Pediatric advanced life support (PALS) focuses on the early recognition and treatment of respiratory failure, shock, and cardiac arrest in infants and children. The priority is to prevent cardiopulmonary arrest through prompt interventions for respiratory distress and shock. In the event of an arrest, high-quality CPR with minimal interruptions is crucial. Epinephrine is first-line for pulseless arrest while atropine is first-line for symptomatic bradycardia. Amiodarone, lidocaine and magnesium are antidysrhythmics used for shock-refractory VF, pulseless VT, and stable VT. Adenosine is used for narrow complex SVT. Key aspects of PALS include proper airway management, quality CPR, rhythm assessment, appropriate defibrillation, vascular access for medications, and treating reversible causes. Pharmacists play a vital role in ensuring proper preparation, dosing, and administration of PALS medications as well as optimizing post-resuscitation care.

References and Bibliography

1. de Caen AR, Berg MD, Chameides L, et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S526-42.
2. Topjian AA, Raymond TT, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142(16_suppl_2):S469-S523.
3. Maconochie IK, Aickin R, Hazinski MF, et al. Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2020;156:A120-A133.
4. Kleinman ME, de Caen AR, Chameides L, et al. Part 10: Pediatric Basic and Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122(16 Suppl 2):S466-515.
5. Samson RA, Berg RA, Bingham R, et al. Use of automated external defibrillators for children: an update: an advisory statement from the pediatric advanced life support task force, International Liaison Committee on Resuscitation. Circulation. 2003;107(25):3250-3255.
6. Hazinski MF. Is pediatric resuscitation unique? Relative merits of early CPR and ventilation versus early defibrillation for young victims of sudden cardiac arrest. Ann Emerg Med. 1995 Aug;26(2):240-4.
7. American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care – Part 12. Pediatric Advanced Life Support. https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/. Accessed November 10, 2015.
8. Chameides L, Hazinski MF, eds. Pediatric Advanced Life Support (PALS) Provider Manual. American Heart Association; 2011.
9. Inaba A. Dr. Al’s 5 and 2 Rule for High-Quality CPR. JEMS. 2006;30(11).
10. Inaba A. PEDS=SD (Pediatric Epinephrine Dosing Story=Slide the Decimals). AHA Currents in Emergency Cardiovascular Care. 2008;19(3).