Part 4: Systematic Approach to the Seriously ill or Injured Child Flashcards
Use the Pediatric Assessment Triangle (PAT) to ___
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.
You can use the PAT immediately on entering the scene to ____
help identify the general type of physiologic problem (ie respiratory, circulatory, or neurologic) and urgency for treatment and transport.
For infants and children, give 1 breath every ____, and give each breath over ____. Each breath should result in ____. Monitor ____ and ____.
- 2 to 3 seconds (about 20-30 breaths/min)
- 1 second
- visible chest rise
- pulse and oximetry
The PAT uses A-B-C, which stands for ____, ____, and ____.
appearance, work of breathing, and circulatory status
Evaluating appearance as an indicator of ____, including ____, ____, and ____.
- overall physiologic status
- degree of interactivity
- muscle tone
- verbal response/ cry
The TICLS mnemonic is used to evaluate ____, and stands for ____, ____, ____, ____, and ____.
- the Childs appearance
* Tone, interactiveness, consolability, look/gaze, speech/ cry
The second component of the PAT is breathing, which determines whether a child has increased work of breathing by assessing ____, ____, and ____.
- the patients position (tripod, or sniffing position)
- work of breathing (retractions)
- adventitial breath sounds (stridor, sonorous respirations)
The final component of the PAT evaluates the child’s overall circulatory status based on ____.
general color (pale, mottled, cyanotic)
A child with abnormal PAT findings requires ____
prompt evaluation and management.
A flushed appearance may suggest ____
fever or distributive shock such as from sepsis, toxins, or anaphylaxis. `
Petechiae or purpura is a purplish discoloration of the skin that may be a sign of ____
a life threatening infection.
Use these clinical assessment tools to evaluate a child after determining the scene is safe.
- Initial assessment
- Primary assessment
- Secondary assessment
Initial assessment:
A first quick from the doorway observation of the Childs appearance, breathing and color, performed within the first few seconds after encountering the child.
Primary assessment:
A rapid, hands on ABCDE approach to evaluate respiratory, cardiac, and neurological function; includes assessment of vital signs and pulse oximetry
Secondary assessment
A focused medical history and a focused physical exam
Continue the ____ sequence until the child is stable. Use this sequence before and after ____, and ____.
- evaluate-identify-intervene
- each intervention
- when the child’s condition changes or deteriorates
When assessing the airway for patency you should ____
Look for chest or abdomen movement
Listen for air movement and breath sounds
Feel for air movement at the nose and mouth
The following signs suggest that the upper airway is obstructed:
- 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)
Assessing breathing includes evaluating:
- Respiratory rate and pattern
- Respiratory effort
- Chest expansion and air movement
- Lung and airway sounds
- O2 saturation by pulse oximetry
Normal Respiratory Rate for an Infant
30 - 53
Normal Respiratory Rate for a Toddler
22 - 37
Normal Respiratory Rate for a Preschooler
20 - 28
Normal Respiratory Rate for a School age child
18 - 25
Normal Respiratory Rate for a Adolescent
12-20
A consistent respiratory rate of less than 10 or more than 60 breaths per minute in a child of any age is ____
often abnormal and warrants further assessment for the presence of a potentially serious condition.
Evaluate respiratory rate before your hands on assessment because ____
anxiety and agitation commonly alter the baseline rate.
What is often the first sign of respiratory distress in infants?
tachypnea
Tachypnea without signs of increased respiratory effort (quiet tachypnea) may result from conditions that are not primarily respiratory in origin, such as…
- High fever
- Pain
- Anemia
- Cyanotic congenital heart disease
- Metabolic acidosis
- Dehydration
- Sepsis (serious infection)
Bradypnea may be caused by…
- 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
Bradypnea or an irregular respiratory rate in an acutely ill infant or child is ____.
an ominous clinical sign and often signals impending arrest
Apnea is when breathing stops, typically defined as longer than ____.
20 seconds
Apnea may be classified as ____ or ____, depending on whether ____ is present.
- central or obstructive
* inspiratory muscle activity
Central apnea indicates ____
that the child is making no respiratory effort because of an abnormality or suppression of the brain or spinal cord.
Obstructive apnea occurs when ____
the passage of air is impeded, resulting in hypoxemia, hypercapnia, or both.
Agonal gasps appear ____, and will not produce effective oxygenation and ventilation.
late in the deterioration of a very sick child
Increased respiratory effort results from conditions that ____
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)
Signs of increased respiratory effort include:
- Nasal flaring
- Retractions
- Head bobbing or seesaw respirations
Grunting is a serious sign of increased respiratory effort and may indicate____
respiratory distress or failure.
Location of retractions in mild to moderate breathing difficulty.
Subcostal, Substernal, Intercostal
Location of retractions in Severe breathing difficulty.
Supraclavicular, Suprasternal, Sternal
Inspiratory snoring or stridor suggests ____
upper airway obstruction
expiratory wheezing suggests ____
lower airway obstruction
Head bobbing and seesaw respirations often indicate that the child has ____
increased risk for deterioration
Seesaw breathing usually indicates ____, but also may be observed in severe ____
- upper airway obstruction
* lower airway obstruction, lung tissue disease, and states of disordered control of breathing.
Normal tidal volume is approximately ____ to ____ or ideal body weight throughout life.
5 to 7 ml/kg
