Cardiac arrest (PALS)
Paediatric emergency management · Resuscitation · Emergency
Unresponsive, not breathing normally, no pulse within 10 s → start CPR. Push hard and fast (at least one-third of AP chest depth, 100–120/min), full recoil, minimise interruptions, attach monitor/defibrillator.
Every 2-minute cycle
- Ventilate 15:2 (2 rescuers) without an advanced airway; with an advanced airway give continuous compressions plus 1 breath every 2–3 s.
- Rotate the compressor, check rhythm briefly, resume compressions immediately.
- Seek and treat the reversible causes (H’s and T’s).
Shockable – VF / pulseless VT
- Give adrenaline after the 2nd shock, then every 3–5 min.
- Amiodarone (or lidocaine) after the 3rd shock.
- Consider an advanced airway plus waveform capnography; ETCO2 under 10–15 mmHg suggests poor CPR quality.
Non-shockable – asystole / PEA
- CPR plus adrenaline 0.01 mg/kg every 3–5 min as early as possible.
- Aggressively search for and treat reversible causes.
Common questions
What is the first step in cardiac arrest (pals)?
Unresponsive, not breathing normally, no pulse within 10 s → start CPR. Push hard and fast (at least one-third of AP chest depth, 100–120/min), full recoil, minimise interruptions, attach monitor/defibrillator.
What drug doses are used in cardiac arrest (pals)?
Defibrillation: 2 J/kg first shock, then 4 J/kg, then up to 10 J/kg (or adult dose). Adrenaline IV/IO: 0.01 mg/kg (0.1 mL/kg of 1:10,000) every 3–5 min. Amiodarone IV/IO: 5 mg/kg bolus after the 3rd shock; may repeat up to 2 times.
About this page
Compiled from standard paediatric references. Verify against a current formulary and your local protocol.
Spotted something wrong? Report an error on this page — corrections from clinicians are welcome and are reviewed before any change is published.
Last reviewed 2026-08-12.