Pediatric Advanced Life Support (PALS) Systematic Approach

Introduction

• Focus on Pediatric Advance Life Support (PALS) using the 2020 American Heart Association guidelines.
• Aim: Identify and immediately intervene in life-threatening conditions in children via a systematic approach.

Components of PALS Systematic Approach

1. Initial Assessment
2. Primary Assessment
3. Secondary Assessment
4. Diagnostic Tests

Evaluation Strategy

• Evaluate, Identify, Intervene
  • Continuously assess child's condition and intervene as needed.
  • If life-threatening conditions are identified, immediately perform life-saving interventions.

Initial Assessment

• Utilize the Pediatric Assessment Triangle (PAT)
  • Appearance: Level of consciousness, interaction ability.
  • Breathing: Work of breathing, position, audible breath sounds (stridor, grunting, wheezes).
  • Color/Circulation: Skin color, signs of bleeding, perfusion indicators like pallor, mottling, cyanosis, flushing, petechiae, or purpura.

Primary Assessment (ABCDEF)

1. Airway: Open, maintain, and protect airway.
2. Breathing: Evaluate respiratory rate, pattern, effort, and oxygen saturation.
   • Abnormal respiratory rates (<10 or >60) warrant further assessment.
3. Circulation: Assess heart rate, rhythm, blood pressure, capillary refill, and pulses.
   • Critical blood pressure values:
     • Term neonate: ≤60 mmHg
     • Infants 1-12 months: ≤70 mmHg
     • Children 1-10 years: Age x 2 + 70
     • Children ≥10 years: ≤90 mmHg
4. Disability: Evaluate neurological function using AVPU and Glasgow Coma Scale (GCS).
5. Exposure: Consider blood glucose levels and determine the case type (respiratory or shock).

Types of Respiratory Conditions

• Respiratory Distress vs. Failure:
  • Upper Airway Obstruction: Foreign body, anaphylaxis, croup.
  • Lower Airway Obstruction: Asthma, bronchiolitis.
  • Lung Tissue Disease: Involves lung parenchyma.
  • Disordered Control of Breathing: Seizures, CNS infection, head injuries.

Types of Shock

• Shock: Inadequate tissue perfusion; not always hypotensive.
  • Hypovolemia: Reduced intravascular volume.
  • Distributive Shock: Maldistribution of blood.
    • Examples: Septic shock, anaphylactic shock, neurogenic shock.
  • Obstructive Shock: Impaired blood flow.
    • Examples: Pericardial tamponade, tension pneumothorax.
  • Cardiogenic Shock: Reduced cardiac output due to cardiac issues.

Secondary Assessment

• SAMPLE Pneumonic
  • S: Signs and symptoms
  • A: Allergies
  • M: Medications
  • P: Past medical history
  • L: Last meal
  • E: Events leading up to the injury/illness
• Focus Physical Examination
  • Head-to-toe check: Head, ears, eyes, nose, throat, chest, abdomen, extremities, back, neurological function.
  • Repeat vital signs for ongoing evaluation.

Diagnostic Assessments

• Use further diagnostic tests as needed: Chest x-ray, ECG, ABG, echocardiogram.

Conclusion

• Emphasize continual evaluation and timely intervention for optimal pediatric care.
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