PALS Cardiac Arrest Algorithm

1. Activate emergency medical services, call a pediatric “code blue”, obtain AED or defibrillator

2. Is the rhythm shockable?

Rhythm IS shockable (ventricular fibrillation or unstable ventricular tachycardia)

1. Administer shock at 2 Joules/kg

2. Administer high-quality CPR for 2 minutes

3. Check rhythm

If not shockable, move to asystole/PEA rhythm protocol

If shockable, continue

4. Administer shock at 4 Joules/kg

5. Administer epinephrine 0.01 mg/kg IV or 0.1 mg/kg per ETT every 3-5 minutes

6. Administer high-quality CPR for 2 minutes

7. Check rhythm

If not shockable, move to asystole/PEA rhythm protocol

If shockable, continue

8. Administer shock at >4 Joules/kg

9. Administer amiodarone 5 mg/kg IV (repeat 2 times if needed) or lidocaine 1 mg/kg IV

10. Administer high-quality CPR for 2 minutes

11. Check rhythm

If not shockable, move to asystole/PEA rhythm protocol

If shockable, repeat steps 8-11

Rhythm IS NOT shockable (asystole or pulseless electrical activity)

1. Administer high-quality CPR for 2 minutes

2. Administer epinephrine 0.01 mg/kg IV or 0.1 mg/kg per ETT every 3-5 minutes

3. Check rhythm

If shockable, move to VF/VT rhythm protocol

If not shockable, continue

4. Administer high-quality CPR for 2 minutes

5. Check rhythm

If shockable, move to VF/VT rhythm protocol

If not shockable, continue

6. Administer amiodarone 5 mg/kg IV (repeat 2 times if needed)

7. Administer high-quality CPR for 2 minutes

8. Check rhythm

If shockable, move to shockable rhythm protocol

If not shockable, continue CPR and medications