unit25 management of a child Flashcards
Children Main Groups
Infants Birth – 12 months (Neonates – first 4 weeks) Toddler Approx 1 – 2 years of age Pre-school 2 – 5 years School-age 5 – 12 years (onset of puberty) Teenager Onset of puberty – 18 years of age
Approach to the child
Prevent/minimise separation with parent/carer Attempt to decrease loss of control Use play to lesson stress (distraction) Support family members Demonstrate: interest, empathy, concern Never ignore/dismiss what a parent says Involve child & parents in all aspects of care Be confident but gentle Never dominate the child Use appropriate communication Refer to the child by name Be aware of child development
Plan (consider)
The environment (privacy) Purpose of assessment Developmental level of recipients Stage of child’s illness/condition Emotional state of child/family
Paediatric Assessment Triangle (PAT)
Part of the initial assessment Indication of how serious the patient is Done across the room Fast (30-60 seconds) Not painful, not scary! Repeatable
PAT – a useful tool
Appearance
Work of Breathing
Circulation to skin
PAT Appearance TICLS
Tone Interactiveness Consolability Look/gaze Speech/cry
PAT Work of Breathing – Signs
Abnormal Breath Sounds
Abnormal Positioning and Posture
Recession
Nasal Flaring
PAT Circulation to skin – Signs
Colour White or pale skin/lips Mottling Patchy skin Cyanosis Bluish discolouration of skin and lips
child Primary survey
Airway
Look & listen for possible obstructions
Inspiratory stridor indicative of upper airway obstruction
Wheezing indicating lower airway obstruction
Volume does not indicate severity
child Primary survey
Breathing
Assess the effectiveness of breathing Respiratory rate Tachypnoea at rest gives cause for concern Recession Use of accessory muscles Flaring of the nostrils Presence of expiratory grunt (infants) Positioning
child Primary survey
Respiration
Rate, effort, efficacy, effects Recession: intercostal increased subcostal work sternal of tracheal tug breathing
Respiratory failure
Compensated: respiratory distress
Decompensated: unable to maintain appropriate blood levels of 02 & C02
Falling respiratory rate in presence of other worsening parameters is suggestive of exhaustion – indicating imminent respiratory arrest
child Circulation
Pulse volume (actually feel the pulse) Absent peripheral and weak central pulses = advanced shock Capillary refill (forehead or sternum) Do not rely on feeling peripheral pulses to estimate blood pressure as in adults – children react differently
Child Heart rate
Site: < 1 yr = brachial > 1 yr = carotid Capillary Refill Ambient temperature Forehead or sternum Apply digital pressure for 5 seconds Refill should occur within 2 seconds
Blood Pressure
Childs circulating volume is greater per kg of body weight (80 ml/kg) than that of an adult
Actual volume is small
Small amounts of blood loss may be critical
Hypotension is a late & pre-terminal sign
Children compensate well
BP is maintained until shock is severe
BP recording in the pre hospital setting is of limited use
Before the age of 12 months cranial sutures are not fused.
A large blood volume may be lost before changes occur.
Shock may be noticed before GCS changes
Compensated:
vital organ perfusion is maintained
BP stable
Decompensated:
Hypotensive
Reduced LOC
Disability child PS
AVPU
GCS – modified for < 4 years
Pupils
Posture
Time Critical child
Any child with significant difficulties with
Airway, Breathing, Circulation or Disability
Must be treated as time critical!
The recognition of the seriously ill child is of greater importance than establishing a specific diagnosis
FLACC Scale
face legs activity cry consolibility
History Taking
As for adult, also include: Questioning PMH, inc birth history Meds Immunisations History of this illness Intake: diet & fluids
Output: urine, bowels, vomit
Social history
Observe
At skin level: chest, bruising/injury, rashes
Developmental stage
Interaction with carer
Vital signs
Management Time critical
A & B problems addressed on scene
C problems addressed en-route
Rapid transport to a suitable receiving hospital with a pre-alert message
Airway child
Management Time critical
Stepwise approach
Position of comfort/choice
Constant re-evaluation of vital signs
Breathing child
Management Time critical
Adequate oxygenation via a non-rebreathing mask
If not tolerating find alternative method
Constant re-evaluation of vital signs
Consider assisted ventilations
Circulation
Management Time critical
Consider Paramedic assistance for IV/IO fluids
Do not delay on scene to gain access
Management Time critical
Exposure
Exposure
Prevent hypoxia
Normalise circulation (paramedic assistance)
Treat hypoglycaemia
child Pain management
Non-pharmacological
Parent/carer present, preparation, distraction, dressings, splintage
Pharmacological
Paracetamol orally, Ibuprofen, Entonox (technician)
Morphine, Paracetamol IV (Paramedic).
