PALS Post Arrest Shock Management Algorithm

The PALS Algorithm Stabilizes pediatric patients’ post-cardiac arrest optimizing recovery through targeted interventions

After a child's heart restarts (ROSC) following cardiac arrest, the PALS Post Arrest Shock Management Algorithm takes over. This crucial guide outlines essential steps to stabilize their condition and maximize recovery chances.

From assessing and maintaining proper oxygen and breathing to optimizing their heart function with fluids and medication, the PALS algorithm covers it all. Monitoring for re-arrest and understanding the initial cause to prevent repeat occurrences are also key. By following the steps given below, healthcare providers can improve the child's hemodynamic stability and reduce the risk of their heart stopping again.

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Understanding the Flow Chart

  1. Ensure Optimal Oxygen Saturation:
    Maintain the patient’s oxygen saturation levels within 94% to 99%, ensuring adequate oxygenation.
  2. Identify Underlying Causes with Hs and Ts:
    Utilize the Hs and T’s mnemonic to explore potential causes of the arrest, including factors such as hypovolemia, hypoxia, hypoglycemia, electrolyte imbalances, pneumothorax, toxins, tamponade, trauma, and thrombosis.
  3. Promptly Address Root Causes
    Take immediate and appropriate actions to address any identified underlying causes of the cardiac arrest.
  4. Administer Crystalloid Bolus
    Initiate fluid resuscitation by administering a bolus of crystalloid solution
  5. Close Monitoring
    Vigilantly monitor the patient’s response to treatment and closely observe vital signs for any changes
  6. Management of Hypotensive ShockIn cases of hypotensive shock, commence an infusion of Epinephrine or Norepinephrine within the recommended dosage range.
  7. Alternative Vasopressors
    If hypotensive shock is not present, consider other vasopressors based on clinical judgment, such as Dobutamine, Dopamine, or additional doses of Epinephrine or Norepinephrine.
  8. Continuous Assessment of Critical Parameters
    Regularly monitor blood glucose levels, consciousness status, and serum electrolytes, and contemplate transfer to a tertiary care facility for specialized management if necessary.
  9. Therapeutic Hypothermia Consideration
    For unresponsive patients experiencing out-of-hospital cardiac arrest, contemplate the implementation of therapeutic hypothermia, adhering to specific temperature protocols for optimal outcomes

Essential elements of the PALS cardiac arrest algorithm include

The main elements of the PALS Post Arrest Shock Management Algorithm center on stabilizing pediatric patients post-return of spontaneous circulation (ROSC) after cardiac arrest:

  1. Check Oxygenation and Ventilation: Ensure oxygen saturation remains within the range of 94% to 99% and maintain appropriate ventilation levels.
  2. Identification of Underlying Causes: Utilize the Hs and T’s framework to pinpoint potential causes like hypovolemia, hypoxia, and electrolyte imbalances.
  3. Addressing Identified Causes: Promptly and correctly treat any underlying causes detected.
  4. Initiate Fluid Resuscitation: Administer isotonic crystalloid boluses for fluid resuscitation to optimize intravascular volume.
  5. Employ Continuous Monitoring: Diligently monitor vital signs, including blood pressure, heart rate, and oxygen saturation, to evaluate the patient’s response.
  6. Go for Vasopressor Therapy: Initiate vasopressor therapy, such as an Epinephrine infusion, if the patient is experiencing hypotensive shock.
  7. Consideration of Alternative Vasopressors: Depending on the clinical context, contemplate alternative vasopressors like Dopamine, Norepinephrine, or Dobutamine.
  8. Comprehensive Monitoring and Transfer: Continuously monitor blood glucose levels, consciousness levels, arterial blood gases, and electrolytes. Consider transferring to a tertiary care center if specialized care is required.
  9. Consideration of Therapeutic Hypothermia: Assess and contemplate therapeutic hypothermia for unresponsive patients, adhering to specific temperature protocols to minimize neurological damage.


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