Assessment of Children in Emergencies

Committee on Pediatric Resuscitation, The Indonesian Society of Pediatrician

1. PAT2. ABCDE

The PAT

Appe

aran

ceWork of Breathing

Circulation to Skin

Appearance (“Tickles” =TICLS)

TonusInteractivenessConsolabilityLook/GazeSpeech/Cry

Appe

aran

ce

Work of Breathings

Work of Breathings

Abnormal airway soundsAbnormal positioningRetractionsNasal flaring

Applying The PAT for WOB

Seesaw Respiration

Respiratory Effort

Retraction The Sniffing PositionThe Tripod Position

PallorMottlingCyanosis

Circulation to Skin

Circulation to Skin

Respiratory distress

N

N

N

Cardiopulmonary failure

/

Shock

N

N

Primary CNS dysfunction/

metabolic abnormality

N

NN

N

N

The ABCDEsAirwayBreathingCirculationDisabilityExposure

Jalan Napas (Airway)

BebasDapat dipertahankanPerlu intubasiTersumbat

Pernapasan (Breathing)

Frekuensi (sesuai usia)Upaya napasKeluar/masuk udaraWarna kulit (sianosis)

Breathing AssessmentRateEffort / mechanicsAir entrySkin color

Respiratory Rate by Age

Age(years)

Respiratory rate(breaths per minute)

<12-5

5-12>12

30-4020-3015-2012-16

Sirkulasi (Circulation)

Frekuensi nadiPerfusiKualitas nadiPerfusi kulitKesadaranTekanan darah

Frekuensi Nadi Sesuai Usia

Usia (tahun) Frekuensi Nadi<1 100-1601-5 95-1405-12 80-120>12 60-100

Central & Distal Pulses

Skin PerfusionExtremity temperatureCapillary refillColorPinkMottledPaleBlue

Skin Perfusion Examination

Minimal Systolic Blood Pressure by Age

Age Fifth percentile mmHg

Systolic BP0 – 1 Mo 60

> 1 mo – 1 yr 70> 1 yr 70 + (2 x age in

years)

Disability

Kesadaran AVPUFungsi batang otakMotorik Kejang Gerakan asimetris Flasiditas/spastisitas Postur

Level of Consciousness

A = AwakeV = Responsive to voiceP = Responsive to painU = Unresponsive

CNS Level Pupil Oculo-cephalic

Pola Napas Posture

Thalamus Small, reactive Variable Cheyne-Stokes

Normal

Midbrain Mid position, fixed

Absent Hyperventilation

Decorticate

Pons Pin point, fixed Absent Rythmic pauses

Decorticate or flacid

Medulla Small reactive Present Irregular Flacid

Menilai Fungsi Batang Otak

Motor ActivitySymmetrical movementsSeizuresPosturingFlaccidity

Exposure

RuamHematomaIkterusdll

Stable Respiratory dysfunction

Potential respiratory failure Probable respiratory failure

Shock Compensated Decompensated

Cardiopulmonary failure

Classification of Physiologic status

TERIMAKASIH