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Pediatric Advanced Life Support (PALS) Tips

  1. What's your initial impression of Appearance, Breathing, and Circulation using the Pediatric Assessment Triangle (PAT). If there is a life-threatening problem, start the steps of CPR. If not, continue an evaluate-identify-intervene sequence.

  2. Begin with your Primary Assessment (ABCDE) to evaluate respiratory, cardiac, and neurologic function. Is the Airway maintainable or not?

  3. Assess Respiratory rate and pattern, effort, chest expansion, air movement, abnormal airway and lung sounds, and pulse oximetry.

  4. Evaluate Heart rate and rhythm, pulses, capillary refill time, skin color and temperature, and blood pressure.

  5. Assess Disability using the AVPU mnemonic - Alert, Responds to Voice, Pain, or Unresponsive. Assess Pupil size and reaction to light. Check blood Glucose.

  6. Expose the child to check temperature and look for rashes or trauma.

  7. The Secondary assessment includes the SAMPLE (S/S, Allergies, Medications, Pertinent history/Parents impression, Last oral intake, Events leading up to Illness/Injury) history and focused physical exam.

  8. Obtain laboratory and radiographic diagnostic tests to help identify the physiologic condition and diagnosis.

  9. Identify if the child's problem is Respiratory, Circulatory (Shock), or Both.




PALS References

1. American Heart Association. Textbook of Pediatric Life Support, 2016. https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/

2. Deboer, Scott. Certified Pediatric Emergency Nurse, Putting it all Together, 3rd edition, 2015.

3. Emergency Nurses Association. Emergency Nurses Pediatric Course Provider Manual, 5th edition.

Sheehy, S. Sheehy’s Manual of Emergency Care, 7th ed. Elsevier, 2013.

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