Systematic Approach to the Seriously Ill or Injured Child Flashcards
Why should you use a systematic approach and why
When caring for a seriously ill or injured child so that you can quickly recognize signs of respiratory distress, respiratory failure, and shock and immediately provide lifesaving interventions
What is the Pediatric Assessment Triangle (PAT) consist of
Appearance
Degree of interactivity
Muscle tone
Verbal response or cry
Work of breathing
Tripod or sniffing position
Retractions
Audible breath sounds (grunting, wheezing or stridor)
Circulation (color)
Pale
Mottled
CyanoticChild who is unresponsive and not breathing or is only gasping
*if no normal breathing but a pulse is felt
**if heart rate is less than 60/min with signs of poor perfusion despite adequate oxygen and ventilation
- activate the emergency response system then immediately start CPR, beginning with chest compressions
- check for breathing and pulse simultaneously
*provide rescue breaths , open and maintain an airway, administer oxygen as soon as it’s available. Each breath should result in visible chest rise
**provide chest compressions and breaths. If heart rate is greater than 60/min continue rescue breathing as needed. Begin evaluate-identify-intervene sequence.
Check pulse about every 2 minutes
TICLS mnemonic
Tone Interactiveness Consolability Look/gaze Speech/cry
Evaluating work of breathing
- respiratory effort
- lung and airway sounds
- nasal flaring
- retractions or use of accessory muscles
- increased, inadequate, or absent respiratory effort
-noisy breathing (wheezing, grunting, stridor)
Evaluating skin and mucous membranes
- skin color
- *petechiae or visible bleeding wounds
- pallor
- mottling
- cyanosis
- obvious significant bleeding
- bleeding within the skin (purpura)
When and why would you use the Evaluate-Identify-Intervene Sequence
When caring for seriously ill or injured children to help you to determine the best treatment or intervention at any point.
From the information gathered, identify the child’s clinical condition by type and severity
What are the 3 levels of evaluating
Initial assessment: a quick “from the doorway” observation of the child’s 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 neurologic function; includes assessment of vital signs and pulse oximetry
Secondary assessment: a focused medical hex and a focused physical exam
Respiratory issues leading to
-upper respiratory obstruction
-lower airway obstruction
-lung tissue disease
-disordered control of breathing
Leading to respiratory distress and or respiratory failure
Circulatory issues leading to
-hypovolemic shock
-distributive shock
-Cardiogenic shock
-Obstructive shock
Leading to compensated shock and or hypotensive shock
What are some ways to intervene when dealing with respiratory or circulatory problems
- positioning the child to maintain an open/patent airway
- activating the emergency response system
- starting CPR
- obtaining the code cart and monitor
- placing the child on a cardiac monitor and pulse oximeter
- administering O2
- supporting ventilation
- starting medications and fluids (nebs, IV/IO fluid bolus)
For how long do you continue to evaluate-identify-intervene sequence
Until the child is stable.
After implementing interventions, you should re-evaluate for any kind of changes or improvements
What does ABCDE stand for in an assessment
- airway
- breathing
- circulation
- disability
- exposure
What takes priority during primary assessment
Treat life-threatening abnormalities before completing the rest of the assessment.
Correcting those conditions takes precedence over establishing baseline
How do you assess if a child’s airway is open/patent
- look for chest or abdomen movement
- listen for air movement and breath sounds
- feel for air movement at the nose and mouth
What are some signs that indicate the upper airway is obstructed
- increased inspiration effort with retractions
- abnormal inspiratory sounds (snoring or high-pitched stridor)
- episodes where no airway or breath sounds are present despite respiratory effort
Ways to maintain the airway
Positioning
-head tilt-chin lift
-jaw thrust
Suctioning
Relief techniques for obstruction
-younger than 1: 5 back slaps and 5 chest compressions
-1 year or older: abdominal thrusts
Keep tongue from falling back and obstructing
Advanced airways
-endotracheal intubation or laryngeal mask airway
-applying continuous positive airway pressure or noninvasive ventilation
-remove foreign body
-cricothyrotomy
How to assess breathing
Respiratory rate and pattern Respiratory effort Chest expansion and air movement Lung and airway sounds O2 saturation by pulse ox
What is the Normal respiratory rate by age Infant Toddler Preschooler School-aged Adolescent
30-53 22-37 20-28 18-25 12-20
Abnormal respiratory rate and pattern
- irregular respiratory pattern
- fast respiratory rate (tachycardia)
- slow respiratory rate (bradycardia)
- apnea
What are some irregular respiratory patterns
- a deep gasping breath, followed by a period of apnea (no breathing or only gasping)
- a rapid respiratory rate, followed by periods of apnea or very shallow breaths
Irregular patterns such as these require urgent evaluation
What is tachypnea and may be caused by what
Fast respiratory rate faster than what is normal for age. It is often the first sign of distress in infants and can develop during periods of stress A fast respiratory rate without signs of increased respiratory effort may result from -high fever -pain -anemia -cyanotic congenital heart disease -metabolic acidosis -dehydration -sepsis
