2. PALS Systematic Approach Algorithm
1. Check
responsiveness
2. Call for help
3. Check for a
pulse
4. PALS Cardiac
Arrest Algorithm
1
2
3
4
E-I-T
3. • The BLS Assessment is the first step that you
will take when treating any emergency
situation
• This initial impression of consciousness,
breathing, and color helps to answer the
following question:
4. “Is the child unresponsive with no
breathing or only gasping?”
• Consciousness:
– Unresponsive
– Irritable
– Alert
• Breathing
– Abnormal breath sounds
– Abnormal breathing patterns
– Accessory muscle use
• Color
– Cyanosis
– Pallor
– Mottling
5. Phone First vs Phone Fast
• Infants and Children < 8 years:
– CPR first, then
– Phone fast
– Exeption: apparent sudden cardiac collapse
• Children > 8 years and Adults:
– Phone first, then
– Provide CPR
– Exception: unresponsiveness w/t respiratory
compromise (submersion, trauma, drug overdose)
6. Check for a pulse
• Check the pulse in the infant using the
brachial artery on the inside of the upper arm
between the infant’s elbow and shoulder
• Check for pulse in child using the carotid
artery on the side of the neck or femoral pulse
on the inner thigh in the crease between the
leg and groin.
12. Start CPR
5 components of high-quality CPR
• Adequate depth: ≥ 1/3 diameter of chest – 6cm
• Adequate rate: 100-120 beats/minute
• Full chest recoil
• Minimize interuptions
• Avoid excess ventilation
– One cycle CPR:
• 15:2 (no advanced airway)
• 5 cycles = 2 minutes
– If advanced airway
• 10 breaths per minute (1 breath every 6 secs)
Check rhythm every 2 minutes
– Rotate compressors every 2 minutes, rhythm checked
13. Give Oxygen
• Open the airway
• Provide basic ventilation
– Bag-mask ventilation
– ± Use of artificial airways (OPA and NPA)
Only use an OPA in unresponsive patients with NO cough or gag reflex
– Avoid hyperventilation
• Suction to maintain a clear airway
– 10 seconds or less
14.
15. Inserting An Oropharyngeal Airway
1. Clear the mouth of blood or secretions with suction, if
possible.
2. Select an airway device that is the correct size for the
patient.
3. Place the device at the side of the patient’s face.
Choose the device that extends from the corner of
the mouth to the earlobe
4. Insert the device into the mouth so the point is
toward the roof of the mouth or parallel to the teeth
5. Once the device is almost fully inserted, turn it until
the tongue is cupped by the interior curve of the
device
21. Part 1-Sequence: Evaluate
Primary Assessment
Maintainable
Unmaintainable
R Distress
R Failure
Compensated
Uncompensated
Alert
Voice
Pain
Unreponsive
22. A - Airway
• Is the airway open?
– This means open and unobstructed
– If yes, proceed to B (Breathing)
• Can the airway be kept open manually?
– Jaw Lift/ Chin Thrust
– Nasopharygeal or oropharygeal airway
• In an advanced airway required?
– Endotracheal intubation
– Cricothyrotomy, if necessary
23. B - Breathing
1. Respiratory Rate
2. Respiratory Effort and Mechanics
3. Air entry/Tidal volume
4. Skin color
Respiratory Distress: increased WOB
Respiratory Failure: Inadequate gas exchange
resulting in inadequate oxygenation and/or
ventilation (distress ±)
25. Secondary assessment
• A search for underlying causes
- 4 H’s
- 4 T’s
• If possible a focused medical history
- SAMPLE: (S) Signs and symptoms
(A) Allergies
(M) Medications
(P) Past illnesses
(L) Last Oral Intake
(E) Events Leading Up To Present illness
