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PALS Manual Updates At-A-Glance: 2020 to 2025

PALS Manual Updates At-A-Glance: 2020 to 2025

The pediatric advanced life support participant’s manual includes essential concepts covered by the industry. The course ensures that everyone can provide the right treatment to pediatric patients experiencing a medical emergency. The concepts focus on offering high-quality patient care by integrating rhythm interpretation, psychomotor skills, and electrical interventions with problem solving to achieve the best outcomes. PALS manual has undergone several revisions from 2020 to 2025. In this blog, explore the latest PALS manual updates.

What are the key changes in treatment PALS guidelines?

First responders and bystanders must perform cardiopulmonary resuscitation while wearing an N95 face mask. According to the updated recommendations, it is crucial to perform chest compressions in a safe manner. The new guidelines assist in situations while making individuals feel less scared. If CPR is simpler while keeping everyone safe, people are likely to help if they know it is a lot safer and easier to perform.

Current recommendations and guidelines on PALS updates

Cardiopulmonary resuscitation (CPR)

Here are the updated PALS CPR guidelines:

  • Bystanders must offer CPR to infants and children with ventilation for children less than 18 years of age.
  • Bystanders who are not well-versed in PALS rescue breaths must provide chest compressions.
  • EMS dispatchers must offer dispatcher-assisted CPR instructions for instances of cardiac arrest.
  • EMS dispatchers must offer dispatcher-assisted instructions during instances of sudden cardiac arrest in children.
  • The routine use of extracorporeal CPR is not recommended due to the lack of evidence.
  • Consider extracorporeal CPR for select pediatric patients with in-hospital cardiac arrest. This serves as a rescue therapy when conventional CPR does not respond well.
  • Use continuous arterial blood pressure and end-tidal carbon dioxide measurements to boost the quality of CPR during ACLS resuscitation.
  • Debriefing is a must for EMS providers, lay rescuers, and healthcare workers to support mental health and well-being.
  • Consider extracorporeal CPR for pediatric in-hospital cardiac arrest (IHCA) to perform cardiac diagnoses.

Respiratory arrest

  • Pals rescue breathing rate: For pediatric patients in respiratory distress or arrest, provide 1 breath every 2 to 3 seconds. Suggest recommendations: 1 breath every 3 to 5 seconds.
  • Use the same PALS respiratory rate every 2–3 seconds using an advanced airway. On the other hand, previous recommendations for intubated pediatric patients were to take 1 breath every 6 seconds.
  • For patients undergoing respiratory arrest, maintain PALS rescue breathing until the patient gets back to breathing spontaneously.

Cardiac arrest

  • Administer the first dose of epinephrine within 5 minutes of starting chest compressions in pediatric patients.
  • Use diastolic blood pressure and check the quality of CPR when arterial blood pressure monitoring is in place.


  • Bag-mask ventilation is a suitable alternative to endotracheal intubation.
  • Cuffed endotracheal tubes are better than uncured endotracheal tubes. Ensure that you use the right size and cuff inflation according to the patient.
  • Do not perform cricoid pressure during endotracheal intubation.

Targeted temperature management

  • Use either targeted temperature management at 32 degrees Celsius to 34 degrees Celsius, followed by targeted temperature management at 36 degrees Celsius to 37.5 degrees Celsius. 
  • Alternatively, use targeted temperature management at 36°C to 37.5°C. 
  • Use this on infants and children between 24 hours and 18 years of age who stay comatose after out-of-hospital or in-hospital cardiac arrest.

Ventricular fibrillation/pulseless ventricular tachycardia

  • Lidocaine or amiodarone are beneficial for ventricular fibrillation or pulseless ventricular tachycardia. These do not respond to defibrillation.

Shock management

  • In trauma-related hypotensive hemorrhage shock, use blood products instead of volume resuscitation in pediatric patients.
  • Pediatric patients may receive 10–20 mL/kg intravenous fluid aliquots. A 20-mL/kg bolus was usually recommended previously. However, less fluid was considered.
  • Infants and children with septic shock who do not respond favorably to fluid administration may require vasopressors and consider stress-dose corticosteroids.

Supplemental oxygen

  • Patients must receive 100% supplemental oxygen. Do not use a pulse oximetry measure to titrate supplement oxygen.
  • Acute coronary syndrome pulse oximetry range: 90% or higher
  • Stroke pulse oximetry range: pulse oximetry 95% to 98% (inclusive).
  • ROSC and post-cardiac care pulse oximetry range: pulse oximetry 92% to 98%.

Post-cardiac arrest care

  • Opt for continuous electroencephalography and detect nonconvulsive status epilepticus.
  • Treat clinical seizures and nonconvulsive status epilepticus.
  • Evaluate pediatric cardiac arrest survivors for rehabilitation services for at least one year.

Suspected opioid overdose

  • Naloxone administration is reasonable in addition to BLS/PALS. Give priority to resuscitative measures for cardiac arrest.


  • For children with this condition, it is necessary to use extracorporeal life support, such as mechanical circulation devices. This helps prevent cardiac arrest.
  • If cardiac arrest does occur in pediatric patients with cardiomyopathy, opt for extracorporeal CPR and transfer to an ICU at the earliest.


  • If a pediatric patient is awake and not willing to swallow oral glucose, then place a slurry of sugar and water below the tongue of the child.


The PALS manual updates from 2020 to 2025 are a significant evolution in pediatric emergency care. These are the results of the latest research, evidence-based practices, and advancements in the industry. Follow the above-mentioned guidelines to enhance the quality of care and improve patient outcomes. To learn more, enroll online and seek a PALS certification course.,safest%20resuscitation%20technique%20going%20ahead.



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