The PALS Playbook: See Earlier, Act Faster, Communicate Clearly

If you’ve ever watched a stable-looking child become unstable in minutes, you understand why PALS exists. The physiology is different, compensation is rapid, and small mistakes in dose or timing can have big consequences. The good news: a small set of habits—consistent assessment, weight-based thinking, and closed-loop teamwork—prevents most chaos. Here’s how PALS training at Chicago’s Pulse helps you turn guidelines into muscle memory.

Start with the pediatric assessment triangle
Before you touch a monitor, scan appearance, work of breathing, and circulation to skin. This rapid visual gives you a “green/yellow/red” gut check and tells the team what to do first. If appearance is poor or work of breathing is heavy, you already know you’re leaning toward airway/oxygenation and rapid escalation. During training scenarios, you’ll practice saying your triangle out loud—so your team understands your mental model instantly.

Airway: simple first, escalate only when ready
Children respond to repositioning and basic maneuvers. You’ll drill head-tilt–chin-lift vs. jaw thrust, OPA/NPA sizing, and effective BVM technique with two-person seal. Escalation (supraglottic device or ETT) comes only when it won’t interrupt life-saving compressions or oxygenation. You’ll also practice titrating ventilations; in pediatrics, over-bagging is a fast path to harm.

Circulation: recognize shock type early
PALS sorts shock as hypovolemic, distributive (e.g., sepsis, anaphylaxis), cardiogenic, or obstructive (e.g., tension pneumothorax). In scenarios, you’ll decide fluid vs. pressor vs. immediate procedural actions by reading the clues: capillary refill, pulses, mental status, lung sounds, and history. Weight-based dosing (10–20 mL/kg crystalloid boluses, carefully reassessing; epinephrine infusions titrated to effect) becomes second nature when you say it out loud every time: “Child is ~18 kg; 20 mL/kg is 360 mL—get a 250 mL bag and a 110 mL flush ready.”

Rhythm problems: treat the child, not just the monitor
Tachyarrhythmias that threaten perfusion need synchronized cardioversion. Bradycardia with poor perfusion needs epi/atropine and often pacing. You’ll practice the language of action: “Unstable SVT—synchronize, 0.5–1 J/kg; ready to escalate to 2 J/kg if needed.” The phrasing matters because it coordinates hands, not just ideas.

Seizures, fever, and respiratory infections
A large share of pediatric emergencies revolve around seizures, febrile illnesses, and lower airway disease. You’ll rehearse practical approaches: positioning, oxygen, suction, a clear benzodiazepine plan for status epilepticus, and escalation if glucose or electrolytes are the trigger. For wheeze vs. stridor, you’ll internalize the upper vs. lower airway split—racemic epi and steroids vs. bronchodilators and steroids—and how to avoid agitating the child with suspected epiglottitis.

Teamwork: the sound of a good room
In PALS, you’ll rotate through roles and listen for the music of a competent team: short sentences, specific asks, and confirmations. You’ll learn to “narrate the why” so the family—and your teammates—understand the plan. That reduces panic and errors.

Prep that pays off

• Skim the algorithms, then write your own 10-line “cheat sheet” in your words.

• Practice weight math on common sizes (10, 15, 20, 25 kg).

• Rehearse your pediatric assessment triangle on every child you encounter this week, even stable ones.

After class
Run a five-minute “peds huddle” with your unit: pick one scenario (asthma exacerbation, anaphylaxis, febrile seizure), and walk the first three moves. Little reps compound.

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