular bed. Readings are unreliable with poor perfusion, motion, or bright ambient light, and the value does not reflect ventilation.

Continuous measurement and display of exhaled carbon dioxide. In PALS it confirms tracheal tube placement, monitors the quality of ventilation, and helps detect return of spontaneous circulation during resuscitation.

Blockage of the airway by a solid object, producing sudden choking, coughing, stridor, or inability to speak. Management depends on whether the child is conscious and whether the cough is effective.

Air entering the stomach during positive-pressure ventilation, usually from excessive volume, a poor mask seal, or an airway that is not opened well. It raises the diaphragm, reduces lung volumes, and promotes regurgitation and aspiration.

A slow heart rate accompanied by signs of poor perfusion such as hypotension, altered mental status, or weak pulses. In PALS, hypoxia is a common cause, so ventilation and oxygen come before medications.

A fast heart rate that may be sinus, supraventricular, or ventricular. Narrow-complex rhythms with adequate perfusion are treated with supportive care and vagal maneuvers before drugs or cardioversion are considered.

A disorganized, chaotic ventricular rhythm with no effective contractions and no palpable pulse. It is a shockable rhythm and is treated with immediate high-quality CPR and unsynchronized defibrillation.

A rapid ventricular rhythm that produces no effective cardiac output. It is treated the same as ventricular fibrillation, with CPR and unsynchronized shocks, followed by epinephrine and an antiarrhythmic drug.

Absence of electrical and mechanical cardiac activity, seen as a flat line on the monitor. It is not shockable; treatment is high-quality CPR, epinephrine, and a search for reversible causes.

An organized rhythm on the monitor without a detectable pulse or effective output. Management focuses on high-quality CPR, epinephrine, and correcting reversible causes such as hypoxia, hypovolemia, or tension pneumothorax.

An unsynchronized electrical shock delivered to terminate ventricular fibrillation or pulseless ventricular tachycardia. Pediatric energy doses are 2 J/kg for the first shock and 4 J/kg for the second.

A shock timed to the QRS complex, used to convert a tachyarrhythmia that has a pulse but poor perfusion. Pediatric starting energy is 0.5 to 1 J/kg, increasing to 2 J/kg if needed.

Chest compressions of adequate rate and depth with full recoil, minimal interruptions, and avoidance of excessive ventilation. For children, push at least one third of the chest depth at 100 to 120 compressions per minute.

A device that analyzes the rhythm and advises a shock for shockable rhythms. Pediatric attenuator pads or a pediatric mode lower the energy dose for children under about 8 years or 25 kg.

A vasoconstrictor and bronchodilator given during cardiac arrest at 0.01 mg/kg of the 0.1 mg/mL concentration IV or IO. It is also used for anaphylaxis and for bradycardia unresponsive to oxygenation and ventilation.

An antiarrhythmic given for ventricular fibrillation or pulseless ventricular tachycardia that persists after defibrillation and epinephrine. The pediatric dose is 5 mg/kg IV or IO, and it may be repeated.

An alternative antiarrhythmic to amiodarone for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia. The pediatric dose is about 1 mg/kg IV or IO, followed by additional doses if needed.

An anticholinergic drug that increases heart rate by blocking vagal tone. In PALS it is used for vagally mediated bradycardia when oxygenation and ventilation have not worked, at 0.02 mg/kg with a minimum dose.

A very short-acting drug given by rapid IV push that briefly blocks conduction through the AV node to terminate supraventricular tachycardia. The first pediatric dose is 0.1 mg/kg, up to 6 mg.

An inhaled beta-2 agonist that relaxes bronchial smooth muscle. It is a first-line treatment for bronchospasm in asthma and is commonly given by nebulizer, often repeated and combined with other therapies.

An opioid antagonist that reverses respiratory depression caused by opioids. It is given IV, IO, IM, or intranasally, and repeat doses may be needed because its effect can be shorter than that of the opioid.

A concentrated sugar solution given to correct hypoglycemia, which is a reversible cause of altered mental status, seizures, and cardiac arrest. Pediatric dosing is commonly 0.5 to 1 g/kg using a concentration appropriate for age.

A drug used for torsades de pointes and for severe asthma that does not respond to initial treatment. In children it is typically given as 25 to 50 mg/kg IV over 10 to 20 minutes.

Placement of a needle into the bone marrow space to give fluids and medications when IV access cannot be obtained quickly. It functions like a vein and is preferred over delaying treatment in an emergency.

The reappearance of a palpable pulse and effective blood flow after resuscitation, often signaled by a sudden rise in exhaled carbon dioxide. It marks the beginning of post-cardiac arrest care.

A combination of brain injury, myocardial dysfunction, systemic inflammation, and the unresolved cause of the arrest that follows resuscitation. It guides monitoring, blood pressure support, oxygen targets, and temperature control.

Controlled cooling, or active prevention of fever, for a period after cardiac arrest to protect the brain. It requires close temperature monitoring and is part of comprehensive post-arrest care.

A team practice in which the leader directs a specific person, that person repeats the order back, and the leader confirms it was heard. It reduces errors during fast-moving resuscitations.

A short, structured review after a resuscitation or simulation in which the team discusses what went well and what should improve. It supports learning and better performance in future events.