Get your online CPR Certification & Training, life saving course!
| Main medications in PALS | |||
| Agent/Indication(s) | Dosage and Administration | Actions | Adverse Effects and Considerations |
| Oxygen Hypoxemia, hypoxia, respiratory distress, respiratory failure, shock, trauma, cardiopulmonary failure, cardiac arrest | 100% oxygen initially via high flow delivery system. After ROSC, titrate between 94%-99% O2sat to prevent cardiac reperfusion injury | Increases O2 content and saturation within arteries. Increases tissue perfusion if cardiac output is adequate. Dilates pulmonary blood vessels | Headache, dry mucous membranes, airway obstruction secondary to dry membranes, gastric distention Use O2 cautiously in children who have had cardiac surgery for single ventricle malformations. Obtain specialist consult before administering, if possible. |
| Adenosine Supraventricular arrhythmia | Initial dose= 0.1 mg/kg bolus. Maximum initial dose is 6 mg. If sinus rhythm does not occur within 30 seconds of administration, administer 1 dose of 0.2mg/kg (maximum dose 12 mg). Administer a rapid flush of 5-10 mL NS after each dose. Must give rapidly. The drug’s half-life is less than 10 seconds. | Temporarily interrupts electrical conduction through AV node Allows return of sinus rhythm if SVT present Decreases automaticity of sinus node | Dizziness, tingling, numbness, headache, anxiety, metallic taste, nausea, throat tightness, hypotension, palpitations, atrial tachycardia, flushing, sweating A 10- to 15-second period of bradycardia, asystole, or 3rd degree heart block may ensue after administration May help to distinguish atrial flutter from SVT Monitor BP during administration Provide continuous ECG monitoring during administration Theophylline reduces effectiveness Limited adult data suggest dose may need to be reduced post cardiac transplant or if taking carbamazepine |
| Amiodarone Shock, VTach, VFib | Used to treat multiple types of tachyarrhythmias. For SVT and ventricular arrhythmias with poor perfusion; administer a loading dose of 5mg/kg over 20-60 minutes. Maximum initial dose= 300 mg. Repeat dose =5-15mg/kg per 24 hours. Do not exceed 2.2 mg/24 hr……….. For cardiac arrest, administer 5mg/kg as a rapid bolus. May repeat x2 for refractory VT/VF | Slows AV conduction Prolongs AV refractory period Prolongs QT interval Slows conduction through the ventricles | Syncope, headache, tremors, pulmonary fibrosis and inflammation, ARDS, CHF, GI distress, coagulation abnormalities. May cause bradycardia. Administer slowly, as rapid administration may result in heart block, polymorphic VT, or hypotension. If a tachyarrhythmia is present, administer drug at a slower rate than used during cardiac arrest due to risk of hypotension. Monitor BP frequently during administration. Obtain expert advice for administration. |
| Atropine Symptomatic bradycardia, overdose, poisoning, rapid sequence intubation | IV/IO: 0.02mg/kg.May repeat x1. Minimum dose=0.1 mg Maximum single dose= 0.5mg Maximum total dose for children=1mg; for adolescents=3mg ET: 0.04 – 0.06mg/kg | Increases heart rate and cardiac output Blocks vagal stimulation | Headache, dizziness, confusion, blurred vision, decreased secretions, dilated pupils, tachycardia, HTN, GI, dermatological, and GU distress Larger doses may be needed to treat organophosphate poisoning May be given IM prior to rapid sequence intubation Monitor SpO2, BP, and rhythm continuously |
| Epinephrine Anaphylaxis, asthma, symptomatic bradycardia, croup, cardiac arrest, shock, overdose, poisoning | Anaphylaxis: IM epinephrine every 10-15 minutes as needed. Epinephrine infusion if BP remains low Cardiac arrest: administer 0.01 mg/kg which is available as 0.1mL/kg of 1: 10,000 concentration IO or IV every 3-5 minutes. If no venous access is present; administer 0.1 mg/kg, which is available as 0.1mL/kg of 1:1000 concentration via ET Bradycardia: administer 0.01 mg/kg, which is available as 0.1mL/kg of 1: 10,000 concentration IO or IV every 3-5 minutes. Shock:0.1 mcg/kg/min infusion | Increases heart rate, myocardial contractility, automaticity, and conduction speed | CNS changes, dyspnea, nausea/vomiting, renal ischemia, hypokalemia, increases serum lactate levels Monitor BP frequently,SpO2and ECG continuously High doses cause vasoconstriction, which may reduce organ perfusion and subsequently damage organs Myocardial O2 needs increase Central line administration preferable If giving IM, administer in thigh |
| Other medications in PALS | ||
| Agent | Indication(s) | Actions |
| Albumin | Shock, trauma,burns | Blood product, expands intravascular volume; improves cardiac output; monitor for pulmonary edema |
| Albuterol | Asthma, anaphylaxis, hyperkalemia | Bronchodilator reduces serum potassium levels; causes tachycardia, frequently combined with ipratropium bromide, administer via nebulizer |
| Alprostadil ( Prostaglandin PGE1) | Used for neonates to maintain patency of ductus arteriosus in children with heart defects | Vasodilator |
| Calcium Chloride | Hypocalcemia, hypokalemia, hypomagnesemia, calcium channel blocker overdose | Electrolyte, supports homeostasis; maintains contractility of heart muscle; and aids coagulation |
| Dexamethasone | Croup, asthma | Corticosteroid, reduces inflammation |
| Dextrose (Glucose) | Hypoglycemia | Use point of care testing to monitor impact of administration |
| Diphenhydramine (Benadryl) | Anaphylaxis | Antihistamine, may exacerbate glaucoma |
| Dobutamine | Impaired ventricular function, CHF, cardiogenic shock | Increases heart rate and vasodilation. May worsen hypotension |
| Dopamine | Ventricular dysfunction, cardiogenic and distributive shock | Increases heart rate, contractility, automaticity, and conductivity; central venous access is preferred |
| Etomidate | Preparation for rapid sequence intubation agent of choice for intubation of head-injured children, hypotension, cardiovascular disease, and multiple trauma | Sedative, hypnotic; no analgesic actions, very short acting |
| Furosemide (Lasix) | Pulmonary edema, fluid excess | May cause significant hypokalemia |
| Hydrocortisone | Adrenal insufficiency | Reduces inflammation |
| Inamrinone (Amrinone) | Myocardial dysfunction, cardiogenic shock, post cardiac surgery CHF, increased SVR | Loading dose may precipitate severe hypotension |
| Ipratropium bromide | Asthma | Administer via nebulizer or MDI, not absorbed into bloodstream, vasodilator |
| Lidocaine | VF, VT, wide complex tachycardia;preparation for rapid sequence intubation | Antiarrhythmic, reduces automaticity; cardiovascular depression; seizures |
| Magnesium sulfate | Asthma, torsades de pointes, hypomagnesemia | Electrolyte, bronchodilator; have calcium on hand to reverse magnesium toxicity |
| Methylprednisolone | Asthma, anaphylactic shock | Corticosteroid, anti-inflammatory, |
| Milrinone | Myocardial dysfunction with increased SVR, cardiogenic shock, CHF post cardiac surgery | Increases contractility, reduces preload and afterload |
| Naloxone (Narcan) | Narcotic reversal | Repeat dosing often needed. Administer to newborns born to opioid dependent mothers to avoid seizures and other withdrawal symptoms |
| Nitroglycerin | CHF,cardiogenic shock | Vasodilator, antihypertensive |
| Nitroprusside | Cardiogenic shock with high SVR and severe HTN, severe HTN | Use special IV tubing or protect medication from light |
| Norepinephrine | Hypotensive shock | Administer via central line if possible |
| Procainamide | SVT, atrial flutter, VTach with pulses | Antiarrhythmic |
| Sodium bicarbonate | Severe metabolic acidosis, hyperkalemia, drug overdose | Use to treat tricyclic antidepressant overdose, ensure adequate ventilation |
| Terbutaline | Asthma | Hyperkalemia |
| Vasopressin | Cardiac arrest, septic shock | Limited data available regarding use in children |
Thank you for taking the time to study this PALS training manual.
Now it’s time to test your knowledge in a 50- question PALS examination.
Are you ready?
Let’s go!
Location: Nationwide Health Training, 3240 118th Ave SE, Unit #100, Bellevue, WA 98005
