In Pediatric Advanced Life Support (PALS), the secondary assessment is a crucial step that follows the primary assessment. While the primary assessment focuses on immediate life-threatening conditions in children or infants, the secondary assessment provides a more detailed evaluation to uncover the underlying causes of the patient’s condition. This blog will walk you through the secondary assessment and its essential components in PALS and highlight why it’s vital for healthcare providers.
What is Secondary Assessment in PALS?
A secondary assessment in Pediatric Advanced Life Support (PALS) is a rapid, systematic, top-to-toe examination of a critically ill young patient. It involves injured patients or those whose signs and symptoms are unclear. It is a detailed evaluation conducted after the primary assessment.
Secondary Assessment includes taking a focused history using the SAMPLE acronym (Signs and symptoms, Allergies, Medications, Past medical history, Last meal, Events leading to the present condition), performing a thorough head-to-toe physical examination, conducting relevant diagnostic tests (such as laboratory tests, imaging studies, and ECG), and continuous monitoring of vital signs and other critical parameters.
The Importance of the Secondary Assessment in PALS
The secondary assessment is important for several reasons:
- Comprehensive Patient Evaluation: The secondary assessment provides a thorough evaluation of the patient’s condition. It makes sure that no critical details are missing out.
- Identifying Underlying Conditions: It helps healthcare providers uncover the root cause of the patient’s symptoms and not just address the immediate threats.
- Guiding Further Management: The information gathered during the secondary assessment informs the next steps in patient care and treatment planning.
- Monitoring and Detecting Changes: Frequent monitoring during the secondary assessment helps detect any changes in the patient’s condition. If any changes are needed, healthcare providers can provide timely interventions.
Related Post: Common Mistakes in PALS
Components of the Secondary Assessment
1. Focused History (SAMPLE)
Taking a detailed history is crucial to understand the patient’s background and the events leading to the current situation. The SAMPLE acronym is a helpful guide. Let’s take a look at each of the components:
S: Signs and symptoms
What are the patient’s symptoms, and how have they progressed? For very young patients who can’t communicate their symptoms, you need to talk to their caregiver.
A: Allergies
Does the patient have any known allergies? Knowing all potential allergies, including food allergies, is crucial to avoid complications.
M: Medications
Is the patient taking any medications, including over-the-counter or herbal supplements? These could affect the child’s current condition or interact with treatments you might provide.
P: Past medical history
Does the patient have significant past medical issues, chronic conditions, or recent illnesses or surgeries? This information is important to understand the child’s baseline health.
L: Last meal or oral intake
When did the patient last eat or drink? Sick kids can burn through their energy reserves quickly. So, knowing their last intake helps you manage their glucose levels.
E: Events leading up to the present illness or injury
What events or activities preceded the current condition? Get a clear history from the caregiver about the events leading up to the current situation, including when and how it happened. This context directs you to appropriate treatment.
2. Focused Physical Examination
A thorough head-to-toe examination helps to identify any abnormalities or areas of concern. Here’s how you can conduct it:
Head and Neck: Check for signs of trauma, deformities, or neurological issues. Look for any swelling, bruising, or unusual bumps, and ensure there are no signs of neurological deficits such as unequal pupils or abnormal reflexes.
Chest: Evaluate breathing, lung sounds, and heart sounds. Listen carefully for any abnormal breath sounds like wheezing or crackles, and check for irregular heartbeats or murmurs that could indicate cardiac problems.
Abdomen: Assess for tenderness, distension, or organomegaly. Gently touch the abdomen to identify any pain points, swelling, or enlarged organs that could signal internal injury or infection.
Pelvis: Look for signs of trauma or instability. Carefully check for any pelvic pain or movement that seems off, which could indicate fractures or other injuries.
Extremities: Examine for fractures, cyanosis(bluish or purplish discoloration of the skin, lips, and nail beds), or circulatory issues. Check each limb for signs of broken bones, poor blood flow, or discoloration that could mean a lack of oxygen.
Back: Inspect for injuries or abnormalities. Make sure to turn the patient over, if possible, to look for any unnoticed trauma or structural issues on their back.
3. Diagnostic Tests
Based on the findings from the history and physical examination, various diagnostic tests may be necessary like:
- Laboratory Tests: These can include complete blood count (CBC), electrolytes, blood glucose, blood gases, and other specific tests as needed.
- Imaging Studies: X-rays, CT scans, ultrasounds, or MRI to evaluate internal structures and identify any hidden issues.
- Other Tests: An electrocardiogram (ECG) to assess cardiac function or an echocardiogram to evaluate heart structure and performance.
4. Monitoring
It is very important to track the progress of a child or an infant to know the effectiveness of the treatment. So, continuous monitoring is very essential. Healthcare providers should regularly monitor vital signs like heart rate, respiratory rate, blood pressure, and temperature to stay updated on their condition. Pulse oximetry can be used to ensure adequate oxygenation. Oxygen saturation levels should also be measured. It is equally important to measure end-tidal CO2 to assess ventilation status and ensure proper breathing. Additionally, cardiac monitoring helps you keep an eye on the patient’s heart rhythm, detecting any arrhythmias or other cardiac issues that may arise.
5. Interventions
Based on the findings from the secondary assessment, appropriate interventions should be implemented. It includes:
- Medications: Pediatric healthcare providers should administer medications as indicated to address specific conditions or symptoms.
- Fluid Therapy: The young patients should be provided with intravenous fluids if necessary to maintain adequate hydration and circulation.
- Respiratory Support: Ensure the patient has adequate oxygenation and ventilation, using supplemental oxygen or mechanical ventilation if needed.
- Other Specific Treatments: Adapt treatments to the patient’s specific needs and conditions.
Conclusion
By the end of this blog, you have understood that secondary assessment in PALS is a thorough and systematic process that builds on the primary assessment to provide a complete picture of the patient’s condition. By following the components of the secondary assessment, healthcare providers can deliver high-quality care and improve outcomes for pediatric patients in emergencies.
At Heart Start CPR, we emphasize the importance of comprehensive training for all healthcare providers. We understand that executing the PALS algorithm, including the secondary assessment, is crucial for effective pediatric emergency care. If you are a healthcare provider working in pediatric care, join our PALS course in the San Francisco Bay Area to gain the knowledge and skills needed to perform these assessments confidently and competently. We offer flexible classes to fit your busy schedule. With Heart Start CPR, you can gain the necessary skills for pediatric care and advance your professional career. Contact us to gain more information about our courses.
