PALS Systematic Approach
The systematic approach is the backbone of PALS. It is a repeatable way to look at any seriously ill or injured child, decide how sick they are and what kind of problem they have, and act — then look again. This guide explains its parts in plain language; the course teaches it hands-on.
The loop
Evaluate → identify → intervene, repeated. Start with an initial impression, then the primary assessment (airway, breathing, circulation, disability, exposure), secondary assessment and diagnostic tests, and categorise the problem by type and severity.
In the first seconds, from the doorway: what is the child’s appearance and level of consciousness, how hard are they working to breathe, and what is their colour? A child who is unresponsive, not breathing normally or without a pulse needs BLS and a call for help immediately. Otherwise, you move on to the primary assessment.
A hands-on ABCDE: airway patency; breathing rate, effort, air movement and oxygen saturation; circulation, including heart rate, pulses, capillary refill, skin and blood pressure; disability, meaning neurological status and glucose; and exposure, to find injuries, rashes and temperature problems. You treat what you find as you go.
PALS separates respiratory distress, where the child is compensating, from respiratory failure, where they no longer can. It then sorts the problem by type:
Shock is compensated while blood pressure is maintained and hypotensive once it is not. By cause it is hypovolaemic (such as dehydration or bleeding), distributive (such as sepsis or anaphylaxis), cardiogenic or obstructive (such as tension pneumothorax or tamponade). The type drives the treatment, from fluid boluses to drugs and specialist procedures.
A focused history — signs and symptoms, allergies, medications, past history, last meal, events — and a focused examination, then diagnostic tests such as blood gas, glucose and imaging as appropriate.
The approach only becomes automatic with practice on scenarios. That is what the case stations on the PALS course are for, and what the case testing in the PALS exam guide assesses.
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Initial impression, then a primary assessment (ABCDE), secondary assessment and diagnostic tests, applied in a continuous evaluate-identify-intervene loop.
In distress the child is compensating for the problem; in failure they can no longer maintain adequate oxygenation or ventilation without help.
Hypovolaemic, distributive, cardiogenic and obstructive.
Shock in which blood pressure is still maintained by the body's compensation, although perfusion is inadequate. It becomes hypotensive shock when blood pressure falls.
Yes, it runs through the case-based testing on the PALS course.
Safety First Medical Services is an American Heart Association training centre on Al Reem Island. HeartCode blended PALS, classroom PALS and on-site group sessions for paediatric, emergency and neonatal teams, with a two-year AHA PALS Provider eCard on completion.
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What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.
Last reviewed by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.