Rapid Pediatric Assessment Judy Leverette, MSN, APN, ACHPN, CEN, EMT
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Rapid Pediatric Assessment
Judy Leverette, MSN, APN, ACHPN, CEN, EMT
Characteristics of Pediatric Population
l Lack of primary carel Children with special health care needsl Violence against childrenl Violence against childrenl Non-immunized and under immunized
children
Dealing with Children
Childhood-Dynamic state ofChange.
Growth and Development
l Predictable, directional, and sequentiall Multifacetedl Affected by genetic, nutritional, and l Affected by genetic, nutritional, and
environmental factorsl Developmental Milestonesl Erickson/Piaget
Epidemiology
l Trauma is the leading cause of death in children > 1 y/o
l MVCs are the leading cause of unintentional injury-related deaths in children of all age injury-related deaths in children of all age groups
l Child maltreatment is the leading cause of injury related death in children 4 y/o and younger
l Severe head trauma is the primary cause of death from child maltreatment
Anatomic and Physiologic Features of Children
l Airwayl Breathingl Circulationl Circulationl Disabilityl Exposurel Additional Differences
Airway
l Large Tonguel Smaller airway
diameter
l Airway Obstructionl Obstruction from
secretions/small objects
l Cartilaginous larynx
objectsl Airway obstruction
from hyperflexion or hyperextension
Breathing
l Compensatory mechanisms less effective
l Higher metabolic rate
l Tire easily=rapid decompensation
l Less efficient use of oxygen and glucose;
l Respiratory rate varies with age
l Fewer smaller alveoli
oxygen and glucose; increased with fever and anxiety
l Normal resp rate inversely related to age
l Less surface area for gas exchange
Circulation
l Increased circulating blood volume
l Rapid heart rateMyocardium less
l Small amts of blood loss can lead to circulatory compromise
l Normal ranges vary with age
l Myocardium less compliant with less contractile mass and limited stroke volume
l Higher cardiac output
agel CO=HRxSV (↑HR)
l ↑oxygen demand but depletes cardiac output reserve
Disability (Neuro)
l Level of consciousness
l Greatly affected by adequate ventilation and oxygenation
Exposure
l Children have a higher body surface area to weight ratio
l Ill and injured children are at increased risk for hypothermia which hypothermia which can result in:
l Hypoglycemial Altered LOCl Hypoxia
Additional Differences
l High metabolic rate with limited glycogen stores
l Medications
l Increased risk for hypoglycemia
l Medication l Medications metabolized differently
l Proportionally larger and heavier head as compared to body size
l Medication administered based on weight
l High risk for head injury from falls
Initial Assessment
l A=Airway with cervical spine controll B=Breathingl C=Circulationl D=Disability (Neurologic status)l D=Disability (Neurologic status)l E=Exposure and Environmental Controll F=Full set of VS and family presencel G=Give comfort Measuresl H=Head-to-toe assessment/Historyl I=Inspect posterior surfaces
Triaging the Pediatric Patient
l Pediatric Assessment Trianglel Physical Assessmentl History (CIAMPEDS or SAMPLE)l History (CIAMPEDS or SAMPLE)l Triage Decision
Pediatric Assessment Triangle
Physical Assessment
l Head to toe examl Focused exam
History
l CIAMPEDSl SAMPLE
TRIAGE DECISION
RED Flagsl Chokingl Droolingl Audible airway soundsl Positioningl Gruntingl Cyanosisl Cool or clammy skinl Altered LOCl Petechial Signs of Abusel Severe Pain
Children with Special Health Care Needs
l Respiratory-cystic fibrosis; asthmal Cardiovascular-congenital heart diseasel Neurologic-spina bifida; cerebral palsy;
seizure disordersseizure disordersl Immunologic-HIV; Hepatitisl Mental Retardation-
Medical Technology
l Tracheostomy Tubesl Ventilatorsl Central Venous Access Devicesl Central Venous Access Devicesl Gastrostomy Tubesl Ventriculoperitoneal Shunts
Trouble Shooting-Central Lines
l DOPE Pneumonicl D-Displacement, disconnection, damagel O-Obstructionl P-Pneumothorax, pericardial
tamponade, pulmonary embolusl E-Equipment Failure
Trouble Shooting Ventilators
l D-Displacement or disconnection of the tube or ventilator circuit
l O-Obstruction of airflowl O-Obstruction of airflowl P-Pneumothorax or other patient related
probleml E-Equipment Failure
Troubleshooting VP shunts
l D-Displacementl O-Obstructionl P-Peritonitis, perforationl P-Peritonitis, perforationl E-Elevated temperature
Emergency Information Form
l Form
Injury
“I tripped and fell on the playground”
Abdominal Pain
l “I’ve been throwing up”
Injury“I fell of my bicycle”
Case A An 8-year-old boy, accompanied by his parents, walks in cradling his left arm. He is not in any obvious respiratory distress and his skin color is normal. Chief complaint: “I wrecked my bike.”
Adolescent with Syncope
“I passed out”
Case A A 14-year-old adolescent is brought in by wheelchair accompanied by his wrestling coach. The adolescent appears pale and is slouched in the wheelchair. Chief Complaint: “I passed out at school.”
Injury Preventionl MVCl Pedestrianl Bicyclel Fires/burnsl Fallsl Poisonsl Firearmsl Child abusel Playgroundsl Sportsl Drowning
Summary
l Children are not “small adults”l Pediatric Assessment Trianglel Historyl Historyl Physical Examl Priorities of Carel Disposition
Health Promotion and Injury Prevention
l The best treatment for illness or injury is:
References
l Emergency Nursing Pediatric Coursel http://hsc.unm.edu/emermed/ped/school
_rn/course.shtml_rn/course.shtml
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