The Secondary and Tertiary Assessments—The Next Steps In Pediatric Emergencies

For the seriously ill infant or child, doctors use the algorithms of the pediatric advanced life support (PALS) course. In the first step, but the doctor rapidly assesses the child by looking for and listening for life-threatening problems called the general assessment (the pediatric assessment triangle). Any life-threatening problems found on this assessment are treated immediately before proceeding to the next step.

The next step in the algorithm is the primary assessment (ABCDE). As the doctor goes through each step of the primary assessment, immediately treat any potentially life-threatening problem before going to the next part, the primary assessment. Once every step in the primary assessment has been completed and treatment beyond, the doctor proceeds to the secondary assessment.

The Secondary Assessment consists of a medical history and a physical examination.

The medical history is obtained using the SAMPLE mnemonic looking for information on what caused the pediatric emergency. See pages 60 and 61 of the 2016 PALS Manual for the complete STABLE history of the secondary assessment.

S stands for signs and symptoms.

A stands for allergies.

M stands for medicines that the patient is currently taking.

P stands for past medical history.

L stands for last meal (When was the last time the infant or child had something to eat or drink?).

E stands for the events leading up to this emergency.

A complete but rapid physical exam is then performed to look for and begin to treat additional causes of the illness or injury. See p 61 of the 2016 Pediatric Advanced Life Support Provider Manual For the Focused Physical Examination.

This completes the secondary assessment.

The Tertiary Assessment

The tertiary assessment consists of laboratory tests, x-rays, scans, heart tests, and other tests that are performed to determine the causes and severity of the respiratory and circulatory problems.

Actually, the tests of the tertiary assessment are usually begun while the earlier steps are being completed. For example, blood can be drawn by the lab tech while the doctor as the doctor is performing his evaluations.

The tests used to evaluate serious respiratory problems are the arterial blood gas (ABG), hemoglobin concentration (part of the complete blood count), pulse oximetry, exhaled CO2 measurement, chest x-ray, and peak expiratory flow rate.

Tests used to evaluate circulatory problems include the arterial blood gas (ABG), arterial lactate, total serum CO2, chest x-ray, ekg, and echocardiogram (ultrasound heart scan).

All seriously ill infants and children will usually receive a complete blood count, a complete metabolic panel, and a urinalysis.

Other lab tests, imaging tests, and other tests will depend on what the doctor finds on the medical history and physical exam.

Tomorrow—Serious Breathing Problems in Children

This entry was posted in Emergency Medicine, Pediatric Advanced Life Support, Pediatrics and tagged , , . Bookmark the permalink.