Table of Contents
- Overview of the PALS Approach
- Steps Involved in the Secondary Assessment
- Improve Your Skills with Secondary Assessment PALS
In 2019, around 5.2 million children under the age of 5 died, mainly from preventable or treatable causes. This is where Pediatric Advanced Life Support (PALS) training can make a difference. It equips healthcare professionals to save children’s lives by providing timely and effective care during emergencies. The focus is on assessing and managing critically ill or injured children, especially those with cardiac arrest or breathing difficulties. The first step in PALS is a primary assessment, which quickly addresses life-threatening conditions to stabilize the child.
Once the primary assessment is complete, the PALS secondary assessment follows. It aims to identify and manage critical issues that may not be immediately apparent. The second assessment includes gathering a focused medical history using the SAMPLE method, performing a full head-to-toe physical exam, and possibly running a few diagnostic tests.
This blog will explore the secondary PALS assessment’s importance, outline its steps, and explain how it helps ensure complete and effective care for pediatric patients.
Overview of the PALS Approach
In PALS, both primary and secondary assessments are important for the proper evaluation and management of an injured child as well as ill patients. Some of the key elements of both the assessments are discussed as follows:
Primary Assessment
The primary assessment, which can be divided into the ABCDE approach, identifies life-threatening conditions that require immediate intervention.
- Airway: Doing a proper check-up to see if the airway is clear of any obstruction.
- Breathing: Understanding the breathing patterns of the distressed child.
- Circulation: Checking the pulse and signs of shock or bleeding in infants.
- Disability: Properly assessing the neurological status using the AVPU (Alert, Voice, Pain, Unresponsive) scale gives a clear idea about the seriousness of the condition.
- Exposure: Full exposure of the child helps to identify hidden injuries and signs of poisoning.
Secondary Assessment
The secondary assessment PALS is performed after completing the primary assessment, which addresses life-threatening conditions such as severe airway obstruction, inadequate breathing, or abnormal circulation. The main goal is to collect detailed information which would be helpful for further treatment. Let’s now take a look at what is included in secondary assessment PALS:
- Obtaining the History: In this step, medical practitioners ask questions to understand the patient’s history. They use a method called SAMPLE, which stands for Signs and symptoms, Allergies, Medications, past medical history, Last meal, and Events that led to the emergency. This helps them know more about what happened before and what might be causing the problem so they can choose the best way to help the patient.
- Evaluating Vital Signs: Next, the vital signs are checked. For example, measuring temperature, blood pressure, and respiratory rate helps identify trends and monitor the patient’s condition over time.
- Diagnostic Testing: Blood tests, X-rays, ECG (electrocardiogram), and imaging studies help confirm the condition and provide a clearer picture of the patient’s health status.
- Reevaluation: Continuous monitoring of the patient’s vital signs and overall condition shows how well the treatment is working and whether adjustments are necessary.
Also Read: PALS Class Requirements
Steps Involved in the Secondary Assessment
The PALS secondary assessment requires step-by-step knowledge because each step is essential to evaluate and manage the patient’s condition thoroughly. This approach ensures that no important details are overlooked. This comprehensive assessment involves securing a detailed health history of the patients, conducting thorough physical tests, and using diagnostic tools to facilitate effective care for critically ill children.
Evaluating Medical History
In this step, patients’ medical histories are evaluated to look for any other medical issues. This step is important as it will help decide the best course of action.
The process begins with identifying the Chief Complaint, which is the main reason the patient is seeking medical attention. The doctor then focuses on the primary symptoms the patient is experiencing.
Next, the pediatric secondary assessment includes understanding the history of the present illness, which looks at how the symptoms began, how they have changed over time, and the patient’s current condition. After that, a focused history is taken using the SAMPLE method:
- S (Signs and Symptoms): Details about the patient’s current symptoms, such as difficulty breathing or pain.
- A (Allergies): Any known allergies to medications, foods, or environmental factors.
- M (Medications): All medications the patient is taking, including prescriptions, over-the-counter drugs, and supplements.
- P (Past Medical History): Pre-existing conditions such as asthma, heart disease, or any recent surgeries.
- L (Last Meal): When the patient last ate and what they consumed, as this can affect their energy levels.
- E (Events): A description of the events leading to the emergency, helping to understand the context of the situation.
Last but not least, doctors also check the immunization status. This is important as it helps prevent illnesses like respiratory infections during the treatment period. It also ensures the patient’s vaccination history, which could influence medical decisions.
Physical Examination
In this step, you need to go through the following procedures, which explain the different physical examinations included in PALS secondary assessments.
- General Appearance and Behavior: In the primary assessment procedure, the child’s behavior, social alertness, and signs of distress or lethargic behavior are observed, which could potentially indicate a more serious condition.
- Airway and Breathing: You can then analyze the patient’s breathing pattern, quality of breathing sound, oxygenation, and respiratory effort. Look for signs of respiratory distress, such as abnormal lung sound or retraction.
- Cardiovascular System: Evaluating the cardiovascular system of the patient is the next most important task in PALS secondary assessment. You should check heart rate, rhythm, capillary refill time, and skin color to determine the signs of poor perfusion.
- Neurological Assessment: The AVPU scale is used to assess the patient’s neurological system. It evaluates the child’s level of alertness and verbal responsiveness to determine their consciousness and overall responsiveness.
- Gastrointestinal and Abdominal Assessment: To check for gastrointestinal and abdominal conditions, you should check tenderness, distension, and abnormal bowel sounds. All these may indicate abdominal issues or dehydration.
- Musculoskeletal System: This assessment requires careful inspection of any signs of deformities, trauma, or other abnormalities that could affect the child’s stability or mobility.
Diagnostic Tests and Monitoring
After completing the physical examination, you may wonder: what are some examples of diagnostic assessment PALS? It includes proper diagnostic tests and careful monitoring of vital signs, such as blood tests, ultrasonography, EKG monitoring, and so on.
- Vital Signs Monitoring: In this, the vital signs of the patients, such as heart rate, blood pressure, oxygen saturation, and respiratory rate, are monitored to identify changes in the condition early. Moreover, assessing skin temperature is a crucial part of the secondary assessment. So, what should be used to assess skin temperature in PALS? Typically, healthcare providers will use a thermometer, often infrared, or simply check the skin manually for signs of abnormal temperature.
- Imaging (if needed): This is not always needed. However, when required, patients are advised to undergo radiographs (such as chest X-rays or skeletal radiographs) and ultrasound testing. This is done to evaluate traumatic or structural injuries as indicated.
- Blood Tests and Labs: Healthcare providers often want to monitor electrolytes and blood gas levels. These assessments offer valuable insights into metabolic rates and detect any imbalances in blood chemistry.
- EKG Monitoring: EKG monitoring is done to determine the heart condition of patients with arrhythmias, especially children who show signs of cardiovascular instability.
Read More: Basic Airway Management in Children
Reassessments and Treatment Adjustments
Adjustments are critical for providing the optimum treatment in the context of secondary assessment. Reassess the ABCD and various secondary aspects, such as collecting patient history and vital signs. Based on these findings, use and modify secondary assessment ACLS methodologies as needed. This includes adjusting medication dosages, altering fluid management protocols, and considering further diagnostic tests to identify any underlying issues. For example, if electrolyte imbalances or abnormal lab results are detected, you might need to adjust the treatment approach, including medication changes or administering IV fluids.
Collaboration and Communication
PALS secondary assessment components also involve the right collaboration and communication. For comprehensive care, the secondary assessment requires input from the entire healthcare team within an organization, including physicians, nurses, and respiratory therapists. Moreover, effective communication helps avoid mistakes and forms an informed decision that guides the ongoing treatment procedures in the right direction.
Improve Your Skills with Secondary Assessment PALS!
As heart problems in babies are becoming more common. Thus, it is important for healthcare workers to be aware of the PALS secondary assessment. This skill helps them find problems that might not be life-threatening right away but still need attention. The secondary assessment in PALS helps doctors and nurses check for other issues, like breathing problems or injuries, that could get worse if not treated.
When you learn PALS, you get the right tools and are ready for emergencies. With proper training, you can help kids in critical situations. Choose a reliable provider who can offer high-quality programs!
