PALS: Pediatric Advanced Life Support
PALS stands for Pediatric Advanced Life Support, which is a specialized emergency cardiovascular care protocol designed for healthcare providers who respond to emergencies involving infants and children. 1
Core Components of PALS
PALS is a comprehensive approach to pediatric emergency care that includes:
Recognition and management of pediatric emergencies, including:
- Respiratory distress and failure
- Shock (hypovolemic, distributive, cardiogenic, obstructive)
- Cardiac arrhythmias
- Cardiac arrest
Systematic assessment using the Pediatric Assessment Triangle to rapidly evaluate:
- Appearance
- Work of breathing
- Circulation
Resuscitation protocols for:
- Airway management techniques
- Breathing support
- Circulation support
- Medication administration
- Defibrillation/cardioversion
Key Differences from Adult Advanced Life Support
PALS differs from adult protocols in several important ways:
- Emphasis on respiratory support: Most pediatric arrests are secondary to respiratory failure rather than primary cardiac events 1
- Modified compression-to-ventilation ratios: 15:2 for two-rescuer CPR (versus 30:2 in adults)
- Different equipment sizing: Age/weight-based equipment selection
- Medication dosing: Weight-based dosing calculations 1
Clinical Applications
PALS is applied in various clinical settings:
- Emergency departments
- Pediatric intensive care units
- Inpatient pediatric units
- Pre-hospital emergency medical services
- Primary care offices that see pediatric patients 1
Evidence Supporting PALS Training
Research demonstrates that PALS training improves clinical outcomes:
- PALS-trained EMS personnel show significantly higher success rates with critical procedures such as intubation (85% vs 48%) and vascular access (100% vs 70%) compared to non-PALS trained providers 2
- Pediatric residents who complete PALS training demonstrate improved intubation success rates (65.4% vs 53.3% before training) 3
Common Pitfalls in PALS Implementation
- Delayed initiation of positive pressure ventilation in children with severe bradycardia 4
- Incorrect medication dosing: Weight-based calculations are essential but prone to error 4
- Inappropriate equipment selection: Using adult-sized equipment on pediatric patients
- Infrequent practice of critical skills: Some procedures like pediatric intubation or intraosseous access may be performed rarely in typical practice 5
PALS Certification
PALS certification typically involves:
- Completion of a standardized course (usually 2 days)
- Demonstration of skills proficiency
- Passing a written examination
- Recertification every 2 years
Healthcare providers who regularly care for pediatric patients should maintain current PALS certification to ensure they can deliver optimal emergency care when needed 1.