The PALS Systematic Approach Algorithm is the primary algorithm used in Pediatric Advanced Life Support. The algorithm allows the healthcare provider to systematically evaluate and manage the critically ill child.

Click below to view the PALS Systematic Approach Algorithm Diagram. When finished, click again to close the diagram.

Systematic Approach Diagram

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The algorithm begins with the “Initial Impression.” The initial impression consists of a quick assessment of three characteristics:

• Consciousness: Assessment of consciousness will include one of the following characteristics: unresponsive, irritable, or alert.
• Breathing: Assessment of breathing may include abnormal breath sounds, abnormal breathing patterns, and/or accessory muscle use.
• Color: Assessment of skin color can include visual characteristics that indicate poor perfusion and/or oxygenation such as cyanosis, pallor, or mottling.

This initial impression of consciousness, breathing, and color helps to answer the following question: “Is the child unresponsive with no breathing or only gasping?” This question is the first decision point of the algorithm.

The left side of the algorithm leads to the Pediatric Cardiac Arrest Algorithm. The right side of the algorithm flows into the Evaluate-Identify-Intervene Sequence. The right side of the algorithm is where the effective treatment of the critically ill child occurs.

The goal of treatment is to keep the child away from the left branch of the algorithm. Prevention of cardiopulmonary arrest using the Evaluate-Identify-Intervene Sequence is central to PALS. This sequence of Evaluate-Identify-Intervene allows you to carry out the best treatments based upon ongoing assessment.

Evaluate-Identify-Intervene Sequence

Part 1-Sequence: Evaluate

The evaluate portion of the sequence consists of three assessment tools: primary assessment, secondary assessment, and diagnostic tests.

• Primary assessment: This is a rapid, hands-on assessment using the ABCDE evaluation tool to evaluate respiratory, cardiac, and neurological function. Vital signs are also included in this assessment.
• Secondary assessment: This assessment consists of a focused history and a focused physical exam.
• Diagnostic tests: This assessment tool can include a number of advanced tests that can help identify the cause of the pediatric emergency. Examples include ABG, x-ray, and laboratory blood tests.

The evaluation portion of the Evaluate-Identify-Intervene Sequence provides you with the information you need to move forward into the next portion of the sequence which is Identify.

Part 2-Sequence: Identify

Identification of the specific problem that caused the pediatric emergency is essential for improving outcomes. Specific problems within PALS are broken down into 4 categories: respiratory problems, circulatory problems, cardiopulmonary failure, and cardiac arrest. These problems will all be reviewed thoroughly throughout this course. Once the focused problem has been identified, this allows for problem-specific interventions to be implemented.

Part 3-Sequence: Intervene

Interventions for the treatment of the critically ill child include both general interventions and specific interventions. These interventions for the management of the critically ill child are thoroughly reviewed throughout this course.

Once the sequence is complete, the sequence starts again with an evaluation of the child’s clinical condition. This Evaluate-Identify-Intervene Sequence is carried out until the child is stable.

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