Paediatric Advanced Life Support (PALS) provides a structured framework for managing critically ill or injured infants and children. Children are not simply small adults; their unique anatomical and physiological profile demands a distinct resuscitation approach.
The Pediatric Assessment Triangle is a rapid, visual, and auditory tool used within seconds to form a general impression of a child's condition without touching them. It dictates the urgency of intervention.
| Component | What to Observe | Clinical Significance | |
|---|---|---|---|
| --- | --- | --- | > |
| Appearance | Muscle tone, interactiveness, consolability, look/gaze, speech/cry | Reflects brain perfusion and central nervous system function. | |
| Work of Breathing | Abnormal breath sounds, abnormal positioning, retractions, nasal flaring | Indicates how hard the child is working to maintain ventilation. | |
| Circulation to Skin | Pallor, mottling, cyanosis, flushing | Shows systemic perfusion and skin microvascular status. |
An abnormality in any one side of the triangle indicates physiological compromise, while abnormalities in all three suggest imminent cardiopulmonary arrest.
Initiating high-quality basic life support promptly improves survival outcomes in paediatric arrest. Rescuers must deliver effective chest compressions coupled with safe rescue breaths.
Airway patency takes priority in paediatric emergencies. Simple maneuvers like the jaw-thrust or gentle head-tilt chin-lift clear most upper airway blockages.
Bag-valve-mask (BVM) ventilation requires an appropriately sized mask that covers the mouth and nose without resting on the eyes or extending past the chin. Excessive tidal volumes or high pressure can cause gastric inflation, restricting diaphragmatic movement and increasing aspiration risk. Advanced airways, such as endotracheal tubes, require careful sizing based on length-based tape formulas or age calculations. Always confirm endotracheal tube placement using continuous waveform capnography alongside physical auscultation.
Respiratory compromise precedes cardiac arrest in the vast majority of paediatric cases. Differentiating between upper airway obstruction, lower airway disease, lung tissue disease, and disordered control of breathing guides targeted therapy.
Shock is a critical condition where systemic tissue perfusion fails to meet metabolic demands. In children, maintaining blood pressure is a late compensatory mechanism; a normal blood pressure does not rule out shock.
Initial treatment centers on rapid vascular access and fluid resuscitation with isotonic crystalloids (20 mL/kg), except in cardiogenic shock where fluid overload worsens the condition.
Paediatric cardiac arrest management splits into shockable and non-shockable pathways. Unlike adults, non-shockable rhythms like Asystole and Pulseless Electrical Activity (PEA) are far more common than ventricular fibrillation or pulseless ventricular tachycardia.
Restoring spontaneous circulation marks only the first milestone; post-resuscitation care focuses on preventing secondary multi-organ injury. Stabilization involves optimizing oxygenation and ventilation to avoid normocapnia or hypocarbia, which can cause cerebral vasoconstriction.
Cardiovascular support requires maintaining age-appropriate blood pressure using inotropes or vasopressors. Neurological monitoring must watch for seizures, and providers should actively prevent fever, as hyperthermia worsens ischemic brain damage. Managing blood glucose levels prevents both hypoglycemia and hyperglycemia, ensuring the recovering brain and heart have stable metabolic support.