components of the breathing assessment pals

Daniel Parker

3 min read

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22-02-2025

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The Pediatric Advanced Life Support (PALS) course emphasizes a systematic approach to assessing a child's breathing. A thorough breathing assessment is crucial for identifying respiratory distress and guiding appropriate interventions. This article will break down the key components of a PALS breathing assessment. Remember, always follow your local protocols and guidelines.

1. Initial Assessment: Looking for Clues

The first step in any PALS breathing assessment begins even before you physically touch the patient. Observe the child's overall appearance. Are they alert and interacting normally, or are they lethargic or unresponsive? This initial visual assessment offers crucial clues.

What to Look For:

• Level of Consciousness: Is the child alert, responsive, or unresponsive?
• Work of Breathing: Note the child's effort in breathing. Are they using accessory muscles (like their neck and abdominal muscles)? Are their nostrils flaring? Are they retracting (pulling in) their chest wall?
• Appearance: Is the child pale, cyanotic (blue-tinged), or flushed? Is the child diaphoretic (sweating)?
• Positioning: Note the child's posture. Are they sitting upright, leaning forward, or lying down? A child in distress may assume a position that helps them breathe more easily.

2. Auscultation: Listening to Breath Sounds

After your initial visual assessment, auscultate the child's lungs. This involves listening for breath sounds using a stethoscope.

What to Listen For:

• Breath Sounds: Are the breath sounds clear and equal bilaterally? Are there wheezes (high-pitched whistling sounds), crackles (bubbly sounds), or rhonchi (low-pitched snoring sounds)? These sounds indicate the potential presence of airway obstruction, fluid in the lungs (pulmonary edema), or other respiratory issues.
• Air Entry: Note whether air is entering both lungs equally. Unequal air entry can signal a collapsed lung (pneumothorax) or other airway abnormalities.

3. Respiratory Rate and Rhythm: Measuring the Pattern

Measuring respiratory rate and rhythm provides objective data on the child's breathing status.

How to Assess:

• Respiratory Rate: Count the number of breaths per minute. Normal respiratory rates vary with age. Remember to observe for a full minute for accurate results.
• Respiratory Rhythm: Is the breathing regular or irregular? Is there any pattern to the irregularity? Periods of apnea (cessation of breathing) are a serious sign.
• Depth of Breaths: Are the breaths shallow or deep? Shallow breaths may indicate respiratory fatigue or impairment.

4. Pulse Oximetry: Measuring Oxygen Saturation

Pulse oximetry measures the percentage of hemoglobin in the blood that is saturated with oxygen (SpO2). This is a non-invasive way to assess oxygenation.

Interpretation:

• Normal SpO2: Typically above 95% in healthy children.
• Low SpO2: Indicates hypoxemia (low blood oxygen levels), requiring immediate intervention. Remember that SpO2 alone doesn't tell the whole story; always correlate it with clinical findings.

5. Capnography (End-Tidal CO2 Monitoring): Advanced Assessment

Capnography measures the partial pressure of carbon dioxide (EtCO2) in exhaled breath. This is an advanced assessment tool that provides valuable information about ventilation and perfusion.

Interpretation:

• Normal EtCO2: Typically between 35-45 mmHg.
• Elevated EtCO2: Can indicate hypoventilation, increased metabolic rate, or airway obstruction.
• Absent EtCO2: Suggests complete airway obstruction or severe hypoventilation.

Putting it All Together: The PALS Breathing Assessment

A complete PALS breathing assessment considers all the above components. This integrated approach is crucial for efficient and effective care of children with respiratory issues.

Important Considerations:

• Age-Specific Differences: Remember that normal respiratory rates, breath sounds, and other parameters vary significantly with age. Always refer to age-appropriate guidelines.
• Context is Key: The interpretation of any single finding should be done within the context of the entire clinical picture.
• Continuous Monitoring: In critically ill children, continuous monitoring of respiratory parameters is essential.

This comprehensive guide to PALS breathing assessment aims to assist healthcare providers. Remember that practice and ongoing education are crucial for mastering this vital skill. Always consult the latest PALS guidelines and your institutional protocols for the most up-to-date information.