Transcript No Slide Title

ASSESSING SEVERITY OF ILLNESS
IN THE CHILD
By Dr. Derek Louey
ASSESSING SEVERITY OF
ILLNESS
• Applies particularly to
neonates/infants/toddlers
• Don’t be intimidated
• Follow a systematic approach
• Assess severity first - diagnosis comes later
ASSESSING SEVERITY OF
ILLNESS
• Initial assessment
• Occurs without needing to touch the child
• Can be performed rapidly in less than 1 minute
• Done at triage
• Taking of vital signs
ASSESSING SEVERITY OF
ILLNESS
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Airway
Breathing
Circulation
Disability (Neurological)
Exposure
LIFE-THREATENING ILLNESSES ACT BY
EXERTING THEIR EFFECT ON THE ABOVE
AIRWAY
• Stridor
• Tracheal tug
• Drooling
BREATHING
• Increased work
• Increasing fatigue
• Decreased effectiveness
BREATHING
• Increased work
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Recession
 RR
Grunting
Nasal flare
Accessory muscle
BREATHING
• Increasing fatigue
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 RR
 breath sounds
 chest/abdominal movement
Apnoeic spells (c.f. periodic breathing)
BREATHING
• Decreasing effectiveness
• Cyanosis
•  Alertness
CIRCULATION
• Pallor/Peripheral cyanosis
•  capillary refill
DISABILITY
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Conscious state
Eye contact
Activity
Cry
DISABILITY
• Conscious state
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Lethargic/Dull/Expressionless
Irritable
Not recognizing mother
Seizures
Not responding to pain
Quiet/Unresponsive
DISABILITY
• Eye contact/Smile
• Lack of social smile
• Not Fixing/Following/Focusing
• Glassy stare
DISABILITY
• Activity
• Require assistance
• Not ambulating
DISABILITY
• Cry
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Unable to be placated by mother
Whimpering/Sobbing
Irritable
Weak/Moaning/High pitched
EXPOSURE
• Mottled
• Petechiae
• Unexplained bruising (NAI)
VITAL SIGNS
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Different reference range for different ages
BP is an important value often forgotten
Hypothermia is suggestive of sepsis
Pulse oximetry - ‘the fifth vital sign’
Weigh the child
Check blood sugar
WHY WEIGH THE CHILD?
• Changes of weight are a good guide to
degree of dehydration
• Determines drug dosing
• Determines IV fluid calculations
SIGNS OF SEVERE ILLNESS
• Resting stridor
• Marked intercostal/sternal recession with
accessory muscle use and tachypnea
• Cyanosis
• Capillary refill > 4sec (normal < 2 sec) / 
HR
• Impalpable pulse or hypotension or  HR
• Not fixing/following or responding to
environment
REASURRING SIGNS
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No stridor or only stridor with activity
Mild recession
Good colour
Capillary refill < 2 sec
Responding to mother and examiner/Able to
be placated by mother
PRACTICAL TIPS
• Maintain a calm and reassuring manner
(helps the parents and yourself)
• Keep a handy reference at triage of agerelated ranges of paediatric vital signs
• When assessing capillary refill - choose an
area of the trunk and apply pressure for 4
secs before releasing
PRACTICAL TIPS
• Assess pulse at brachial artery (inside
elbow)
• Use age appropriate BP cuff (width 2/3
circumferance)
• Use paediatric probe for pulse oximetry
PRACTICAL TIPS
• Weighing the child
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use proper paediatric scales (NOT adult scales)
ideally unclothed with small babies
Record to within 0.1kg for a neonate
Record to 0.5kg for an infant