PALS

Pediatric Critical Care Columnist · May 21, 2016

PALS actually doesn't require that much ECG recognition. The algorithms are pretty simple. Is it fast, or slow? Is there a pulse? Is it shockable? That's as deep as it's going to go. There's a little fine-tuning for each; fast rhythms are ST (regular, normal morphology, usually gradual onset), SVT (regular, absent or buried P waves, sudden onset and rate is usually higher than ST) and VT +/- pulse (regular, abnormal morphology). Slow rhythms are SB (regular,normal morphology) and junctional escape - not common in children with no underlying cardiac pathology. Shockable rhythms don't include asystole and pulseless electrical activity - you want to shock something that will respond by converting to sinus again, so VT/VF, SVT. SB may require transcutaneous pacing but not cardioversion or defibrillation. That's it in a nutshell. The rest of rhythm analysis is more valuable to nurses working in the cardiac ICU so don't overthink this!

Drugs? If you understand how they work before you do the course, you'll be able to select appropriately and the doses are on the pocket card. I strongly advise studying the workbook ahead of time and working through the scenarios on the included CD. If you do that, you'll pass. Trust me.

emtpbill, ASN, RN, EMT-P · May 21, 2016

Pals is, and has been for a long time, a program to educate and make sure you know the information. I have never, in over 20 years of taking Pals, seen someone not pass. If you happen to not do well on the test the instructors will remediate you until you are sufficiently knowledgable.

nerdynurse22 · May 22, 2016

PALS actually doesn't require that much ECG recognition. The algorithms are pretty simple. Is it fast, or slow? Is there a pulse? Is it shockable? That's as deep as it's going to go. There's a little fine-tuning for each; fast rhythms are ST (regular, normal morphology, usually gradual onset), SVT (regular, absent or buried P waves, sudden onset and rate is usually higher than ST) and VT +/- pulse (regular, abnormal morphology). Slow rhythms are SB (regular,normal morphology) and junctional escape - not common in children with no underlying cardiac pathology. Shockable rhythms don't include asystole and pulseless electrical activity - you want to shock something that will respond by converting to sinus again, so VT/VF, SVT. SB may require transcutaneous pacing but not cardioversion or defibrillation. That's it in a nutshell. The rest of rhythm analysis is more valuable to nurses working in the cardiac ICU so don't overthink this!
Drugs? If you understand how they work before you do the course, you'll be able to select appropriately and the doses are on the pocket card. I strongly advise studying the workbook ahead of time and working through the scenarios on the included CD. If you do that, you'll pass. Trust me.

Thank you so much. I really appreciate the time you took to reply and with the explanations. I am taking the course online and they have videos to watch. Then I go in for the skills assessment and then test. I did purchase the book for additional resource/ study guide. Thank you again and have a wonderful day!!

nerdynurse22 · May 22, 2016

Pals is, and has been for a long time, a program to educate and make sure you know the information. I have never, in over 20 years of taking Pals, seen someone not pass. If you happen to not do well on the test the instructors will remediate you until you are sufficiently knowledgable.

THANK YOU emtpbill. Your comment was so reassuring. I even read it out loud to my husband. His response was "see I told you, you just worry too much and will be just fine". That is a good point as these courses are not meant to be a grade or passing it's education and to gain more knowledge. I guess my mind is stuck in school mode! Thank you again for your insight and information. Have a wonderful day!

~PedsRN~, BSN, RN · May 23, 2016

What they said! Just know brady, tachy, and can you shock it. :) Good luck!

bebbercorn · May 26, 2016

Agreed with above... as far as strips to know, SVT, Vtach w/o pulse, Vfib, S. Brady, S. Tachy, and Asystole. Know what you can shock. It's not as hard as ACLS. Know Epi! (0.01 mg/kg)

jrt4 · May 27, 2016

Agree with the above posters. I am a PALS instructor. Just don't over think it and take enough time to do your initial assessment to figure out what is going on with the patient. All PALS scenarios do not involve the patient coding on the gurney. Everyone wants to pull out all the big guns (EPI, shock, etc)...start with CPR if there is no pulse and take a deep breath. Remember you have 2 minutes between each rhythm check...dont let the instructor rush you if you need a second to think. You will be fine!