Pediatric Advanced Life Support Algorithms

Pediatric Systematic Approach Algorithm: Step by Step

1. 1

   Conduct an initial assessment (PAT)

   • Appearance
   • Work of breathing
   • Circulation to the skin
2. 2

   Is the child unresponsive, or does the child need immediate intervention?

   • Yes: call for help and activate the emergency response system, then check pulse and breathing
   • No: check whether the child’s airway, breathing, or perfusion is severely compromised
3. 3

   Check pulse and breathing simultaneously

   Perform this check for no more than 10 seconds.

   • Pulse not felt, breathing abnormal: start CPR
   • Pulse felt, breathing abnormal: support ventilation
   • Pulse felt, breathing normal: check whether the child’s airway, breathing, or perfusion is severely compromised
4. 4

   Support ventilation

   • Open the airway
   • Begin rescue breathing: 1 breath every 2-3 seconds (20-30 breaths/min)
   • Provide oxygen as needed
   • Attach a cardiac monitor and pulse oximeter
   • Reassess the pulse every 2 minutes
5. 5

   Is the heart rate <60/min and perfusion still poor despite adequate oxygenation and ventilation?

   • Yes: start CPR
   • No: evaluate
6. 6

   Start CPR

   • Begin CPR immediately
   • Initiate the Pediatric Cardiac Arrest Algorithm
7. 7

   Is the child’s airway, breathing, or perfusion severely compromised?

   • Yes: stabilize and monitor, then evaluate
   • No: evaluate
8. 8

   Stabilize and monitor

   • Support airway, breathing, and circulation
   • Provide oxygen as needed
   • Attach a cardiac monitor and pulse oximeter
9. 9

   Evaluate, identify, intervene

   Repeat the cycle until the child is stable. If cardiac arrest occurs at any stage, start CPR.

   • Initial assessment: PAT
   • Primary assessment: ABCDE
   • Secondary assessment: SAMPLE