meng.kegawatan
TRANSCRIPT
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Assessment of Children
in Emergencies
Committee on Pediatric Resuscitation, TheIndonesian Society of Pediatrician
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1. PAT
2. 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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Young infants
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Work of Breathings
Abnormal airwaysounds
Abnormal positioning
Retractions
Nasal flaring
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Applying The PAT forWOB
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Seesaw Respiration
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Respiratory Effort
Retraction The Sniffing Position The Tripod Position
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Pallor
Mottling
Cyanosis
Circulation to Skin
Circulation to Skin
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Respiratory distress
N
N
N o
Cardiopulmonary failure
o/q
Shock
{N
{N
Primary CNS dysfunction/metabolic abnormality
{N
{NN
N
{N
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The ABCDEs
Airway
BreathingCirculation
Disability
Exposure
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Airway AssessmentClear
MaintainableUnmaintainabl
e without
intubationObstructed
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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 perminute)
12
30-40
20-30
15-20
12-16
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Retractionand the use ofAccessory Muscle
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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 bpm
3 mos 2 yrs 100 190 bpm
2 10 yrs 60 140 bpm
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Central & Distal Pulses
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Skin PerfusionExtremity temperature
Capillary refill
Color
Pink
Mottled
Pale
Blue
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Skin Perfusion Examination
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Minimal Systolic Blood
Pressure by AgeAge Fifth percentile
mmHg
Systolic BP
0 1 Mo 60
> 1 mo 1 yr 70
> 1 yr 70 + (2 x age in
years)
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Disability
(neurologic status)
Cerebral cortex
Brain StemMotor activity
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Level ofConsciousness
A = Awake
V = Responsive to voiceP = Responsive to pain
U = Unresponsive
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Brain StemPosture
Central respirationPupil response
Cranial nerve
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MotorActivitySymmetrical movements
SeizuresPosturing
Flaccidity
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Exposure
Skin rashes
BruisesExcoriation
etc.
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Stable
Respiratory dysfunction
Potential respiratory failureProbable respiratory failure
Shock
Compensated
Decompensated
Cardiopulmonary failure
Classification ofPhysiologic
status
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Decompensated Shock
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Definition of Cardiopulmonary Failure
Deficits in
Resulting in
Ventilation
OxygenationPerfusion
Agonal respiration
Bradycardia
Cardiopulmonary arrest
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Begin further workupProvide specific therapy as indicated
Reassess frequently
Priorities in Initial ManagementofStable
Child
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Potential Respiratory Failure Probable Respiratory Failure
Keep with caregiver
Position of comfortOxygen as tolerated
Nothing by mouth
Monitor pulse oximetry
Consider cardiac monitor
Separate from caregiver
Control airway100 % FiO2
Assist ventilation
Nothing by mouth
Monitor pulse oxymetry
Cardiac monitor
Establish vascular access
Priorities in Initial Managementof
Respiratory Dysfunction
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Keepwith
Caregiver!!
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Administer oxygen (FiO2 = 1.0) and ensure
adequate airway and ventilation
Establish vascular accessProvide volume expansion
Monitor oxygenation, heart rate, and urine output
Consider vasoactive infusions
Priorities in Initial
ManagementofShock
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Oxygenate, ventilate, monitor
Reassess forRespiratory failure
Shock
Obtain vascular access
Priorities in Initial Managementof
Cardiopulmonary failure