Part 4: Systematic Approach to the Seriously ill or Injured Child

Question 1

Use the Pediatric Assessment Triangle (PAT) to ___

Answer 1

make your initial assessment during your first quick “from the doorway” observation of the Childs appearance, breathing, and color, within the first few seconds after encountering the child.

Question 2

You can use the PAT immediately on entering the scene to ____

Answer 2

help identify the general type of physiologic problem (ie respiratory, circulatory, or neurologic) and urgency for treatment and transport.

Question 3

For infants and children, give 1 breath every ____, and give each breath over ____. Each breath should result in ____. Monitor ____ and ____.

Answer 3

• 2 to 3 seconds (about 20-30 breaths/min)
• 1 second
• visible chest rise
• pulse and oximetry

Question 4

The PAT uses A-B-C, which stands for ____, ____, and ____.

Answer 4

appearance, work of breathing, and circulatory status

Question 5

Evaluating appearance as an indicator of ____, including ____, ____, and ____.

Answer 5

• overall physiologic status
• degree of interactivity
• muscle tone
• verbal response/ cry

Question 6

The TICLS mnemonic is used to evaluate ____, and stands for ____, ____, ____, ____, and ____.

Answer 6

• the Childs appearance

* Tone, interactiveness, consolability, look/gaze, speech/ cry

Question 7

The second component of the PAT is breathing, which determines whether a child has increased work of breathing by assessing ____, ____, and ____.

Answer 7

• the patients position (tripod, or sniffing position)
• work of breathing (retractions)
• adventitial breath sounds (stridor, sonorous respirations)

Question 8

The final component of the PAT evaluates the child’s overall circulatory status based on ____.

Answer 8

general color (pale, mottled, cyanotic)

Question 9

A child with abnormal PAT findings requires ____

Answer 9

prompt evaluation and management.

Question 10

A flushed appearance may suggest ____

Answer 10

fever or distributive shock such as from sepsis, toxins, or anaphylaxis. `

Question 11

Petechiae or purpura is a purplish discoloration of the skin that may be a sign of ____

Answer 11

a life threatening infection.

Question 12

Use these clinical assessment tools to evaluate a child after determining the scene is safe.

Answer 12

• Initial assessment
• Primary assessment
• Secondary assessment

Question 13

Initial assessment:

Answer 13

A first quick from the doorway observation of the Childs appearance, breathing and color, performed within the first few seconds after encountering the child.

Question 14

Primary assessment:

Answer 14

A rapid, hands on ABCDE approach to evaluate respiratory, cardiac, and neurological function; includes assessment of vital signs and pulse oximetry

Question 15

Secondary assessment

Answer 15

A focused medical history and a focused physical exam

Question 16

Continue the ____ sequence until the child is stable. Use this sequence before and after ____, and ____.

Answer 16

• evaluate-identify-intervene
• each intervention
• when the child’s condition changes or deteriorates

Question 17

When assessing the airway for patency you should ____

Answer 17

Look for chest or abdomen movement
Listen for air movement and breath sounds
Feel for air movement at the nose and mouth

Question 18

The following signs suggest that the upper airway is obstructed:

Answer 18

• Increased inspiratory effort with retractions
• Abnormal inspiratory sounds (snoring or high pitched stridor)
• Episodes where no airway or breath sounds are present despite respiratory effort (ie complete upper airway obstruction)

Question 19

Assessing breathing includes evaluating:

Answer 19

• Respiratory rate and pattern
• Respiratory effort
• Chest expansion and air movement
• Lung and airway sounds
• O2 saturation by pulse oximetry

Question 20

Normal Respiratory Rate for an Infant

Answer 20

30 - 53

Question 21

Normal Respiratory Rate for a Toddler

Answer 21

22 - 37

Question 22

Normal Respiratory Rate for a Preschooler

Answer 22

20 - 28

Question 23

Normal Respiratory Rate for a School age child

Answer 23

18 - 25

Question 24

Normal Respiratory Rate for a Adolescent

Answer 24

12-20

Question 25

A consistent respiratory rate of less than 10 or more than 60 breaths per minute in a child of any age is ____

Answer 25

often abnormal and warrants further assessment for the presence of a potentially serious condition.

Question 26

Evaluate respiratory rate before your hands on assessment because ____

Answer 26

anxiety and agitation commonly alter the baseline rate.

Question 27

What is often the first sign of respiratory distress in infants?

Answer 27

tachypnea

Question 28

Tachypnea without signs of increased respiratory effort (quiet tachypnea) may result from conditions that are not primarily respiratory in origin, such as…

Answer 28

• High fever
• Pain
• Anemia
• Cyanotic congenital heart disease
• Metabolic acidosis
• Dehydration
• Sepsis (serious infection)

Question 29

Bradypnea may be caused by…

Answer 29

• Respiratory muscle fatigue
• A CNS injury or problem that affects the respiratory control center
• Severe hypoxia
• Severe shock
• Hypothermia
• Drugs that depress the respiratory drive
• Some muscle diseases that cause muscle weakness

Question 30

Bradypnea or an irregular respiratory rate in an acutely ill infant or child is ____.

Answer 30

an ominous clinical sign and often signals impending arrest

Question 31

Apnea is when breathing stops, typically defined as longer than ____.

Answer 31

20 seconds

Question 32

Apnea may be classified as ____ or ____, depending on whether ____ is present.

Answer 32

• central or obstructive

* inspiratory muscle activity

Question 33

Central apnea indicates ____

Answer 33

that the child is making no respiratory effort because of an abnormality or suppression of the brain or spinal cord.

Question 34

Obstructive apnea occurs when ____

Answer 34

the passage of air is impeded, resulting in hypoxemia, hypercapnia, or both.

Question 35

Agonal gasps appear ____, and will not produce effective oxygenation and ventilation.

Answer 35

late in the deterioration of a very sick child

Question 36

Increased respiratory effort results from conditions that ____

Answer 36

increase resistance to airflow (asthma, or bronchitis) or that cause the lungs to be stiffer and difficult to inflate (pneumonia, pulmonary edema, or pleural effusion)

Question 37

Signs of increased respiratory effort include:

Answer 37

• Nasal flaring
• Retractions
• Head bobbing or seesaw respirations

Question 38

Grunting is a serious sign of increased respiratory effort and may indicate____

Answer 38

respiratory distress or failure.

Question 39

Location of retractions in mild to moderate breathing difficulty.

Answer 39

Subcostal, Substernal, Intercostal

Question 40

Location of retractions in Severe breathing difficulty.

Answer 40

Supraclavicular, Suprasternal, Sternal

Question 41

Inspiratory snoring or stridor suggests ____

Answer 41

upper airway obstruction

Question 42

expiratory wheezing suggests ____

Answer 42

lower airway obstruction

Question 43

Head bobbing and seesaw respirations often indicate that the child has ____

Answer 43

increased risk for deterioration

Question 44

Seesaw breathing usually indicates ____, but also may be observed in severe ____

Answer 44

• upper airway obstruction

* lower airway obstruction, lung tissue disease, and states of disordered control of breathing.

Question 45

Normal tidal volume is approximately ____ to ____ or ideal body weight throughout life.

Answer 45

5 to 7 ml/kg