In PALS, what is the initial algorithm branch for a child with no pulse and apnea?

• A. Wait for rhythm to stabilize before initiating CPR
• B. Start CPR immediately; assess rhythm; shock if rhythm is shockable; continue CPR and deliver shocks as indicated
• C. Only ventilate for 2 minutes before CPR
• D. Call for help and reassess after 5 minutes

Answer: (B)

When a child has no pulse and is apneic, the priority is immediate, high-quality CPR to maintain blood flow to the brain and heart. Delaying CPR to “wait for rhythm stabilization” would waste crucial seconds and reduce the chance of survival, because perfusion is the most time-sensitive factor in pediatric arrest.

Start chest compressions right away and continue them while you assess the heart rhythm. If the rhythm is shockable (ventricular fibrillation or pulseless VT), deliver a shock and then resume CPR immediately, with ongoing rhythm checks and additional shocks as indicated. If the rhythm is not shockable, keep up CPR and follow the protocol with appropriate medications and subsequent rhythm checks. Throughout, keep interruptions to a minimum so perfusion remains as continuous as possible.

This sequence—begin CPR immediately, then assess rhythm and shock if indicated, continuing resuscitation with minimal pauses—captures the correct approach in pediatric advanced life support.