According to the WHO (World Health Organization), in 2020, about 5 million children under the age of 5 died, mostly from causes that could have been prevented or treated. Nearly half of these deaths, around 2.4 million, occurred in newborns during their first 28 days of life. This is where pediatric advanced life support, or PALS, can truly make a difference. The secondary assessment in PALS involves quickly checking the child’s vital signs, such as pulse, blood pressure, and breathing. It also includes observing how the child responds, like their level of consciousness and skin condition. This stage helps gather important information about what might be causing the problem and guides the next steps in treatment. Essentially, it provides a clearer picture of the child’s overall condition after the initial emergency has been addressed. Learn about the pediatric chain of survival, a life-saving guide for children’s emergencies.
In this blog, we will explore the secondary PALS assessment, walk through its steps, and explain how it helps deliver complete and effective care for pediatric patients.
What is Secondary Assessment In PALS?
The secondary assessment in PALS comes after the initial check or primary assessment of the child’s appearance, breathing, and circulation. It’s a deeper look to find out what’s causing the problem. This step includes asking about the child’s medical history, checking vital signs, doing a focused physical exam, and running tests if needed. You’ll ask questions about things like symptoms, allergies, medications, and past health issues. It’s all about putting the pieces together to understand what’s going on. This information helps guide treatment and makes sure nothing important is missed while caring for the child.
Secondary Assessment Of PALS
When a pediatric patient needs emergency care, it’s important to gather all the information quickly and stay calm. Start by collecting the child’s history, checking vital signs, doing some tests, and then reassessing to see how they’re responding.
1. Obtaining the History
Collecting the pediatric patient history helps us understand what led to the current emergency. You have to ask about how the child was feeling beforehand, any recent illnesses or injuries, and anything unusual that might be relevant. This information gives you clues about what might be causing their condition and helps guide your next steps.
2. Assessing Vital Signs
Checking vital signs gives you important clues about how the child is doing. You have to quickly measure their heart rate, breathing, blood pressure, and temperature to see if anything is abnormal. This step helps you decide what urgent actions to take and how serious the situation might be.
3. Diagnostic Testing
You have to perform some quick tests to get more information about the child’s condition. These tests can include checking blood glucose, listening to the lungs, or using other simple tools to gather details that guide your next steps in care. Your goal is to find clues that can help you understand what is causing the pediatric patient emergency.
4. Reassessing
After your initial treatment, it is important to reassess the pediatric patient to see how they are responding. Check their vital signs again, observe any changes in their condition, and look for signs of improvement or deterioration. This helps you decide if you have to continue, modify, or stop certain interventions to keep the child safe.
Components of PALS Secondary Assessment
The PALS secondary assessment helps healthcare providers gather important information after identifying a patient in distress. It involves reviewing the medical history, doing a focused physical exam, conducting tests, watching the patient closely, and providing necessary treatments.
1. Evaluating Medical History (SAMPLE)
When taking a medical history from a pediatric patient from their family, the SAMPLE approach helps gather important information quickly. It covers key areas like signs and symptoms, allergies, medications, past medical history, last meal, and events leading up to the current situation.
1a. Signs & Symptoms
Asking about signs and symptoms means understanding exactly what the patient is experiencing at that moment. Listen closely to their descriptions of pain, dizziness, trouble breathing, or any other unusual feelings. The aim is to gather a clear picture of their condition to determine the most effective way to assist them.
1b. Allergies
Asking about allergies involves finding out if the patient has ever had a bad reaction to foods, medications, or other substances. This information is crucial to avoid giving anything that might trigger a harmful response and to ensure their safety while providing care.
1c. Medications
When you ask about medications, you have to learn which medicines your patient is taking regularly or has taken recently. Knowing this helps you understand their health better and makes sure you don’t give any treatments that could interfere with or cause problems. It also lets you check if their current medicines might be related to their current condition.
1d. Past Medical History
It’s important to find out if the patient has experienced any illnesses or health problems in the past. This information provides a clearer picture of their overall health and highlights any conditions that could affect how you treat them now. Understanding their medical history helps guide the best decisions for their care.
1e. Last Meal
Ask about the last meal to find out what your patient ate and when they last ate it. This information can be important because it helps you decide the right time to give certain treatments or tests. Knowing about their recent food intake also helps you understand their overall condition better.
1f. Events
When you ask about events leading up to the current situation, you have to know what your patient was doing or what happened before they became unwell. This helps you understand what might have caused their problem and gives you clues about how to treat them. Paying attention to these details can make a big difference in providing the right care.
2. Focused On Physical Examination
When performing a physical exam on a pediatric patient, start by carefully observing their overall appearance and behavior to get a quick sense of their condition. Then move on to examine the head and neck, chest, abdomen, pelvis, extremities, and backside of the body to check for any signs of injury, illness, or abnormality.
1. General Appearance and Behaviour
Starting the physical exam involves observing the child’s overall appearance and behavior. Check if they are alert or sleepy, comfortable or distressed, and pay attention to their skin color and breathing patterns. These observations provide vital clues about the severity of their condition.
2. Head and Neck
When examining a pediatric patient’s head and neck during a PALS assessment, you want to look closely for signs of trauma, swelling, or anything that seems out of place. Check the shape of the head, feel for soft spots if the patient is an infant, and notice any unusual movement or stiffness in the neck. Make sure the airway is clear and look for things like enlarged lymph nodes or swelling that could affect breathing. Pay attention to how the child holds their head; it can tell you a lot about pain or discomfort.
3. Chest
When checking the chest, you want to look at how the pediatric patient is breathing. Watch for chest rise and see if it’s even on both sides. Listen for any unusual sounds like wheezing or crackles, and check if the breathing looks too fast or too slow. Notice if the muscles between the ribs are pulling in or if the child is using extra effort to breathe. These signs help you understand how well the lungs and heart are working.
4. Abdomen
When you check the abdomen, start by looking at its shape and how it moves with each breath. Gently feel the area to see if it’s soft or if there are any tight or tender spots. Ask if there’s any pain when you press certain areas. Listen for bowel sounds like high-pitched, gurgling, or clicking sounds, as they can give you clues about how the digestive system is working. Be alert for swelling, bruises, or anything that seems unusual.
5. Pelvis
Examine the pelvis, gently press on the hips to check for pain or movement that shouldn’t be there. Look for any bruises, swelling, or signs of injury. If the pediatric patient reacts or pulls away, that might mean something is wrong. Be careful during this part, especially if there has been a fall or trauma. Always make sure the child feels as safe and comfortable as possible while you check.
6. Extremities
Check the extremities, look at how the arms and legs move. See if the pediatric patient can wiggle fingers and toes or grip your hand. Check for any swelling, bruises, or obvious injuries. Feel for warmth and pulses to make sure blood is flowing well. If something doesn’t feel right or the child says it hurts, pay close attention and keep them calm while you continue your exam.
7. Backside
When you check the backside, gently roll the pediatric patient to one side while keeping their head and neck steady. Look for any marks, swelling, or signs of injury on the back. Feel along the spine to check for any tenderness or unusual bumps. This part is easy to miss, but it can show important signs, especially if there was a fall or trauma. Always be gentle and talk to the child to help them stay calm.
3. Diagnostic Testing
When caring for a seriously ill or injured pediatric patient, healthcare teams use different tests to quickly find out what’s wrong. These tests help guide treatment and make sure the child gets the right care as fast as possible.
1. Laboratory Test
Blood tests check for things like infection, low blood sugar, or problems with how the body is balancing fluids and salts.
2. Imaging Studies
X-rays, CT scans, or ultrasounds can show injuries, lung problems, or other issues inside the body that aren’t easy to see from the outside.
3. Other Test
Doctors might use heart monitoring, pulse oximetry, or blood gas tests to check how well the heart and lungs are working and how much oxygen the child is getting.
4. Monitoring Of PALS
In PALS, you need to closely watch the child’s breathing, heart rate, and level of alertness. Use tools like a heart monitor, blood pressure cuff, and pulse oximeter to track how well their body is working. It’s also important to measure end-tidal CO2 to check how well they’re breathing and if CPR is effective. Keep an eye on the heart rhythm to detect any arrhythmias or signs of cardiac arrest. Your quick response can make a big difference in their recovery.
5. Interventions Of PALS
When a child is in trouble, quick and clear actions can make all the difference. PALS focuses on key treatments like medications, fluids, breathing help, and other specific care to keep kids safe and stable.
1. Medications
Using medications in PALS involves giving the right medicine at the right time to support the child’s heart and breathing. These drugs can calm the heart, open airways, or correct blood flow issues, so quick and appropriate action can truly make a difference.
2. Fluid Therapy
Administering fluids during PALS helps keep the pediatric patient body hydrated and maintains proper blood circulation. This support can boost blood pressure and ease the heart’s workload, making your care essential for keeping the child stronger.
3. Respiratory Support
Providing respiratory support helps the child breathe more easily and receive the oxygen they need. Using a mask, tube, or machine, timely intervention protects their lungs and keeps their body functioning properly.
4. Other Specific Treatments
Sometimes, your care goes beyond the usual steps with other specific treatments that fit the child’s unique needs. You might need to fix problems like seizures or low blood sugar, making sure every part of their health gets the attention it deserves.
Comprehensive Components and Steps in the Secondary Assessment of PALS
In short, the secondary assessment in PALS Algorithm plays a vital role in understanding the full picture of a pediatric patient’s condition after the initial emergency steps. By carefully gathering the child’s history, checking vital signs, performing focused exams, and running quick tests, healthcare providers can make smart decisions that guide treatment. This thorough approach ensures no important detail gets missed, helping doctors and nurses give the right care at the right time. Staying calm, organized, and attentive during this stage can truly save lives and improve outcomes for children in critical situations. If you’re looking to build your skills and confidence in handling pediatric emergencies, consider training with Bayside CPR, offering PALS classes along with other certification classes like ACLS, BLS and CPR & First Aid to help you be prepared when it matters most.
