PALS · 2025 AHA GUIDELINES
PALS algorithms, explained step by step.
Pick an algorithm below to see a step-by-step flowchart, weight-based doses and energies, and the key points we review in your HeartCode PALS skills session.
Also see: BLS Algorithms · ACLS Algorithms
PALS Algorithm
Pediatric Cardiac Arrest Algorithm
Children usually arrest from breathing problems or shock rather than a primary heart rhythm, so asystole and PEA are common. The flow mirrors the adult algorithm, but every shock and drug is calculated by weight, and early epinephrine for non-shockable rhythms is strongly linked to better outcomes.
Step-by-step flowchart
- Bag-mask ventilation with oxygen
- Attach monitor/defibrillator
- IV/IO access
- Epinephrine every 3–5 min
- Consider advanced airway + capnography
- Amiodarone or lidocaine
- Treat reversible causes
- IV/IO access
- Epinephrine every 3–5 min
- Consider advanced airway + capnography
- Treat reversible causes
PALS Algorithm
Pediatric Bradycardia With a Pulse
In children, a slow heart rate is usually a warning that oxygen is running out. Good ventilation often fixes it. If the heart rate stays below 60/min with poor perfusion even after effective breathing support, start chest compressions.
Step-by-step flowchart
- Open airway, give oxygen
- Positive-pressure ventilation as needed
- Monitor and pulse checks
- CPR if HR below 60/min despite ventilation
- IV/IO access
- Epinephrine
- Atropine for increased vagal tone or primary AV block
- Consider transthoracic or transvenous pacing
PALS Algorithm
Pediatric Tachyarrhythmia With a Pulse
Fast heart rates in children are usually sinus tachycardia from fever, pain, or dehydration. The algorithm separates that from SVT and VT, then uses stability and QRS width (narrow is 0.09 sec or less) to choose adenosine, vagal maneuvers, or synchronized cardioversion.
Step-by-step flowchart
- Airway, ventilation, oxygen as needed
- Monitor, IV/IO access, 12-lead ECG if available
- Adenosine if IV/IO ready, or
- Synchronized cardioversion
- Synchronized cardioversion
- Expert consult before more drugs
- Consider vagal maneuvers
- IV/IO adenosine
- If regular & monomorphic, consider adenosine
- Expert consultation
PALS Algorithm
PALS Septic Shock
Septic shock in children can look subtle at first: fast heart rate, cool or flushed skin, and changes in behavior often come before low blood pressure. Treatment centers on careful fluid boluses with reassessment after each one, antibiotics within the first hour, and vasoactive medication when fluids aren't enough.
Step-by-step flowchart
- Altered mental status, abnormal perfusion, fever or low temperature
- Oxygen and airway support
- IV/IO access
- Labs, blood culture, glucose, lactate
- Isotonic crystalloid
- Reassess after every bolus for fluid overload (crackles, liver enlargement)
- Epinephrine or norepinephrine
- Peripheral IV acceptable until central access
PALS Algorithm
Pediatric Post-ROSC Care
After a child's heart restarts, the team works to prevent a second injury. That means avoiding low blood pressure, too much or too little oxygen, abnormal CO₂, fever, and seizures, while finding and treating the cause of the arrest.
Step-by-step flowchart
- Titrate oxygen to SpO₂ 94–99%
- Normal PaCO₂ for the child's condition
- Confirm airway with capnography
- Systolic and mean BP above the 10th percentile for age
- Diastolic above the 50th percentile for age
- Fluids and vasoactives as needed
- Prevent fever
- Continuous core temperature monitoring
- EEG for seizures when available
- Treat seizures
- Treat reversible causes
- Check glucose and electrolytes
- Sedation and pain control
These summaries are a study aid created by Hale CPR LLC based on the 2025 American Heart Association Guidelines for CPR and ECC. They do not replace an AHA course, your provider manual, or your facility's protocols and medical direction. Always verify doses against current references.