PEPP 1: Pediatric Assessment Flashcards
Sick or not sick
Most important question
PAT
Pediatric Assessment Triangle. Use first for every single pediatric case.
Rapid VISUAL assessment
Formalizes the general impression
PAT elements
Appearance
Work of breathing
Circulation to skin
PAT questions
How severe is the injury?
What is the most likely physiologic abnormality?
How quickly do I need to act?
Appearance
Single most important factor
Responding to stimulus
Looking around the room
Tells about circulation: look to skin color
Use TICLS
Complete visually from across the room while still in caregivers arms
TICLS
Used to quantify Appearance of PAT
Tone: Child moving vigorously, sit or walk, or limp?
Interactiveness: try testing attention with a pen light
Consolability: Yes or No
Look: Looks at your face or track a toy, not vacant start
Speech/cry: strong cry or wimper? Slurring?
Tone
Is the child moving vigorously?
Resisting exam? Or lie limp?
Verbalize as normal, decreased or increased
Interativeness
Can you draw attention? Turn to a sound?
Listless and disinterested?
Verbalize as Normally active and alert, Listless, Lethargic, or Unresponsive
Consolability
Can caretaker console child?
Verbalize as Consolable or Inconsoloable
Look or gaze
Fix gaze on face; track movement?
Speech or cry
Slurring words? Speak in whole sentences?
Respiratory distress
Appearance; normal
Work of breathing: increased
CTC: normal
Not urgent. Since other two elements are ok, pt is successfully compensating with incr work of breating
Work of breathing
Assess from across the room
Listen for abnormal sounds
Look for abnormal positioning, retractions or nasal flaring
Abnormal airway sounds
Upper airway: snoring or stridor
Lower airway: grunting or wheezing
Snoring
Low pitched sound
Caused by loss of tone in upper airway
Partial airway obstruction
Stridor
High pitched whistling sound
Upper airway, partial obstruction of trachea or vocal chords
On inspiration or both
Upper airway obstruction causes
Loss of consciousness Loss of muscle tone Viral or bacterial infection Foreign body aspiration Blunt neck trauma
Grunting
Lower airway
Caused by pushing air against closed vocal chords
Pneumonia, pulmonary contusion or pulmonary edema
Wheezing
Lower airway
High pitched musical sound
Caused by air pushed through small openings in the lungs, usually on expiration
Asthma and bronchiolitis
Sniffing position
Severe upper airway obstruction
Tripod position
Trying to maximize accessory muscle use
Retractions
Seen beneath, between or above ribs, above clavicle or beneath sternum
Nasal flaring
Moderate to high hypoxia
Urgency
Increased work of breathing with normal appearance: respiratory distress, not urgent transport
Increased WOB with poor appearance, respiratory failure, transport quickly
Poor appearance with low WOB means pt may be fatigued and respiratory arrest is imminent. Be ready to bag.
Respiratory failure
Appearance: abnormal
Work of breathing: increased or decreased (fatigue)
Circulation to skin: normal or abnormal
Shock
Appearance: abnormal
Work of breathing: normal
Circulation to skin: abnormal
Skin circulation indicators
Pallor: early sign
Mottling: patchy
Cyanosis: late finding, always critical unless with normal appearance, may just be cold.
CNS disfuntion
Appearance: abnormal
Work of breathing: normal
Circulation to skin: normal
Steps in pediatric assessmetn
1-Scene size up
2-Primary assessment (PAT, hands on ABCDE, transport decision)
3-History taking
4-Secondary assessment: physical exam, monitoring devices
5-Reassessment
Immediate transport if
Cardiac arrest Complete airway obstruction Impending delivery Decompensated shock Status epilepticus Wheezing Stridor Severe pain with normal blood pressure
Immediate transport and treatment enroute if
Incomplete airway obstruction
Closed head injury with normal breathing
Multisystem trauma
Inability to treat on scene (equipment failure, safety)
Causes of unresponsiveness
Sepsis
Seizure
Abuse
Respiratory Rates
Infant 30-60 Toddler 24-40 Preschooler 22-34 School age 18-30 Adolescent 12-16
Heart Rates
Infant 100-160 Toddler 95-150 Preschooler 80-140 School age 70-120 Adolescent 60-100
Blood Pressures
Infant >60 Toddler >70 Preschooler >80 School age >90 Adolescent 12-16
