TRIAGE,ASSESSMENT AND INITIAL MANAGEMENT OF A CHILD AT THE ER BASIC PRINCIPLES OF TRIAGE,ASSESSMENT AND INITIAL MANAGEMENT OF A CHILD AT THE ER Dr. Asma Ali July,19th 2011

Triage is the process of rapidly screening of sick children when they first arrive in Emergency Room and placing them in one of the following groups: those with emergency signs, who require immediate emergency treatment ICU ADMISSION those with priority signs, who should be given priority while waiting in the queue so that they can be assessed and treated without delay WARD ADMISSION non-urgent cases, who have neither emergency nor priority signs OBSERVATION WARD/OUTPATIENT

Emergency signs include: obstructed breathing severe respiratory distress central cyanosis signs of shock (capillary refill longer than 3 seconds, weak fast pulse, cold peripheries) coma convulsions signs suggesting severe dehydration in a child with diarrhoea (any two of the following: lethargy, sunken eyes, very slow return after pinching the skin)

If no emergency signs are found: Check for priority signs that indicate the child needs immediate assessment and treatment. These signs are: visible severe wasting Oedema of both feet Tiny Baby-any sick child aged under 2 months Trauma or other urgent surgical condition Temperature: very hot or Hypothermic Severe palmar pallor Poisoning Severe Pain Respiratory distress child with urgent referral note from another facility.

HOW? The management of a critically ill or injured child requires a systematic , well rehearsed approach that can be instituted almost reflexively One must be able to identify the management priorities for stabilization of the patient even before a complete history and physical examination have been obtained.

PRIMARY SURVEY The Primary survey involves the first evaluation of the patient’s condition at which the life threatening problems are identified A hierarchy of management priorities for resuscitation and stabilization are established in this step

STEPS IN PRIMARY SURVEY Airway ( Patency ) Breathing( Ventilation, saturation) Circulation (Shock , Hemorrhage control) Disability (AVPU,GCS, Neurological exam) Exposure (Temperature)

2)Adequate Gas Exchange PRIMARY SURVEY BREATHING 1)Rate 2)Rhythm 3)Breathsound 4)Stridor 5)Skin Color CIRCULATION 1)Heart rate 2)Rhythm 3)Pulse volume 4)Capillary refill 5)Skin Temperature AIRWAY 1)Patency 2)Adequate Gas Exchange DISABILITY (Neurological) 1)Glasgow CS 2)Pupils 3)Posture 4)Mental status EXPOSURE 1)Temperature LIFE THREATENING SITUATION

LIFE THREATENING SITUATION? YES NO 1)Position 2)Oxygen 3)Ventilatory support 4)Chest Compressions 5)IV/IO Assess for shock management 6)Naso/orogastric tube 7)Monitoring SECONDARY SURVERY 1)Head to Toe Exam 2)Past History 3)Lab results 4)Re evaluation DEFINITIVE CARE

Refrence 1) WHO –Guidelines for the management of common illnesses with limited resourses 2)The Handbook of advanced Pediatric life support 3)WHO -Guidelines for care at the first-referral level in developing countries