Pediatric Assessment

SCENE SIZE-UP & SAFETY Enter Slowly Observe for safety and mechanism of injury

If parents interfere: Try to persuade to assist in care If necessary, have friend or relative remove from scene Child may not live in traditional 2-parent home use tact Gain confidence and calm all involved Don’t distract from care of child

Assessing The condition of a sick/injured child can change rapidly Signs or symptoms can be subtle

INITIAL ASSESSMENT General Impression Well or sick Mental status drowsy sleepy inattentive Effort of breathing

Skin color pale cyanotic flushed Quality of speech strong cry speak only in short sentences grunts

Interaction with the environment or others silence listlessness unconscious

Emotional state withdrawn emotionally flat Response to you inattention to strangers Tone and body position limpness poor muscle tone position to indicate respiratory distress Mental status AVPU never shake

Airway depressed mental status secretions blood vomitus trauma infections Do not hyperextend neck

Breathing Chest expansion Effort of breathing Sounds of breathing Breathing rate Color

“Treat as you go care”

FOCUSED HISTORY AND PHYSICAL EXAM Ask simple questions Always explain what you are doing to a child Base-line vital signs low b/p may indicate imminent cardiac arrest

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

DETAILED PE 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

ON-GOING ASSESSMENT DON’T TAKE YOUR EYES OFF YOUR PEDIATRIC PAITENT FOR A MINUTE

RESPIRATORY COMPRIMISE IS THE PRIMARY CAUSE of CARDIAC ARREST IN CHILDREN