Transcript PEDIATRIC ASSESSMENT

An Overview
Objectives:
 To present the course objective of PALS
 To briefly review BLS
 To give an overview of Rhythm Disturbances
 To review types of vascular access
 To know team dynamics in resuscitation
 To present the pediatric assessment overview
Pediatric Advanced Life Support
 2006 American Heart Association
 Designed for healthcare providers who initiate and
direct advanced life support beyond BLS through the
stabilization or transport phases of a pediatric
emergency, either in or out of hospital.
 Enhance skills in the evaluation & management of an
infant or child with respiratory compromise,
circulatory compromise, or cardiac arrest.
PALS
 Active participation in simulated core cases, designed to
reinforce important concepts, including:
 Identification & treatment medical conditions that place a
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child at risk for cardiac arrest
The systematic approach to pediatric assessment
The assess-categorize-decide-act approach to assessment and
management of a seriously ill infant or child
PALS algorithms & flow charts
Effective resuscitation team dynamics
 The goal of the PALS Provider Course is to improve the
quality of care provided to seriously ill or injured children,
resulting in improved outcome.
Rhythm Disturbances
I.
Parts of the defibrillator
1. Power button
2. Energy selector
3. Paddles
4. Charge button (machine & paddles)
5. Shock button (machine & paddles)
6. Sync
Rhythm Disturbances
II. Identifying rhythm
Non-shockable
Asystole
PEA
Rhythm Disturbances
II. Identifying rhythm
Shockable Rhythm
(1) Defibrillate:
Ventricular
Tachycardia
Ventricular
Fibrillation
2 to 4 J/kg
Rhythm Disturbances
II. Identifying Rhythm
Shockable Rhythm
(2) Synchronized Cardioversion:
Supraventricular
Tachycardia
0.5 to 1 J/kg
Rhythm Disturbances
III. Steps:
1. Identify rhythm
2. Select energy
3. Clear
(1) I’m clear
(2) You’re clear
(3) Everybody clear
(4) Oxygen away
(5) Verify rhythm
4. Deliver shock
Vascular Access
 Intravenous route
 Intraosseous route
 Use IO needle w/ stylet or rigid needle
 Sites: anterior tibia, distal femur, medial malleolus, ASIS
 For drugs and fluids
 Can be established in all age groups
 Can be achieved in 30 to 60 seconds
 Preferred over the ET route for medications
 Any drug that can be administered IV can be given through IO
 Contraindications:
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Fracture in extremity
Previous insertion attempt in extremity that entered the marrow space
Infection overlying bone
Osteogenesis imperfecta
Team Dynamics
 Elements:
1. Closed-loop communication
2. Clear messages
3. Clear roles and responsibilities
4. Knowing one’s limitations
5. Knowledge sharing
6. Constructive intervention
7. Reevaluation and summarizing
8. Mutual respect
Team Dynamics
Role
Responsibilities
Team Leader
Directs the resuscitation
Monitors performance of tasks
Models excellent team behavior
Airway
Checks O2 setup
Administer oxygen
Inserts OPA or NPA
Performs BMV
Inserts NG / OG tube
Prepares / performs ET intubation
IV / IO
Gains IV / IO access
Prepares drugs & fluids
Administers drugs & fluids
Compressor
Performs chest compression
If chest compressions are not needed during a case, team member may
obtain equipment, fluids and drugs or assist the observer
Monitor / defibrillator
Establishes ECG monitoring, checks pulse, operates monitor/defibrillator
Observer / recorder
Monitors performance of the team
Pediatric Assessment
 Objectives:
 To be familiar with the systematic assessment of a
seriously ill or injured child;
 To review the recognition of the signs of respiratory
distress, respiratory failure, and shock & to know when
to refer in these instances.
Pediatric Assessment
 General Assessment
 Primary Assessment
 Secondary Assessment
 Tertiary Assessment
Pediatric Assessment
 General Assessment
 Primary Assessment
 Secondary Assessment
 Tertiary Assessment
General Assessment
 Pediatric Assessment Triangle (PAT)
Appearance
Work of
Breathing
Circulation
General Assessment
 Appearance
 Muscle tone
 Interaction
 Consolability
 Look / gaze
 Speech / cry
General Assessment
 Work of Breathing
 Increased work of breathing
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nasal flaring
retractions
 Decreased or absent respiratory effort
 Abnormal sounds
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wheezing
grunting
stridor
General Assessment
 Circulation
 Abnormal skin color
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pallor
mottling
 Bleeding
Pediatric Assessment
 General Assessment
 Primary Assessment
 Secondary Assessment
 Tertiary Assessment
Primary Assessment
Airway
Breathing
Exposure
Circulation
Disability
Primary Assessment
 Airway
 Look for movement of the chest or abdomen
 Listen for breath sounds and air movement
 Feel for the movement of air at the nose and mouth
Primary Assessment
 Breathing
 Respiratory rate
 respiratory effort
 Tidal volume
 Airway and lung sounds
 Pulse oximetry
Primary Assessment
 Circulation
 Assess cardiovascular function by:
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Skin color and temperature
Heart rate
Heart rhythm
Blood pressure
Pulses (peripheral and central)
Capillary refill time
Primary Assessment
 Circulation
 Assess end-organ function by:
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Brain perfusion (mental status)
Skin perfusion
Renal perfusion (urine output)
Primary Assessment
 Disability
 AVPU Pediatric Response Scale
 Glasgow Coma Scale (GCS)
 Pupillary response to light
Primary Assessment
 Exposure
 Rash
 Temperature
 Evidence of trauma
Pediatric Assessment
 General Assessment
 Primary Assessment
 Secondary Assessment
 Tertiary Assessment
Secondary Assessment
Signs &
Symptoms
Events
Last
Food/Fluid
intake
Allergy
Medications
Past Medical
History
Secondary Assessment
 Signs & Symptoms
 Breathing difficulty
 Fever
 Diarrhea, vomiting
 Bleeding
 Fatigue
 Time course of symptoms
Secondary Assessment
 Allergy
 Medications
 Food
 Latex
Secondary Assessment
 Medications
 Last dose and time
Secondary Assessment
 Past Medical History
 Birth history
 Underlying problems
 Past surgeries
 Immunization status
Secondary Assessment
 Last Meal
 Time and nature of food / drinks
Secondary Assessment
 Events
 Leading to current illness
 Treatment during interval from onset
Pediatric Assessment
 General Assessment
 Primary Assessment
 Secondary Assessment
 Tertiary Assessment
Tertiary Assessment
 Respiratory abnormalities
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ABG / VBG
Pulse Oximetry, CXR, PEFR
 Circulatory abnormalities
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ABG / VBG
Serum lactate
CVP Monitoring
CXR
Echocardiography