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Pediatric Assessment

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  1. Pediatric Assessment BY: Fidel O. Garcia EMT-P Co-Owner ProEMSeducators.com fidel@proemseducators.com

  2. Survival Following Respiratory Arrest vs Cardiopulmonary Arrest in Children 100% Survivalrate 50% 0% Respiratoryarrest Cardiopulmonaryarrest

  3. General Impression • Sick • vs • Not Sick

  4. Pediatric Assessment Triangle (PAT) Breathing W. O. B. Appearance T. I. C. L. S. Circulation to Skin

  5. Respiratory Distress Appearance: Normal Breathing: Increased Circulation to Skin: Normal

  6. Respiratory Failure Appearance: Abnormal Breathing: Increased or decreased Circulation to Skin: Normal to abnormal

  7. Shock Appearance: Abnormal Breathing: Normal Circulation to Skin: Abnormal

  8. CNS dysfunction or Metabolic abnormality Appearance: Abnormal Breathing: Normal Circulation to Skin: Normal

  9. The ABC’s provide maintenance of normal vital function Airway Ventilation Breathing Oxygenation Circulation Perfusion

  10. Respiratory problem or Shock ?

  11. Physical Examination - Airway Rapid Assessment Clear Maintainable Unmaintainable Pediatric vs adult airways BVM considerations Intubation considerations Check D.O.P.E

  12. Physical Examination - Breathing Effort Mental Status Skin Color Rate:Neonate 40 – 60 Infant 40 – 50 Toddler 30 – 40 Child 20 – 30 Adolescent 12 - 20 Air Entry

  13. Common Upper Airway Emergencies Croup: Epiglotitis FBAO 6 months -3 yrs 3yrs – 6 yrs all ages Slow onset rapid onset rapid onset “Seal bark” quiet high pitched squeal Usually quick fix long term fix usually quick fix Fall or winter anytime anytime Usually not life life threatening Usually not life threatening threatening Viral bacterial neither Mild secretions drooling may drool Hx URI no hx URI No hx URI Moderate fever High fever no fever

  14. Common Lower Airway Emergencies Asthma: Hyper - reactive airways RSV : Virus causing bronchiolitis

  15. Common Lowewr Airway Emergencies Asthma RSV Air trapping disease Virus causing bronchiolitis Rapid Onset Slow onset Afebrile Febrile Under 2 years of age 3 years and older Previous history No history Wheezes Wheezes / rhonchi No drainage Rhinorrhea May be life threatening Less life threatening

  16. Shock Or Respiratory?

  17. Assessment of Shock Mental Status:Altered or decreased Extremity temp: Warm or cold Determine Pulses:Infant: 100 – 160 Toddler: 90 – 150 Preschooler: 80 – 140 Child: 70 – 120 Adolescent: 60 – 100 Internal Pulse Quality: Color / Cap refill: Central vs peripheral Renal output: 1 – 2 ml/kg/hr

  18. Blood pressure Low end of normal systolic pressure Age >60 0 to 1 month >70 1 month to 1 yr >70 + (2 x age in yrs) Older than 1 What information does blood pressure provide ?

  19. Hemodynamic Response to Shock Vascular resistance Blood pressure Cardiacoutput Compensated shock Decompensated shock

  20. Review of the Physical Finding in Shock Early signs (compensated) increased rate poor systemic perfusion altered mental status Late signs (decompensated) weak central pulses decreased mental status decreased urine output hypotension

  21. Phases of Pediatric Shock Early Late (hypotension) Delayed death Survival Immediate arrest intact Multiple organ dysfuntion

  22. Physical Finding in Shock Early signs (compensated) increased rate poor systemic perfusion altered mental status Late signs (decompensated) weak central pulses decreased mental status decreased urine output hypotension

  23. Etiologies of Pediatric Shock Hypovolemic Distributive Septic Anaphylactic Neurogenic Cardiogenic Obstructive

  24. Child dying with Multiple Organ Dysfunction Syndrome (MODS) , despite resuscitation efforts

  25. Etiologies of Cardiopulmonary Failure Many Etiologies Respiratory Failure Shock Cardiopulmonary Failure

  26. Definition of Cardiopulmonary Failure Global Deficitis in : Ventilation Oxygenation Perfusion Resulting in : Agonal Respirations Bradycardia Cardiopulmonary arrest

  27. Priorities of Initial Management Cardiopulmonary failure oxygenate, ventilate, monitor reassess for: respiratory failure shock obtain vascular access

  28. Many Etiologies Respiratory Failure Shock Cardiopulmonary Failure Cardiopulmonary arrest Death Cardiopulmonary recovery Unimpaired neurologic recovery Impaired neurologic recovery