PALS Electrical Therapy
Children need the same three electrical therapies as adults — defibrillation, synchronised cardioversion and pacing — but the energies are weight-based and the pads come in different sizes. The PALS course teaches both.
The numbers
Defibrillation for VF/pVT: 2 J/kg first, then 4 J/kg, and higher for later shocks (not exceeding 10 J/kg or the adult dose). Synchronised cardioversion for unstable SVT or VT with a pulse: 0.5 to 1 J/kg, then 2 J/kg.
For VF and pulseless VT. First shock 2 J/kg, second 4 J/kg, subsequent shocks 4 J/kg or more, up to 10 J/kg or the adult dose. Resume CPR immediately after each shock — see the cardiac arrest algorithm.
For unstable tachycardia with a pulse — SVT or VT — start at 0.5 to 1 J/kg and increase to 2 J/kg if needed. Sedate if it will not delay treatment, and check the sync marker before each shock. See the tachycardia algorithm.
Use the largest pads that fit without touching. Paediatric pads suit small children; in infants and small children, front-and-back placement may be needed. AEDs with a paediatric attenuator can be used, and an adult AED is better than none — see using an AED.
Occasionally used for bradycardia from complete heart block or sinus node dysfunction, with expert help — see bradycardia.
Everyone clear, oxygen away from the chest, and energies read back with closed-loop communication — see weight-based dosing. The adult equivalents are in ACLS electrical therapy.
This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.
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2 J/kg, then 4 J/kg.
Up to 10 J/kg or the adult dose, whichever is lower.
Start at 0.5 to 1 J/kg, then 2 J/kg if needed.
Yes, if a paediatric attenuator or pads are not available.
Front and back if the pads would otherwise touch.
Paediatric emergencies are learned by doing. Safety First Medical Services is an American Heart Association training centre on Al Reem Island, Abu Dhabi, with HeartCode, classroom and on-site PALS and a two-year AHA PALS Provider eCard.
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What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.
Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.