Hi there. Marius here with the Resuscitation Coach . On this channel we do all things resuscitation, so please consider subscribing. In today's video, we'll be discussing the pediatric advance life support or PALS systematic approach based on the 2020 American Heart Association guidelines. So let's jump straight in. Here we go! We should always use a systematic approach when caring for a seriously ill or injured child so that we can quickly recognize signs of respiratory distress, respiratory failure and shock, and immediately provide life-saving interventions. The American Heart Association's PALS systematic approach includes four components, the initial assessment, the primary assessment, the secondary assessment and diagnostic tests. We'll be looking at the individual assessments as to make your PALS systematic approach easier. Throughout our PALS systematic approach, we will follow the evaluate, identify, and intervene sequence as we take care of the sick or injured child from the information gathered during our evaluation, we'll identify the child's clinical condition by type and severity and intervene with appropriate actions. So we'll constantly evaluate, identify, and Intervene. Remember, team, at any point if you identify a life-threatening condition, immediately intervene with your life saving interventions. We use the Pediatric Assessment Triangle or P A T to make our initial assessment during our first quick from the doorway observation of the child. Appearance, Breathing and Color within a few seconds, after encountering the child. Here we focus on what we can see and hear before touching the child to help identify the general type of respiratory, circulatory, or neurological issues that will require urgent treatment. The initial assessment helps us to quickly identify life-threatening conditions. If at any time we identify a life-threatening condition, immediately, we will need to start intervening and activate our emergency response system. If a child appears to be unresponsive, immediately follow your B L S assessment of activating the emergency response system, and then checking for the breathing and pulse. If the child is not breathing but having a pulse, we will start with rescue breathing by giving one breath every two to three seconds, which is 20-30 breaths per minute. If the child does not have a pulse immediately start with high quality chest compressions by pushing hard and fast in the center of the chest at the rate of a 100 to 120 pushes per minute. Remembering to allow the chest to fully recoil. Do not interrupt CPR for longer than 10 seconds and do not hyperventilate. You want to give just enough air to see visible chest rise. How deep do we push on the chest. You want to push down one third of the anterior posterior chest. If we do not detect a life-threatening emergency, we can continue forming our initial impression of the child's condition using the P A T. So appearance. Here we are looking at the child's appearance, including the level of consciousness and the child's ability to interact. Breathing here will focus on the work of breathing the position and any audible breath sounds that we can hear. Keep in mind, this is without your stethoscope, so we're looking at things like stridor, grunting, and wheezes Here we also look at signs of absent or increase respiratory effort under the circulation or color. You will look at a child's overall circulatory status, assess the child's color, including the skin, and for obvious signs of bleeding. This section will provide us valuable information about how well the child is perfusing. Look for palor or paleness , motling, which irregular skin color on the face, arms and legs, or cyanosis on the lips and fingernails. A sign of inadequate oxygenation. Flushing can be a sign of distributive shock or petechiae or perpura, which is bleeding under the skin, which can point us to a possible sepsis. The primary assessment uses a quick hands-on A, B, C, D assessment, annual assess, the child airway, breathing, circulation, disability exposure. As you proceed through each component of the primary assessment, treat life-threatening abnormalities in real time, before you complete the remainder of the assessment. Under the airway, ensure that the airway is opened, maintained, and protected. Review the breathing rate. Is it normal, fast, slow. Look at the breathing pattern. Review oxygen saturation, and if the saturation is below 94%, start oxygen. Check the respiratory effort and listen to the lungs and airway sounds. A critical concept here is that when there is a consistent respiratory rate, less than 10 or more than 60 in a child of any age, it's often abnormal and warrants further assessment for the presence of serious conditions. A tip year is to evaluate the respiratory rate prior to the hands-on assessment as anxiety and agitation will increase the breathing rate. Also, bradypnea or an irregular respiratory rate in an acutely ill child is an ominous clinical sign and often signals impending arrest. Under C, we need to evaluate the heart rate and rhythm, blood pressure, capillary refill, which should be below two seconds. Also, the central and peripheral pulses. Weak, central pulses are worrisome and might indicate the need for rapid intervention to prevent cardiac arrest. So what is the definition of hyportension by systolic blood pressure and age? So for a term neonate, between zero to 28 days, it's 60 mmHG, or below, for infants from one to 12 months, it's 70 mmHg and below for children between one to 10, its age times two plus 70, and children at 10 years of age and above its 90 mmHg. The blood pressure or base on the fifth persontile. The fifth persontile is a systolic blood pressure that is lower than all but 5% of normal children. Under the Disability Assessment to quickly evaluate neurological function using one of several tools to evaluate responsiveness and level of consciousness, perform the evaluation towards the end of the primary assessment and repeated during the secondary assessment to monitor for changes in the child's neurological status. Tools that we use includes AVPU, which stands for Alert Voice Pain and Unresponsive, and a Glasgow Coma Scale or GCS. There is also a modified G C S for preverbal or nonverbal children. Also check the pupil response to light. We use the acronym PERRL, which stands for pupils equal round, reactive to light, and last, but definitely not the least consider the blood glucose. Blood glucose, 40 mg/dl or 2.2 mmol/l or less in the newborn. And 60 mg/dl, or 3.2 mmol/l and below in children gets classified as hypoglycemia. So we need to decide if our case is a respiratory case, a shock case, or a combination of both. If it's a respiratory case, we need to decide if it's respiratory distress or respiratory failure. And from there it can be classified into one or more of the following types, upper airway obstruction, lower airway obstruction, lung tissue disease, and disordered control of breathing. Examples of upper airway obstruction could be a foreign body aspiration, anaphylaxis and croup. Examples of lower airway obstruction can be asthma or bronchiolitis. Lung tissue disease involves parenchyma or tissue of the lungs. Examples of disordered control of breathing includes disorders like seizures, central nervous system infection, head injuries to name a few. For more information on the respiratory disorders and treatments, please refer to part seven and eight in your PALS manual. Shock is defined as a physiological state characterized by inadequate tissue perfusion to meet metabolic demand and tissue oxygenation. It is often but not always characterized by inadequate peripheral and end organ perfusion. A critical concept is that shock does not require the presence of hypotension. Shock can be present with a normal increase or decrease systolic blood pressure, compensated shock refers to a clinical state where signs of shock is present, but the blood pressure is in the normal range for age. Hypotensive shock or decompensated shock is characterized by evidence of impaired perfusion. The types of shock is hypovolemia, caused by reduced intervascular volume due to things like diarrhea, vomiting, and bleeding. Distributive shock refers to a clinical state characterized by reduced S V R, leading to maldistribution of blood volume and blood flow. Examples could be septic shock, anaphylactic shock, and neurogenic shock. Obstructive shock refers to a condition that physically impairs blood flow by limiting venous return to the heart, or limit the pumping of blood from the heart, resulting in decreased cardiac output. Causes include pericardial tamponade, tension pneumothorax, massive pulmonary embolism, and ductal dependent heart defects. Cardiogenic shock refers to reduce cardiac output secondary to abnormal cardiac function or pump failure, resulting in decreased systolic function and cardiac output. Common causes of cardiogenic shock include congenital heart disease, myocarditis, arrhythmias, and cardiomyopathy. So let's start with our secondary assessment. The SAMPLE pneumonic provides us a memory aid to help us recall the important medical information necessary to provide you the best care for your young patient following a systematic approach. S stands for signs and symptoms, A for allergies, M for medications, P for past medical history, L for last meal and E for events leading up to the injury or illness. Next, we need to perform a focus physical examination. We need to repeat the vital signs, check for changes from the previous vital signs taken during the primary assessment. Check the vital signs is an ongoing evaluation. For our head to toe evaluation, we will start at the head, ears, eyes, nose, and throat. Chest we will look at the heart and lungs and the outer chest. We'll be looking at the abdomen, we'll be looking at the extremities, the back, and don't forget to repeat your neurological function test. Diagnostic assessments includes further assessments like your chest, x-ray, ECG, ABG, your echocardiogram to mention a few. If you benefited from this video, kindly like, subscribe and smash that notification bell. We'll see you in the next video. Have a fantastic day.