Pediatric Advanced Life Support (PALS) employs a systematic approach to treating children experiencing medical emergencies. This method ensures immediate life threats are addressed quickly, followed by a deeper investigation into the underlying cause of the child’s distress. The Secondary Assessment is the comprehensive phase where healthcare providers seek the specific etiology of the illness or injury. This assessment begins only once the most pressing issues have been stabilized, allowing the team to gather detailed information necessary for a definitive diagnosis and treatment plan.
Moving Beyond the Primary Assessment
The Secondary Assessment represents a transition from rapid stabilization to thorough investigation. It follows the Primary Assessment, which focuses on evaluating and managing immediate problems related to the child’s Airway, Breathing, Circulation, Disability, and Exposure (A-B-C-D-E). Once initial resuscitation efforts have secured the child’s vital functions, the focus shifts to identifying why the emergency occurred. This phase is characterized by a focused history and a detailed physical examination, guided by the patient’s initial presentation and the findings from the Primary Assessment.
The goal of the Secondary Assessment is to uncover the root cause, or etiology, of the child’s condition. For instance, if the Primary Assessment revealed respiratory distress, the secondary phase aims to determine if the cause is asthma, pneumonia, or a foreign body obstruction. This systematic approach allows the medical team to move beyond simply treating symptoms and implement targeted interventions for the underlying disease process.
The Focused Medical History (SAMPLE)
Gathering a focused medical history is the first major component of the Secondary Assessment, often accomplished using the SAMPLE mnemonic. This structured interview quickly collects pertinent information from parents, caregivers, or bystanders, who are typically the primary sources of data for pediatric patients.
The mnemonic directs the provider to six specific categories of historical data:
- Signs and Symptoms: Details what the caregiver has observed (signs) and what the child may report (symptoms), such as fever or pain.
- Allergies: Known sensitivities to medications, food, or environmental factors that could influence treatment.
- Medications: A complete list of all drugs, supplements, and vitamins the child is currently taking.
- Past Medical History: Includes chronic illnesses, previous hospitalizations, recent surgeries, or developmental issues. For infants, this includes birth details.
- Last Meal/Oral Intake: Important for assessing hydration status and determining the risk of aspiration or the need for procedural delays.
- Events Leading Up: Provides a timeline and context for how the illness or injury developed.
Head-to-Toe Physical Examination
Following the focused history, the Secondary Assessment includes a detailed, head-to-toe physical examination to uncover objective evidence related to the child’s condition. This is a systematic inspection, palpation, percussion, and auscultation of the body’s systems, moving from the top of the head down to the extremities. This thorough process helps in localizing the problem and confirming or refuting suspicions raised by the history.
The examination begins with the head and neck, checking for signs of trauma, meningeal irritation, or fontanelle tension in infants, which may indicate increased intracranial pressure. Moving to the chest, the provider performs careful auscultation of the lungs to identify abnormal breath sounds, such as crackles or wheezes, and evaluates the heart for murmurs or abnormal rhythms.
The abdomen is examined next, checking for distension, tenderness, or abnormal bowel sounds that could point to gastrointestinal or intra-abdominal issues. The skin is assessed for color (e.g., pallor, cyanosis), temperature, rashes, or petechiae, which are crucial indicators of perfusion and systemic infection. The extremities are checked for pulses, capillary refill time, and signs of injury, providing further insight into the child’s circulatory status.
Key Diagnostic Tests and Procedures
The final stage of the Secondary Assessment involves initiating specific diagnostic tests and procedures, selected based on the findings from the history and physical examination. These tools confirm a suspected diagnosis, determine the severity of the illness, and monitor the effectiveness of initial interventions.
Common initial tests include a rapid bedside glucose check to rule out hypoglycemia and continuous monitoring of vital signs and oxygen saturation. Advanced laboratory tests may include an arterial or venous blood gas (ABG/VBG) to assess oxygenation, ventilation, and acid-base balance. Blood samples are also drawn to check hemoglobin concentration or lactate levels, providing information about oxygen-carrying capacity and tissue perfusion.
Imaging studies, such as a chest X-ray, may be ordered if a respiratory or cardiac cause is suspected. An electrocardiogram (ECG) is used to analyze the heart’s electrical activity. Establishing vascular access for medication delivery is also a key procedure in this phase, transitioning the care team toward definitive, problem-specific interventions.