👤 By the CinnaEMS Content Team🕐 Updated 2026-09-28🏷️ Cardiology & Resuscitation🔖 Free to read, print, and share
Also known as: PALS · pediatric shock · pediatric arrest · length-based tape · intraosseous · pediatric bradycardia · PAT · decompensated shock
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Use this quick-reference guide to recognise, treat and hand over Pediatric Advanced Care on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Shock
Tachycardia · slow refill = early
Hypotension = late
📌 Bradycardia
Usually hypoxia
Oxygenate + ventilate
HR < 60 + poor perfusion → CPR
📌 Tools
Length-based tape
IO if IV is slow
Bag-mask preferred
🚩 Arrest
Advanced airway: 1 breath / 2–3 s
Check glucose
📚 Pediatric Advanced Care — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
Children compensate well and then crash: blood pressure holds until very late, and most pediatric arrests begin as respiratory failure or shock. Advanced care means recognizing decompensation early, using length-based equipment, and following the pediatric resuscitation sequence.
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Key points
Understand these first
Tachycardia and delayed capillary refill are early shock signs; hypotension is a late, ominous one.
Bradycardia in a child is usually hypoxia — oxygenate and ventilate first.
Use a length-based tape for equipment sizes and weight-based dosing, never a guess.
If an IV is not obtained quickly in a critically ill child, use intraosseous access.
Pediatric CPR with an advanced airway: 1 breath every 2 to 3 seconds with continuous compressions.
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Treatment priorities
What to do, in order
Start CPR for a heart rate below 60 with poor perfusion despite oxygenation and ventilation.
Bag-mask ventilation is the preferred airway for most children in the field.
Check glucose in any critically ill child — small glycogen stores run out fast.
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Red flags — report now
Escalate immediately
Falling heart rate in a distressed child
Hypotension (decompensated shock)
Grunting, head bobbing or altered level of consciousness
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Patient teaching
What patients must know
Pediatric Assessment Triangle from the doorway: appearance, work of breathing, circulation to the skin.
❓ Pediatric Advanced Care: NREMT FAQs
What are the priority actions for Pediatric Advanced Care in the field?
Start CPR for a heart rate below 60 with poor perfusion despite oxygenation and ventilation. Bag-mask ventilation is the preferred airway for most children in the field. Check glucose in any critically ill child — small glycogen stores run out fast.
What findings in Pediatric Advanced Care change your plan or your transport decision?
Falling heart rate in a distressed child. Hypotension (decompensated shock). Grunting, head bobbing or altered level of consciousness.
What do I need to know about Pediatric Advanced Care for the NREMT?
Tachycardia and delayed capillary refill are early shock signs; hypotension is a late, ominous one. Bradycardia in a child is usually hypoxia — oxygenate and ventilate first. Use a length-based tape for equipment sizes and weight-based dosing, never a guess. If an IV is not obtained quickly in a critically ill child, use intraosseous access.
What should the crew communicate or document for Pediatric Advanced Care?
Pediatric Assessment Triangle from the doorway: appearance, work of breathing, circulation to the skin.
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Quick Tip
Tachycardia and delayed capillary refill are early shock signs; hypotension is a late, ominous one.