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Pediatric advanced life support (PALS) is a protocol designed to help pediatric healthcare providers efficiently and effectively manage critically ill infants and children in emergency situations. The first step in managing any pediatric emergency is a thorough patient assessment. After the primary pediatric assessment guide, in which patients’ airway, breathing, circulation, disability and exposure are examined, PALS dictates the secondary assessment procedure. 

Secondary pediatric emergency assessment involves a more in-depth process. At this time, it is appropriate to check the patient’s vital signs, monitor pulse oximetry and order a bedside blood glucose level. In addition to performing a thorough physical exam, additional questions should be asked about the patient and the trauma. When responding to emergencies involving young patients, caregivers—including parents, other family members and babysitters—will generally provide most of the information.

 The SAMPLE mnemonic is often used to guide to lead a healthcare provider with PALS certification through the interview topics that should be covered in the secondary assessment phase. These topics include:

• Signs and symptoms
• Allergies
• Medications
• Past medical history
• Last oral intake
• Events leading to the injury or illness

Signs and symptoms

A symptom is something that the patient (or caregiver) reports, such as, "it hurts to breathe." A sign is something that the clinician observes, such as "the patient is wheezing." The list of possible signs and symptoms is broad but may include change in mental status, vomiting, difficulty breathing, chest pain, abdominal pain, bleeding, fever or diarrhea.
 

Allergies

A complete list of the child’s drug allergies and accompanying reactions should be obtained. It is also important to ask about food allergies, as this may impact the child’s condition or care. For example, some vaccines contain chicken egg proteins, while some asthma inhalers contain peanut byproducts—both of which can cause adverse reactions in patients with particular allergies. Specifically, clinicians should inquire about the child or infant’s latex allergy status.

Medications

A detailed list of the child’s medications should be obtained, including vitamins and over-the-counter supplements and medicines. This medication list can provide clues to the patient’s medical history (for example, the use of insulin suggests diabetes) and may also indicate a reason for the current problem or child injuries (for example, if a drug-drug interaction has occurred). If the child’s symptoms could be the result of an accidental or intentional drug overdose, it is especially important to ask the caregiver what other medications are accessible in the child’s environment (for example, prescription pain medications).

Past medical history

The past medical history should include the child or infant’s underlying medical conditions, surgeries, immunizations and a brief general health history. Individual details provided in this conversation can sometimes take on new meaning when seen within the context of the child’s complete medical history. For instance, a history of frequent night coughing may suggest asthma as a possible reason for a child’s present trouble breathing.

Last oral intake

The patient’s last oral intake is important for three primary reasons—timing, content and treatment. First, the time that has elapsed between the onset of the trauma and a child or infant’s last meal can often suggest a reasonable cause for the current problem; the contents of the last oral intake are also important to note as they, too, might be related to the present condition. Lastly, treatment of childhood emergencies sometimes requires surgery, in which case the surgical team will want to know when the child or infant last ate or drank.

Events leading to injury or illness

Often, the events leading up to a medical problem are more important than the resulting injury or condition. For example, it’s important to treat the contusions on a child who fell down the stairs, but it is more important to know if the child’s fall was accidental or due to a seizure or another kind of neural episode. Additionally, clinicians should ask about hazards at the scene of the emergency and inquire about any treatment the child has received since the trauma occurred.

For more information about PALS, see our PALS certification or recertification course overviews.

The information included in this article is based on the 2020 guidelines for CPR, first aid and advanced cardiovascular care. Read more about the 2020 changes to the online PALS course.