The PALS Systematic Approach Initial Assessment

The initial assessment is your quick “from the doorway” assessment you will observe the child’s appearance, breathing, and circulation. This will help you quickly identify a life-threatening condition if there is one activate emergency response and begin interventions. If there is NO life-threatening emergency start with the systematic approach

  • Appearance-level of consciousness and ability to interact
  • Breathing-work of breathing, position, audible breath sounds
    • Abnormal-nasal flaring, retractions, increased/inadequate/absent effort
  • Circulation-child’s color, skin color, obvious bleeding this will allow for assessment of perfusion
    • Abnormal-pallor, mottling, cyanosis, petechiae/purpura

PALS Systematic Approach Primary Assessment

The primary assessment consists of evaluating ABCDE

  • Airway-determine if the airway is open and patent.
    • LOOK-chest/abdominal movement
    • LISTEN-air movement and breath sounds
    • FEEL-air movement at the nose and mouth
  • Breathing-Evaluate
    • Respiratory rate/pattern/effort
    • Chest expansion/air movement
    • Lung and airway sounds
    • Oxygen saturation level
  • Circulation-Evaluate
    • Heart rate and rhythm
    • Pulses central and peripheral
    • Capillary refill time
    • Skin color and temperature
    • Blood pressure
  • Disability-Neurological Function and LOC
    • AVPU scale-alert, responsive to voice, responsive to pain, unresponsive
    • Glascow Coma Scale
    • Pupil response to light
    • Blood glucose test
  • Exposure-physical examination of child
    • Core temperature
    • Evidence of trauma
    • Injury

PALS Systematic Approach Secondary Assessment

Secondary assessment is SAMPLE

  • Signs and Symptoms
    • At onset of illness-tachycardia, tachypnea, LOC, anxiety, diarrhea, vomiting, pain
  • Allergies
  • Medications
  • Past medical history
  • Last meal
  • Events-leading to the onset of illness

Diagnostic Testing

  • Blood gas
  • CVP
  • Art line
  • Chest Xray
  • EKG
  • Ultrasound
  • CT


  • Evaluate-Initial assessment, primary asessment, secondary assessment, diagnostic testing
  • Identify
    • Circulatory-Shock(hypovolemic, distributative, obstructive, cardiogenic)
    • Respiratory-Failure, distress, upper/lower obstruction, lung tissue disease, disordered control of breathing
  • Intervene
    • Interventions that are general and specific for the child
      • Positioning-maintain patent airway
      • Activate emergency response
      • Perform CPR
      • Administer O2
      • Supporting ventilation
      • Medications/Fluids

Pediatric Vital Signs

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