emergencies in pediatrics

1. Monitoring in PICU

2. Objectives
• Define monitoring
• Describe different methods of monitoring in PICU
• Describe the importance of different alarms

3. Definition of monitoring
• Monitoring means measurement and interpretation of biological
systems that describe performance of the various systems of the
body

4. Monitoring parameters in PICU

5. Types of monitoring
NON INVASIVE MONITORING INVASIVE MONITORING
Clinical
Temperature, pulse, RR, CRT, Sensorium,
Heart Rate, intake and output
Device assisted monitoring
CVP, IBP, mixed venous oxygen saturation (svo2),
ET cuff pressure
Device assisted monitoring
NIBP ,SPO2, ECG, Capnography
Laboratory monitoring
CBC, cultures, ABG, renal function test, liver
function test, coagulation profile
Radio-imaging
Chest X-Ray, Echocardiography, Point of
care ultrasound (POCUS)

6. Clinical Assessment
• Sensorium:
o Awake, Irritable or Agitated, Lethargy or Unresponsiveness
oAwake (GCS 15)
oResponse to Voice (GCS 12)
oResponse to Pain (GCS 8)
oUnresponsive (GCS 3)

7. • Capillary refill time:
o 2-3 seconds is normal finding
oMeasure of peripheral microvascular perfusion
oVery prolonged CRT (>6 seconds) has better correlation
o<1 second: flash CRT, warm shock

8. • Central and peripheral pulses:
oPulse: Rate, Rhythm, and volume.
oPulse volume reflects the pulse pressure
oLow: Hypovolemic or Cardiogenic shock.
oHigh: Warm shock

9. • Temperature:
oThe core to peripheral temperature gradient
o reflects adequacy of the peripheral circulation
oNormal value 3-4 C0
oIncreased: cold shock
oDecreased: warm shock

10. • Non Invasive Oscillometric BP:
oSafe, Simple, Reliable, Reproducible, and Inexpensive
oErrors: mainly due to inappropriate cuff size.
oCuff: cover at least two third of the upper arm.
oLarger cuff- underestimates BP
o small cuff overestimates BP.

11. oAutomated Oscillometric Technology : now the standard of
care
oMean arterial pressure (MAP) is most accurate and diastolic
pressure is the least accurate with this technique.
oLower limit of systolic BP
o ≥ 60 mm Hg in neonates,
o ≥ 70 mm Hg in infants,
o ≥ 70 mmHg (2 X Age in years) for children 1-10 years of
age and
o ≥ 90 mmHg for children >10 years of age

12. Dimensions of BP cuff bladders
AGE WIDTH (cms) LENGTH (cms) MAC (cms)
Newborn 4 8 10
Infants 6 12 15
Child 9 18 22
Small adult 10 24 25
Adult 13 30 34
Obese 16 38 44
Thigh 20 42 52

13. • Pulse Oximeter:
oMeasures arterial oxygen saturation (Oxygenation), not Ventilation.
oNon Invasive, safe, simple, continuous method for assessing
oxygenation.
oNormally target SpO2 94- 96%
oLow SpO2
oHypoxia
oPoor peripheral circulation
oNail polish
oExternal light (eg phototherapy)

14. Advance monitoring parameters
• Invasive BP monitoring
• Waveform Capnograph
• Central venous pressure

15. Importance of alarm
• Early detection of malfunction (eg syringe pump)
• Early detection of physiological derangements (eg
tachycardia)
• Early identification of problem (eg shock)
• Early intervention (eg fluid bolus, antibiotics)

16. Types of alarms in the monitor
• Acoustic alarm
• High priority alarm
• Medium priority alarm
• Low priority alarm
• Text alarm
• The text flashing in the window showing the alarm came from the
particular parameter
Visual alarm
• Red light flashing
• Orange light flashing
• Green light flashing

17. • Set alarm limit specific for a patient on admission
• Acknowledge all kind of alarm in the PICU
• “alarm fatigueness”
• Address alarm on time
• DO NOT ignore alarm
• DO NOT just mute alarm

18. Any questions?

19. Summary
• What are the various monitoring methods in PICU?
• What is the significance of alarm light in PICU?
• What are the common types of alarms in PICU?

20. Thank you!