1. Assessment in a systematic way
Dr Anne Ingram

2. Objectives Assessment tool for rapid, thorough examination of children
Give information required to use UCP and determine urgency of care

3. Information from History Physiological observations Examination
Traffic light System: R A G

4. Common presenting complaints
Fever
Breathing difficulty
Vomiting / Diarrhoea
Rash
Fits
Accidental ingestion / overdose / intoxication
Injuries – Accidental / Non accidental

5. Comorbidity Prematurity Neuromuscular conditions – CP
Immunocompromised
Metabolic conditions / diabetes
Social concerns

6. Approach A – Airway B – Breathing C – Circulation D – Disability
E – Exposure
ENT
Tummy
In an unwell/lethargic child
DEFG-don’t Ever Forget Glucose

7. Airway Is it patent – talking, crying Is it obstructed Is it at risk
Swollen lips/tongue
Burns to face/neck
Unconscious
Drooling
Biphasic stridor

8. Breathing Work of Breathing Efficacy of breathing
Rate
Rhythm
Breath sounds/added sounds
Accessory muscle use
Chest recession
Efficacy of breathing
Air entry
Chest movement
Adequacy of ventilation
Tissue oxygenation
Skin colour
Mental status
Cardiac assessment (HR)

9. Respiratory rate
Varies with age, fever, pain, anxiety and respiratory failure
Normal values
Age (years)
Resps per min
< 1
1 – 2
2 – 5
5 – 12
> 12

10. Work of breathing / Respiratory distress
Recessions
Subcostal - Suprasternal / Tracheal tug
Intercostal - Supraclavicular
Sternal
Use of accessory muscles
Abdominal breathing
Prominence of sternomastoid
Head bobbing (in babies)
Flaring of nostrils

11. Noisy breathing Blocked nose / snuffles Stridor – inspiratory noise
Wheeze – expiratory noise
Grunting – expiratory, attempt to maintain end expiratory lung volume

12. Auscultation Air entry – is it equal Wheeze Crepitations
Transmitted noises
SILENT CHEST
Heart sounds

13. Oxygen saturations Pulse oximetry using appropriate probe
Good wave form essential
Saturations >=92% normal
CYANOSIS ONLY APPARENT WHEN SATURATIONS LESS THAN 85%

14. Circulation Heart rate Capillary refill time Pulse volume
Peripheral perfusion
Blood pressure

15. Heart rate Varies with age, fever, dehydration, anxiety & pain
Normal values
Age (years)
Pulse per min
< 1
1 – 2
2 – 5
5 – 12
> 12

16. Capillary refill time
Peripheral vs central Press for 5 seconds Time taken for colour to return Normal <2seconds

17. Pulse volume
Comparison of central and peripheral pulses

18. Disability Assesses neurological status A – Alert
V – responds to Voice
P – responds to Pain (equivalent to 8 on GCS)
U – Unresponsive to any stimulus
Posture
Pupils

19. Exposure
Rash
Bruises
Temperature

20. ENT Examination
If febrile child or presenting with symptoms alluding to ENT
Lymphadenopathy
Positioning really important

21. Tummy(abdomen)
Distension
Tenderness
Masses
Bowel sounds
Hernia sites

22. Rapid Examination Airway Breathing Circulation Disability ENT
RR, WOB, SaO2, auscultation
Circulation
Colour, HR, CRT, Temp hands and feet
Disability
Pupils, Limb tone and movement, AVPU
ENT
T – palpation, auscultation
In an unwell/lethargic child DEFG-don’t Ever Forget Glucose

23. Red flags in history High temperature – risk of bacterial infection
Bilious vomiting
Bloody diarrhoea
Rash which does not disappear on tumbler test
Stopped breathing / gone blue
Abnormal movements or behaviour

24. Red flags on examination
Apnoea
Biphasic stridor
Silent chest
Non blanching rash
Poor perfusion / Thready pulse
Responds to pain only or unresponsive
Any unexplained injuries / bruises

25. Investigations
Urine analysis
Blood sugar

26. Any Questions?

27. Objectives Assessment tool for rapid, thorough examination of children
Give information required to use UCP and determine urgency of care

28. Thank you References: www.spottingthesickchild.com
Advanced Paediatric Life Support (APLS)
European Paediatric Life Support (EPLS)