A Medications Guide for the PALS Exam

All healthcare workers who work with children or infants should take the PALS {pediatric advanced life support} course. This course equips them with skills essential to caring for children who are critically ill. Successful completion of a PALS course allows healthcare workers to improve the survival chances of the critically ill children they treat.

If you have been postponing your PALS training because you lack time for in-person learning, online classes offer an easy solution. There are free PALS certification classes online, as well as online recertification courses, such as those offered by medtigo Connect.   

One of the important topics covered in these courses is the medications used in pediatric emergencies. Below is a list of these medications, which you can refer to as you prepare for your free PALS certification or recertification exam.


Indications: Supraventricular tachycardia and pre-supraventricular tachycardia.

                        Wide QRS tachycardia.          

Dosage: Initial dose: 0.1 mg/kg as an IV push {maximum dose is 6 mg}.   

                        Second dose: 0.3 mg/kg as an IV push {maximum dose is 12 mg}.

Cautions: Should be administered as a bolus injection that is followed by flushing.

                        It can cause bronchospasms, so should be used cautiously in asthmatics.

                        Commonly causes chest tightness and/or flushing.


Indications: Symptomatic bradycardia.

Dosage: 0.02 mg/kg, given intravenously every 3-5 minutes. {Maximum single dose is 0.5 mg}

Cautions:  A dose that is less than 0.1 mg might result in paradoxical bradycardia.

                   The maximum total dose for a child is 1 mg, while that for an adolescent is 3 mg.


Indications: Symptomatic bradycardia.

                      Severe anaphylactic or allergic reactions.

                      Cardiac arrest.

                      Severe hypotension.

Dosage: 0.01 mg/kg of a solution with a strength of 1:10,000.

                The drug is administered intravenously or intraosseously.

                 Repeat the administration every 3-5 minutes.

                 An IV fluid flush should follow each dose.

Caution: You might need to administer a higher dose when handling a pediatric patient with a calcium channel blocker or beta-blocker overdose. In these instances, you might also need a continuous infusion.

                A high dose does not necessarily improve neurological or survival outcomes.

                A high dose stops myocardial dysfunction after resuscitation.


Indication: Low magnesium levels {hypomagnesia}

                    Digitalis toxicity.

                    Torsade de Pointes.

Dosage: 25-50 mg/kg, given as an intraosseous or intravenous injection for 15-30 minutes.

               Magnesium should be diluted in 10 mg/ml of 5% dextrose in water for administration.

               The maximum dose of magnesium is 2 g.

Cautions: Administering magnesium too fast may cause a drop in blood pressure.

                  High doses may result in respiratory distress (calcium can be used to manage this).

                  Magnesium should be used cautiously in renal failure patients.

Sodium Bicarbonate

Indications: Metabolic acidosis.

Dosage: 1 mEq/kg, given as a slow intraosseous or intravenous injection.

Maximum dose: 50 mEq.

Cautions: Adequate ventilation is essential prior to magnesium administration, in order to manage or avert respiratory acidosis.

 Use ABG {arterial blood gas} results to monitor a patient’s PH when administering magnesium.

Taking PALS certification online and PALS recertification online courses will not do much for your career if you fail your exams. Most people fail these exams because they are not adequately proficient regarding the above drugs. Consider printing the guide provided here, to use as a quick reference for your review. Or save this guide as a .PDF file to which you can refer.

For more information about FREE PALS certification courses and other medical training solutions, contact medtigo Connect today.

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