Most clinicians treat PALS and ACLS as completely separate certifications — two different binders, two different classes, learned years apart and mentally filed in different compartments.

That's a mistake. Understanding where they overlap makes you significantly better at both.

"Adults arrest because the pump stops. Children arrest because the breathing stops. Everything else in pediatric resuscitation follows from that single fact."

The core physiological difference

Adults arrest from cardiac causes first. The rhythm fails, the pump stops.

Children arrest from respiratory causes first — overwhelmingly. The airway and breathing deteriorate, hypoxia progresses, and cardiac arrest follows as a downstream event. This is why pediatric resuscitation is so heavily weighted toward airway management. If you ventilate a child in respiratory failure aggressively enough, you may never need to run a full arrest algorithm.

This distinction changes everything about your initial priorities.

ACLS (Adults)

  • Cardiac cause is primary
  • Rhythm analysis dominates the first minute
  • Defibrillation is often the fix
  • Fixed drug doses (1mg epi, 300mg amio)
  • Compression depth: 2–2.4 inches

PALS (Pediatrics)

  • Respiratory cause is primary
  • Airway/oxygenation dominates the first minute
  • Ventilation is often the fix
  • Weight-based doses (0.01 mg/kg epi)
  • Compression depth: 1/3 chest diameter