Recognition of pediatric emergencies
Upcoming SlideShare
Loading in...5
×
 

Recognition of pediatric emergencies

on

  • 778 views

 

Statistics

Views

Total Views
778
Views on SlideShare
775
Embed Views
3

Actions

Likes
0
Downloads
47
Comments
0

1 Embed 3

http://study.myllps.com 3

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Recognition of pediatric emergencies Recognition of pediatric emergencies Presentation Transcript

  • Dr. Lilia Dewiyanti, SpA, MSiMed.
  • Many etiologiesRespiratory failure Shock Cardiopulmonary failure Cardiopulmonary arrest 2
  • Outcome of respiratory vs Cardiopulmonary Arrest in Children 100% 75 – 90 %Survival rate 75% 7 – 11 % Respiratory arrest Cardiopulmonary arrest 3
  • Core Knowledge and Skills1. Recognize respiratory distress and potensial respiratory failure2. Recognize shock3. Describes priorities for management of respiratory distress, failure, and shock 4
  • Is this child in respiratory failure or shock ?Is this child in respiratoryfailure or shock? 5
  • The Three Phases ofRapid Cardiopulmonary Assessment 1. Physical examination 2. Classification of physiologic status 3. Initial management priorities 6
  • The ABCsNormal Vital Functions Are Maintained By To Provide Airway Ventilation Breathing Oxygenation Circulation Perfusion 7
  • Primary Abnormalities in Respiratory Failure Ventilation Airway AndBreathing OxygenationCirculation Perfusion 8
  • Classification of Respiratory Failure Potential respiratory failure Theraphy (eg, positioning, oxygen administration)Improvement Deterioration Potential Probable Resp. failure Resp. failure 9
  • Initial Assessment Pediatric Assessment Triangle : Circulation to Skin 10
  • Appearance (“Tickles” =TICLS)  Tonus  Interactiveness  Consolability  Look/Gaze  Speech/Cry 11
  • Potential respiratory failure 12
  • Work of Breathings  Abnormal airway sounds  Abnormal positioning  Retractions  Nasal flaring 13
  • The sniffing position The abnormal tripod position Retractions 14
  • Circulation to SkinCharacteristic of Circulation to Skin  Pallor (putih pucat)  Mottling (bercak2)  Cyanosis (kebiruan) 15
  • PAT: Potential Respiratory Failure Normal Increased Circulation to Skin Normal 16
  • PAT: Respiratory Failure Increased Abnormal or decreased Circulation to Skin Normal or abnormal 17
  • Rapid Cardiopulmonary AssessmentPhysical Examination - Airway 1. Clear 2. Maintainable 3. Unmaintanable without intubation 4. Obstructed 18
  • Rapid Cardiopulmonary AssessmentPhysical Examination - Breathing 1. Rate 2. Effort / mechanics 3. Air entry 4. Skin color and temperature 19
  • Rapid Cardiopulmonary AssessmentPhysical Examination - Breathing Evaluation of rate, effort, and mechanics • Tidal Volume ( V T) • Minute ventilation (MV) • MV = VT X RR 20
  • Rapid Cardiopulmonary AssessmentPhysical Examination : Breathing 21
  • Primary Abnormalities in Shock Ventilation Airway AndBreathing OxygenationCirculation Perfusion 22
  • PAT: Shock Abnormal Normal Circulation to Skin Abnormal 23
  • Basic Relationships of Cardiovascular Parameters Preload Stroke Myocardial Volume contractility Cardiac Afterload Output Heart RateBloodPressure Systemic Vascular Resistance 24
  • Cardiac Output = Heart Rate X Stroke VolumeInadequate Compensation • Increased heart rate • Increased SVR • Posible increased SV 25
  • re s is te n s i v a s k u la r 140 100% kon trol 60 C u ra h ja n tu n g T e k a n a n d a ra h 20 25 50 75 % ta s e k e h ila n g a n d a ra h R e s p o n s h e m o d in a m ik te rh a d a p k e h ila n g a n d a ra h 29 26
  • Child in shock 27
  • Rapid Cardiopulmonary AssessmentPhysical Examination - Circulation 1. Heart rate 2. Systematic perfusion • Peripheral pulses • Skin perfusion • Level of consciousness • Urine output 3. Blood pressure 28
  • Heart rates in Normal Children Age RangeNewborn – 3 Mos 85 – 200 bpm3 mos – 2 yrs 100 – 190 bpm2 – 10 yrs 60 – 140 bpm 29
  • Palpation of Central dan Distal Pulses 30
  • Rapid Cardiopulmonary AssessmentPhysical Examination - Circulation Skin perfusion • Extremity temperature • Capillary refill • Color • Pink • Mottled • Pale • Blue 31
  • Normal capillary refill is < 2 seconds in a warm environmentCapillary refill 32
  • Rapid Cardiopulmonary AssessmentPhysical Examination - CirculationLevel of consciousness •A = Awake •V = Responsive to voice •P = Responsive to pain •U = Unresponsive Child in shock with depressed mental status 33
  • Renal perfusion • Urine output (Normal: 1 to 2 mL/kg/hour) reflects • Glomerular filtration rate reflects • Renal blood flow reflects • Vital organ perfusion What information does blood pressure provide ? What is inadequate blood pressure ? 34
  • Rapid Cardiopulmonary Assessment Physical Examination - Circulation Age Fifth percentile mmHg Systolic BP0 – 1 Mo 60> 1 mo – 1 yr 70> 1 yr 70 + (2 x age in years) 35
  • Review of the Physical Findings in ShockEarly signs (compensated) • Increased heart rate • Poor systemic perfusionLate signs (decompensated) • Weak central pulses • Altered mental status • Decreased urine output • Hypotension 36
  • Child dying with anasarca , MOSFdespite resuscitation efforts 37
  • Definition of Cardiopulmonary Failure Deficits in • Ventilation • Oxygenation • Perfusion Resulting in • Agonal respiration • Bradycardia • Cardiopulmonary arrest 38
  • Rapid Cardiopulmonary Assessment Ventilation Airway AndBreathing OxygenationCirculation Perfusion 39
  • The Three Phases ofRapid Cardiopulmonary Assessment 1. Physical examination 2. Classification of physiologic status 3. Initial management priorities 40
  • Rapid Cardiopulmonary AssessmentClassification of Physiologic status • Stable • Respiratory failure • Potential • Probable • Shock • Compensated • Decompensated • Cardiopulmonary failure 41
  • The Three Phases ofRapid Cardiopulmonary Assessment 1. Physical examination 2. Classification of physiologic status 3. Initial management priorities 42
  • Rapid Cardiopulmonary Assessment -Priorities of Initial Management Stable • Begin further workup • Provide specific theraphy as indicated • Reassess frequently 43
  • Rapid Cardiopulmonary Assessment - Priorities of Initial ManagementPotential RF Probable RFKeep with caregiver Separate from caregiverPosition of comfort Control airwayOxygen as tolerated 100 % FiO2 Assist ventilationNothing by mouth Nothing by mouthMonitor pulse oximetry Monitor pulse oximetryConsider cardiac monitor Cardiac monitor Establish vascular- access 44
  • 45
  • Rapid Cardiopulmonary Assessment -Priorities of Initial Management Shock • Administer oxygen (FiO2 = 1.00) and ensure adequate airway and ventilation • Establish vascular access • Provide volume expansion • Monitor oxygenation, heart rate, and urine output • Consider vasoactive infusions 46
  • Rapid Cardiopulmonary Assessment -Priorities of Initial Management Cardiopulmonary failure • Oxygenate, ventilate, monitor • Reassess for • Respiratory failure • Shock • Obtain vascular access 47
  • Case No 1 A 3-week-old infant arrives at the emergency department. • CC : Vomiting and diarrhea • PE : Gasping respirations, bradycardia, cyanosis What is the physiologic status ? What are the initial interventions ? 48
  • Case No 1 - Cardiopulmonary failure Response to intubation and ventilation with FiO2 1.00 • HR : 180; BP 50 mm Hg systolic • Pink centrally; cyanotic peripherally • No peripheral pulses • No response to venipuncture What is the physiologic status ? What is the cause ? 49
  • Case No 1 - Response to Therapy • Vital sign improved • Perfusion still poor 50
  • What is the heart size ? 51
  • Case No 2 A 3-day-old infant has a history of irritability and one episode of vomiting PE : Gasping respirations, bradycardia, cyanosis What is the physiologic status ? What are the initial interventions ? 52
  • Case No 2 - Cardiopulmonary failure Response to oxygenation and ventilation with FiO2 1.00 • HR : 180; BP 40 mm Hg systolic • Pink centrally; cyanotic peripherally • No peripheral pulses • No response to venipuncture What is the physiologic status ? What is the next intervention ? 53
  • Chest X-ray after fluid bolus 54