Pediatric Call

Dispatched to 825 E. Augustus St. for a sick child Dispatched to 825 E. Augustus St. for a sick child. Dispatcher relays that the patient is conscious and breathing.

Part I SCENE SIZE-UP Defined: Begins with dispatch We are instructed to go to the side of the house to the garage which faces Blackford Blvd. We know that Augustus is a one way street going West so we are going to have to go to 14th street where it intersects with Blackford Blvd. and take it South to the residence.

Initial evaluation of the scene Enter Slowly Observe for safety and mechanism of injury Goals: Ensure scene safety Remember you are going to observe as you approach and before you get out of the vehicle To determine if patient is medical or trauma If no mechanism of injury, obtain c/c and ask if any injury has occurred. Mom is holding the child in her arms and tells us her 16 month old son has just not been acting himself, has not been eating or drinking much and has a fever of 102. Determine total number of patients Simply ask if anyone else is injured or ill and needs medical attention

Part II INITIAL ASSESSMENT Defined: Discovering and treating life-threatening conditions PRIORITY PATIENTS: Poor General Impression Unresponsive or listless Does recognize parents or primary care givers Not comforted when held by parent but becomes calm and quiet when set down Compromised airway Respiratory arrest or inadequate breathing Possibility of shock Uncontrollable bleeding Goals: Determine if the patient is ill or injured Ill child Triage One ill 14 month old male

Part II INITIAL ASSESSMENT Components: General Impression Illness or injury- -Ill Mechanism of injury/Nature of illness- -Fever Age, sex, race- -16 month white male Identify life-threatening problems Well or sick Ill Mental status drowsy sleepy- -appears to be inattentive- -appears to be Mental Status A lert V erbal Response P ainful Response U nresponsive Should turn and look or look at you when addressed Should follow simple commands

Part II INITIAL ASSESSMENT Assess Airway Depressed mental status- -Yes as he does not respond to your presence or your voice Secretions- -No Blood- -No Vomits- -No. Inquire as this is a pertinent negative Trauma- -No Infections- -Inquire as this is a PMHx. As well as a pertinent negatige. Do not hyperextend neck Assess Breathing Effort of breathing- -Rate and quality Chest expansion Effort of breathing Sounds of breathing Breathing rate Color Oxygen therapy Blow by method

Part II INITIAL ASSESSMENT Skin color Pale- -Yes cyanotic flushed- -Yes Quality of speech Strong cry- -Silent Speak only in short sentences Meaningful gibberish grunts Interaction with the environment or others Silence- -Quietly in Moms’ arms Listlessness- -yes Unconscious- -no Emotional state Withdrawn- -No Emotionally flat- -Yes Response to you Inattention to strangers- -Seems to care less that you are there

Part II INITIAL ASSESSMENT Tone and body position Limpness- -No, not a rag doll or unable to hold head up Poor muscle tone- -No Position to indicate respiratory distress- -No

Part II INITIAL ASSESSMENT Assess Pulse/ Circulation- -Rate and quality Circulation Skin color Pulse Radial in child Brachial or capillary refill for infants or child <5 Triage One ill child

Part III Focused History and Physical Exam Defined: To identify additional serious or potentially life-threatening injuries or conditions Fever- -febrile to touch Listless- -not too active, quiet in moms’ arms Has not had much to eat or drink

Part III Focused History and Physical Exam Components, Trauma Reconsider Mechanism of injury Index of suspicion Rapid Trauma Assessment Head to toe physical exam quickly conducted Base-line Vital Signs Assess S A M P L E history Not A Trauma

Part III Focused History and Physical Exam Components Medical History of present illness O – P – Q – R – S – T Onset- -noticed didn’t eat much for supper last night, fever this morning and not been playful. Provocation- -None Quality- -fever is high enough to manifest definitive signs and symptoms Radiation- -Always inquire if there is or seems to be any Pain Severity- -Listless, non-responsive, pale and flush Time- -Overall time he’s had the fever Interventions- -What has mom done? Tylenol etc.

Part III Focused History and Physical Exam S A M P L E S/S- -as determined and observed Allergies- -None Medications- -None PMHx- -prone to ear infections, URI etc. Last oral intake- -Important to ascertain when and how much he’s had to eat and drink Inquire as to his diaper changes and how wet Rapid Assessment- -Feel forehead and chest Base-line Vital Signs B/P- -under 3 yrs. So not takes Pulse- -128 Respirations- -30 HIGH NORMS Treat Blow-by O2 VS *Transport

Part III Focused History and Physical Exam IF UNRESPONSIVE: Rapid Assessment Base-line Vital Signs Assess S A M P L E Care Not Unresponsive

Part IV Detailed Physical Exam In this case, probably not necessary. Defined Head to toe physical exam that is performed slower and in a more thorough manner that the rapid assessment Components Head to toe Reassess vital signs Continue care- -Repeat Vital Signs

Part IV Detailed Physical Exam Toe-to-head exam with infants and small children Unless injury/illness won’t permit, allow parent to hold child in lap Shelter from stares and onlookers Children loose heat quickly so recover quickly after exposing for exam

Part V On-Going Assessment Defined: To detect any changes in the patient’s condition To detect any missed injuries or conditions To adjust care as needed Goal: The initial assessment is repeated Vital signs are repeated and recorded Focused assessment repeated for additional complaints

Part V On-Going Assessment Components: Repeat Initial Assessment Discovering and treating life-threatening conditions PRIORITY PATIENTS: Has this changed General Impression Illness or injury Mechanism of injury/Nature of illness Age, sex, race Identify life-threatening problems Well or sick Ill Mental status drowsy sleepy- -appears to be inattentive- -appears to be Mental Status- -Any significant changes A lert V erbal Response P ainful Response U nresponsive Should turn and look or look at you when addressed Should follow simple commands

Part V On-Going Assessment Assess Airway Depressed mental status- -Yes as he does not respond to your presence or your voice Secretions- -No Blood- -No Vomits- -No. Inquire as this is a pertinent negative Trauma- -No Infections- -Inquire as this is a PMHx. As well as a pertinent negatige. Do not hyperextend neck

Part V On-Going Assessment Assess Breathing Effort of breathing- -Rate and quality Chest expansion Effort of breathing Sounds of breathing Breathing rate Color Assess Pulse/ Circulation- -Rate and quality Circulation Skin color Pulse Radial in child Brachial or capillary refill for infants or child <5

Part V On-Going Assessment Skin color Pale- -Yes cyanotic flushed- -Yes Quality of speech *Strong cry- -Silent Speak only in short sentences Meaningful gibberish grunts Interaction with the environment or others *Silence- -Quietly in Moms’ arms *Listlessness- -yes Unconscious- -no Emotional state Withdrawn- -No *Emotionally flat- -Yes Response to you *Inattention to strangers- -Seems to care less that you are there Tone and body position Limpness- -No, not a rag doll or unable to hold head up Poor muscle tone- -No Position to indicate respiratory distress- -No

Part V On-Going Assessment Repeat focused assessment To identify additional serious or potentially life-threatening injuries or conditions Fever- -febrile to touch Listless- -not too active, quiet in moms’ arms Has not had much to eat or drink Repeat Vital Signs Check interventions Note trends in patient condition Changes can occur quickly and dramatically. Don’t take your eyes off of this child for a second