7. Management of Children in Emergencies
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MANAGEMENT OF CHILDREN IN EMERGENCIES Pediatric Critical Care Division Child Health Department, Faculty of Medicine University of Indonesia
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Transcript of 7. Management of Children in Emergencies
8/3/2019 7. Management of Children in Emergencies
http://slidepdf.com/reader/full/7-management-of-children-in-emergencies 1/31
MANAGEMENT OF CHILDREN
IN EMERGENCIES
Pediatric Critical Care DivisionChild Health Department, Faculty of MedicineUniversity of Indonesia
8/3/2019 7. Management of Children in Emergencies
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Emergency sign
Priority sign
Non UrgentTriage
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Emergency sign
CNS
Respiratory
CardiovascularGastrointestinal
Endocrine
Etc
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PAT
ABCDE
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The PAT
Circulation to Skin
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Appearance
(“Tickles” =TICLS)
Tonus
InteractivenessConsolability
Look/Gaze
Speech/Cry
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Work of Breathings
Abnormal airwaysounds
Abnormal positioningRetractions
Nasal flaring
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Pallor
Mottling
Cyanosis
Circulation to Skin
Circulation to Skin
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Respiratory distress
N
N
N
Cardiopulmonary failure
/
Shock
N
N
Primary CNS dysfunction/metabolic abnormality
N
NN
N
N
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The ABCDEs
Airway
Breathing
Circulation
Disability
Exposure
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Airway Assessment
Clear
Maintainable
Unmaintainablewithoutintubation
Obstructed
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Breathing Assessment
Rate
Effort / mechanics
Air entry
Skin color
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Respiratory Rate by Age
Age
(years)
Respiratory rate
(breaths per minute)
<1
2-5
5-12>12
30-40
20-30
15-2012-16
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Circulation Assessment
Heart rate
Systematic perfusion
Peripheral pulses
Skin perfusion
Appearance
(Urine output) Blood pressure
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Heart Rate by Age
Age Range
Newborn – 3 mos 85 – 200 bpm3 mos – 2 yrs 100 – 190 bpm
2 – 10 yrs 60 – 140 bpm
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Skin Perfusion
Extremity temperature
Capillary refill
Color Pink
Mottled
Pale
Blue
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Minimal Systolic Blood Pressure by Age
Age Fifth percentile mmHg
Systolic BP
0 – 1 Mo 60
> 1 mo – 1 yr 70
> 1 yr 70 + (2 x age inyears)
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Disability
(neurologic status)
Cerebral cortex
Brain Stem Motor activity
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Level of Consciousness
A = Awake
V = Responsive to voice P = Responsive to pain
U = Unresponsive
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Brain Stem
Posture
Central respiration
Pupil response
Cranial nerve
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Motor Activity
Symmetrical movements
Seizures
Posturing
Flaccidity
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Exposure
Skin rashes
Bruises
Excoriation
etc.
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Stable
Respiratory dysfunction
Potential respiratory failureProbable respiratory failure
Shock
Compensated
Decompensated
Cardiopulmonary failure
Classification of Physiologic
status
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Case Scenario 1
15-month-old childHistory
Diarrhea, vomitting for 3 days
Refused bottle this morning
Sleepy, lethargic today
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Physical Examination
PAT:
A : Very lethargic child in mother’s lap WB: Normal
CS : mottled
ABCA : clearB : RR 45/min, breath sounds clear bilaterallyC : HR 178 regular, BP 90 mmHG systolic,
CRT : > 4 sec, Temp 38oC
Weak peripheral pulsesCool, mottled extremities,dry mucousmembranes
CNS: V
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What would be your approach to
this patient?
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UKKPGD IDAI 27
Initial Approach to the Patient in
Shock
Evaluate the ABCs
Deliver high concentration of oxygen Monitor oxygenation and heart rate
Achieve vascular access
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UKKPGD IDAI 28
Case Scenario 1: progression
The patient receives oxygen and is placed ona monitor; attempts at peripheral vascular
access fail
What would you do now?
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UKKPGD IDAI 29
What fluid would you give?
How much and how fast?
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Treatment of Shock
Initial rapid fluid administration of 20 mL/Kg
of:
Crystalloid Colloid
Blood
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