AHA PALS Provider Cheat Sheet

Cheat sheet AHA PALS Provider Cheat Sheet Practice Questions Study Guide Print / Save PDF

Pediatric Assessment Not published of exam Assessment Loop PAT Primary Assessment Compromise

Respiratory Emergencies Not published of exam Respiratory Clues Croup Infant FBAO Ventilation

Pediatric Shock Not published of exam Shock Clues Septic Fluids Cardiogenic Shock Reassessment

BLS, Arrest and Rhythms Not published of exam CPR Ratios Defibrillation Bradycardia Tachyarrhythmia

Post-Arrest Care Not published of exam Post-ROSC Targets Oxygen Sources Temperature Blood Pressure

Access and Medications Not published of exam Drug Doses Epinephrine Adenosine Amiodarone

Team and Course Skills Not published of exam Team Actions Course Checklist Closed Loop Core Cases

Quick Facts Course AHA PALS Provider Science 2025 AHA/AAP guidelines Written Open-resource; minimum 84% Skills Child and infant BLS tests Cases One cardiac; one respiratory/shock Role Team member or team leader Card Two-year completion eCard Topic weights Not published by AHA Written length Current public count not specified

Pediatric Assessment Triangle AS PAT: appearance, breathing, skin circulation Appearance Breathing work Skin circulation

Initial Pediatric Response AS Unsafe scene → Protect team and child ( Call for help ) Unresponsive; no normal breathing → Check pulse ≤10 seconds ( Activate emergency response ) No pulse felt → Start high-quality CPR ( Attach AED/monitor ) Pulse; inadequate breathing → Ventilate every 2–3 seconds ( Reassess pulse ) Threat detected during PAT → Treat immediately ( Continue primary assessment )

Assessment Loop AS PAT Appearance, breathing, skin circulation Appearance Tone and interaction clues Breathing work Effort, sounds, posture Skin circulation Pallor, mottling, cyanosis Primary assessment Airway, breathing, circulation, disability, exposure Secondary assessment Focused history and examination Reassessment Evaluate after each intervention Immediate threat Treat before exhaustive diagnosis

Distress vs Respiratory Failure RE

Distress Work increased Effort maintained Watch progression

Failure Exchange inadequate Effort may fall Ventilation support urgent Quiet can mean worse

Respiratory Problem Picker RE Stridor; croup pattern → Give corticosteroid ( Assess severity ) Moderate/severe croup → Consider nebulized epinephrine ( Monitor response ) Wheeze; lower-airway pattern → Assess airflow and oxygenation ( Treat cause ) Quiet effort; poor appearance → Support ventilation urgently ( Possible respiratory failure ) Severe responsive infant FBAO → Five back blows/thrusts ( Heel-of-hand chest thrusts )

Respiratory Clues RE Distress Increased effort; compensation remains Failure Poor exchange or exhausted effort Stridor Consider upper-airway obstruction Wheeze Consider lower-airway obstruction Quiet chest May signal severe airflow failure Croup steroid Use corticosteroid treatment Moderate/severe croup Consider nebulized epinephrine Humidified mist Not evidence-based croup treatment

Airway and FBAO RE Pulse; inadequate breathing Ventilate every 2–3 seconds Bag-mask ventilation Visible chest rise, avoid overventilation Advanced airway Confirm ETT with exhaled CO₂ Severe infant FBAO Five back blows, five chest thrusts Infant chest thrust Heel of one hand Unresponsive infant FBAO Start CPR; inspect visible object Severe child FBAO Five back blows, five abdominal thrusts

Shock Loop SH BOLUS: begin, observe, look, update, stop Begin indicated aliquot Observe perfusion Look for overload Update plan Stop if harm

Compensated vs Hypotensive Shock SH

Compensated Poor perfusion Pressure may remain Treat before collapse

Hypotensive Pressure falls Late decompensation Immediate escalation Normal pressure cannot exclude shock

Shock Type Picker SH Perfusion poor; pressure preserved → Recognize compensated shock ( Treat early ) Septic shock → Give 10 or 20mL/kg ( Reassess each aliquot ) Fluid-refractory septic shock → Consider vasoactive infusion ( Epinephrine or norepinephrine ) Cardiogenic signs → Use fluid caution ( Assess pump function ) Hemorrhage suspected → Control bleeding ( Tailor resuscitation )

Shock Clues SH Compensated shock Perfusion impaired; pressure may persist Hypotensive shock Late decompensation Hypovolemic Suspect volume loss Distributive Vasodilation; consider sepsis Cardiogenic Pump dysfunction; fluid caution Obstructive Relieve mechanical cause Perfusion markers Mentation, pulses, capillary refill Trend Recheck after each action

Septic Fluids SH Septic shock 10 or 20 mL/kg aliquots Each aliquot Reassess response and overload Fluid choice Isotonic crystalloid or colloid Fluid-refractory sepsis Epinephrine or norepinephrine infusion Cardiogenic physiology Avoid automatic large boluses Hemorrhagic shock Control bleeding; tailored resuscitation Fluid overload Watch worsening oxygenation

CPR Quality AR RATE: recoil, airway, tempo, exchange Recoil fully Airway support Tempo 100–120 Exchange compressors

VF/pVT vs PEA/Asystole AR

VF/pVT Shockable Defibrillate Resume CPR

PEA/asystole Nonshockable CPR plus epinephrine Treat reversible causes Rhythm determines shock

Rhythm Decision AR VF or pulseless VT → Defibrillate 2 J/kg first ( 4 second; later capped ) PEA or asystole → CPR plus epinephrine ( No defibrillation ) HR <60 with compromise → CPR after effective ventilation ( Treat cause ) Unstable tachycardia with pulse → Synchronized cardioversion ( 0.5–1 then 2 J/kg ) Stable probable SVT → Vagal manoeuvre; adenosine ( Rapid push and flush )

CPR Ratios AR One rescuer 30:2 before advanced airway Two; prepuberty 15:2 before advanced airway Two; postpuberty 30:2 before advanced airway Compression rate 100–120/min Compression depth At least one-third AP chest diameter Pause Keep under 10 seconds Advanced airway CPR Continuous compressions; breath every 2–3s Compressor switch About every two minutes

Prepuberty vs Postpuberty CPR AR

Two rescuers; prepuberty 15:2 No advanced airway Pediatric ratio

Two rescuers; postpuberty 30:2 No advanced airway Adult ratio Puberty changes ratio

Arrest and Rhythms AR VF/pVT Shockable arrest Asystole/PEA Nonshockable arrest First shock 2 J/kg teaching dose Second shock 4 J/kg Later shock ≥4 J/kg; cap applies Shock ceiling 10 J/kg or adult maximum Shock action Resume CPR immediately Rhythm reassessment About every two minutes

Defibrillation vs Cardioversion AR

Defibrillation Pulseless VF/pVT Unsynchronized shock 2 then 4 J/kg

Synchronized cardioversion Unstable tachycardia; pulse Synchronized shock 0.5–1 then 2 J/kg Pulse and rhythm determine mode

Bradycardia and Tachyarrhythmia AR Bradycardia first Support airway and ventilation HR <60; compromise persists CPR after effective oxygenation/ventilation Atropine indication Vagal tone or primary AV block Stable probable SVT Consider vagal maneuvers Unstable tachycardia Synchronized cardioversion Cardioversion initial 0.5–1 J/kg Cardioversion repeat 2 J/kg if ineffective Regular monomorphic wide Adenosine only with expert context

Post-ROSC Oxygen Sources PO

2025 AHA guideline May target 94–99% Underlying condition matters Wean from hyperoxia

2025 AHA checklist 94–98% or normal baseline Practical care target Separate source document Do not conflate ranges

After ROSC PO Reliable oximetry available → Titrate oxygen appropriately ( Guideline 94–99% ) Known lower baseline → Use child-specific target ( Checklist permits baseline ) Blood pressure low → Support perfusion ( SBP/MAP >10th percentile ) Comatose post-arrest child → Prevent temperature >37.5°C ( Central monitoring ) Seizure suspected → Evaluate and treat ( Avoid early single-test prognosis )

Post-ROSC Targets PO 2025 oxygen guideline 94–99% if appropriate; titrate 2025 care checklist 94–98% or child baseline Ventilation Target condition-appropriate normocapnia Systolic and MAP Above age tenth percentile Comatose child Monitor central temperature continuously Temperature Avoid central >37.5°C Seizures Monitor and treat Prognosis Use multimodal, serial assessment

Drug Doses ME Arrest epinephrine IV/IO 0.01 mg/kg; 0.1 mg/mL Epinephrine maximum 1 mg per dose Epinephrine interval Every 3–5 minutes Adenosine first IV/IO 0.1 mg/kg; maximum 6 mg Adenosine repeat IV/IO 0.2 mg/kg; maximum 12 mg Adenosine delivery Rapid push, then flush Arrest amiodarone first IV/IO 5 mg/kg; maximum 300 mg Arrest amiodarone repeats 5mg/kg; maximum 150mg per repeat Arrest lidocaine IV/IO 1 mg/kg alternative Drug calculation Verify weight and concentration

Team Communication TE LOOP: lead, order, observe, playback Lead roles Order clearly Observe completion Playback confirmation

Written vs Hands-On Completion TE

Written Open-resource Minimum 84% Cognitive component

Hands-on Child/infant BLS Two core scenarios Team member or leader Both components required

Team Actions TE Leader Assign roles; maintain overview Closed loop Order, repeat, perform, confirm Dose readback Weight, dose, route, timing Recorder Track shocks, drugs, times Constructive intervention State specific safety concern Two-minute rhythm check Pause <10s; summarize during CPR Debrief Identify improvements without blame

Course Checklist TE Learning stations Participate as required Written assessment Open-resource; at least 84% Child BLS One- and two-rescuer skills Infant BLS One- and two-rescuer skills Cardiac case Pass team scenario Respiratory/shock case Pass team scenario Case role Leader or member accepted Completion card Valid two years

Common Traps

Puberty changes ratio Two rescuers prepuberty: 15:2 ≠ Two rescuers postpuberty: 30:2

Epinephrine cap Arrest dose: 0.01mg/kg IV/IO ≠ Maximum: 1mg per dose

Shock escalation First: 2; second: 4J/kg ≠ Later: ≥4; capped 10J/kg/adult

Sepsis bolus scope Septic shock: 10 or 20mL/kg ≠ Not every shock: automatic 20mL/kg

Croup therapy Corticosteroid; nebulized epinephrine if moderate/severe ≠ Humidified mist lacks evidence

Infant choking Five back blows/chest thrusts ≠ No infant abdominal thrusts

Post-ROSC oxygen Guideline: 94–99% if appropriate ≠ Checklist: 94–98% or baseline

Course completion 84% written is one component ≠ Skills and two cases also required

Last Minute 1 . No official PALS topic weights 2 . ILT written: open-resource, minimum 84% 3 . Pass child and infant BLS skills 4 . Pass cardiac plus respiratory/shock cases 5 . Prepuberty two-rescuer CPR: 15:2 6 . Postpuberty two-rescuer CPR: 30:2 7 . Shock: 2→4→≥4J/kg; max10J/kg-or-adult 8 . Arrest epinephrine: 0.01mg/kg; max 1mg 9 . Adenosine: 0.1→0.2 mg/kg; caps 6→12mg 10 . Septic bolus: 10 or 20mL/kg 11 . Reassess after every septic bolus 12 . Infant FBAO: 5back-blows; 5chest-thrusts 13 . Croup: steroid; neb epi for moderate–severe 14 . Post-ROSC oxygen: check source range

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