Pediatric Assessment and Management Chapter 32

Scene size up Take note of your surroundings. Scene assessment will supplement additional findings. Observe: – Position of the patient – Condition of the home – Clues to child abuse Take note of your surroundings. Scene assessment will supplement additional findings. Observe: – Position of the patient – Condition of the home – Clues to child abuse

Initial assessment Begins before you touch the patient Form a general impression. Determine a chief complaint. The Pediatric Assessment Triangle can help. Begins before you touch the patient Form a general impression. Determine a chief complaint. The Pediatric Assessment Triangle can help.

Pediatric Assessment Triangle Appearance – Awake – Aware – Upright Work of breathing – Retractions – Noises Skin circulation Appearance – Awake – Aware – Upright Work of breathing – Retractions – Noises Skin circulation

Assessing the ABCs Ensure airway is open and position patient. Breathing assessment – Effort – Obstructions – Rate Circulation assessment – Rate – Skin color, temperature, and capillary refill Ensure airway is open and position patient. Breathing assessment – Effort – Obstructions – Rate Circulation assessment – Rate – Skin color, temperature, and capillary refill

Transport Decision Children under 40 lb should be transported in a child safety seat, if the situation allows Seat should be secured to the cot or captain’s chair Cannot be secured to bench seat Child may have to be transported without a seat, depending on condition Children under 40 lb should be transported in a child safety seat, if the situation allows Seat should be secured to the cot or captain’s chair Cannot be secured to bench seat Child may have to be transported without a seat, depending on condition

Focused history and Physical exam Should be completed on scene unless severity requires rapid transport Young children should be examined toe to head Focused exam on noncritical patients Rapid exam on potentially critical patients Should be completed on scene unless severity requires rapid transport Young children should be examined toe to head Focused exam on noncritical patients Rapid exam on potentially critical patients

Vital Signs by Age AgeRespirations (breaths/min) Pulse (beats/min) Systolic Blood Pressure (mm Hg) Newborn: 0 to 1 mo30 to 6090 to to 70 Infant: 1 mo to 1 yr25 to to to 95 Toddler: 1 to 3 yr20 to 3090 to to 100 Preschool age: 3 to 6 yr20 to 2580 to to 100 School age: 6 to 12 yr15 to 2070 to to 110 Adolescent: 12 to 18 yr12 to 1660 to to 110 Older than 18 yr12 to 2060 to to 140

Respirations Count respirations for 30 seconds. In children less than 3 years, count the rise and fall of the abdomen Note effort of breathing Listen for noises Count respirations for 30 seconds. In children less than 3 years, count the rise and fall of the abdomen Note effort of breathing Listen for noises

Pulse In infants, feel over the brachial or femoral area In older children, use the carotid artery Count for at least 1 minute Note strength of the pulse In infants, feel over the brachial or femoral area In older children, use the carotid artery Count for at least 1 minute Note strength of the pulse

Blood Pressure Use a cuff that covers two thirds of the upper arm If scene conditions make it difficult to measure blood pressure accurately, do not waste time trying Use a cuff that covers two thirds of the upper arm If scene conditions make it difficult to measure blood pressure accurately, do not waste time trying

Skin Signs Feel for temperature and moisture Estimate capillary refill Feel for temperature and moisture Estimate capillary refill

Ongoing assessment Status changes frequently in children If child deteriorates, repeat the initial assessment Status changes frequently in children If child deteriorates, repeat the initial assessment

Care of the Pediatric Airway Positioning the airway: – Place the patient on a firm surface. – Fold a small towel under the patient’s shoulders and back. – Place tape across patient’s forehead to limit head rolling Positioning the airway: – Place the patient on a firm surface. – Fold a small towel under the patient’s shoulders and back. – Place tape across patient’s forehead to limit head rolling

Oxygen Delivery Devices Nonrebreathing mask at 10 to 15 L/min provides 90% oxygen concentration Blow-by technique at 6 L/min provides more than 21% oxygen concentration Nasal cannula at 1 to 6 L/min provides 24% to 44% oxygen concentration Nonrebreathing mask at 10 to 15 L/min provides 90% oxygen concentration Blow-by technique at 6 L/min provides more than 21% oxygen concentration Nasal cannula at 1 to 6 L/min provides 24% to 44% oxygen concentration

Airway Obstruction Croup – A viral infection of the airway below the level of the vocal cords Epiglottitis – Infection of the soft tissue in the area above the vocal cords Foreign body airway obstructions Croup – A viral infection of the airway below the level of the vocal cords Epiglottitis – Infection of the soft tissue in the area above the vocal cords Foreign body airway obstructions

Neonatal Resuscitation Deliver chest compressions at 120 per minute Coordinate chest compressions with ventilations at a ratio of 3:1 If meconium is present, suction infant vigorously Deliver chest compressions at 120 per minute Coordinate chest compressions with ventilations at a ratio of 3:1 If meconium is present, suction infant vigorously