This document provides guidance on approaching paediatric patients in emergency medicine. It outlines several key differences between adult and paediatric patients, including vital signs, assessment scales, and approaches to primary and secondary surveys. Tools for paediatric assessment and resuscitation are described, including the paediatric assessment triangle, length-based resuscitation tapes, and considerations for consent and family presence in emergency care of children. References for further information are also provided.

1. APPROACH TO PAEDIATRIC PATIENTS IN EMD
Dr K RAHINI

2. INTRODUCTION
• Newborn usually refers to a baby from birth to about 2
months of age.
• Infants can be considered children from birth to 1 year old

3. • Children can present diagnostic and management challenges due to
their anatomic , physiologic and developmental differences from
adult patients
• Understanding these differences is crucial to the recognition and
appropriate treatment of many pediatric emergencies
• In addition to changes in cognitive and behavioral development,
temperature regulation , airway anatomy , cardiovascular physiology ,
immune function and the musculoskeletal system all changes as
children grow

7. HIGH RISK VITAL SIGNS
AGE RR HR
< 6 MONTHS >60 >180
6-12 MONTHS >50 >160
1-2 YEARS >40 >160
2-8 YEARS >30 >140
>8 YEARS >20 >100

8. EVALUVATION
TRIAGE EMERGENCY
SEVERITY
INDEX
PEDIATRIC
CANADIAN
TRIAGE AND
ACUITY SCALE
MANCHESTER
TRIAGE
SYSTEM
AUSTRALASIAN
TRIAGE SCALE

11. PRIMARY SURVEY
• Assess airway / cervical spine
• Assess breathing
• Assess circulation
• Disability
• Exposure

12. LEVEL OF AROUSAL GCS
A ALERT 15
V VOICE 13
P PAIN 8
U UNRESPONSIVE 3

13. SECONDARY SURVEY
• Chief complaints
• Immunization and isolation
• Allergies
• Medications
• Past medical history
• Events
• Diet and diapers
• Symptoms associated with illness and injury

14. PECARN RULE

15. PAEDIATRIC ASSESSMENT TRIANGLE

16. APPEARANCE WORK OF BREATHING CIRCULATION TO SKIN
TONE ABNORMAL SOUNDS –STRIDOR
GRUNTING SNORING WHEEZING
PALLOR
IRRITABLE , INTERACTIVE ABNORMAL POSITIONING-
SNIFFING TRIPODING REFUSAL TO
LIE DOWN
DELAYED CRT, MOTTLING
CONSOLABLE RETRACTIONS CYANOSIS
LOOK GAZE HEAD BOBBING PETECHIAE
SPEECH CRY NASAL FLARING

17. INTERPRETATION OF PAEDIATRIC ASSESSMENT
TRIANGLE
PHYSIOLOGIC STATE APPEARANCE WORK OF BREATHING CICULATION TO SKIN
RESPIRATORY DISTRESS NORMAL ABNORMAL NORMAL
RESPIRATORY FAILURE ABNORMAL ABNORMAL NORMAL-ABNORMAL
COMPENSATED SHOCK NORMAL NORMAL ABNORMAL
DECOMPENSATED SHOCK ABNORMAL NORMAL-ABNORMAL ABNORMAL
BRAIN INJURY OR
DYSFUNCTION
ABNORMAL NORMAL NORMAL
CARDIOPULMONARY
FALURE
ABNORMAL ABNORMAL ABNORMAL

18. LENGTH BASED
RESUSCITATION TAPE • Its to estimate child’s weight
• Each color on the tape corresponds
to a weight range that corresponds
to an ideal body weight for length
• Medication doses and appropriate
equipment are listed on tape for
each weight range
• It avoids error prone calculations of
medication dose and equipment size
• It minimize the need to search for
appropriate sized equipment

20. CONSENT FOR EMERGENCY CARE
PEDIATRIC READY EMD
• It requires a plan for continuing
care of critically ill and injured
• Plan for transfer of patients
whose needs exceed available
resources is necessary
PEDIATRIC FRIENDLY EMD
• Appropriate use of analgesia
anesthesia and non
pharmacological pain
management for procedural pain
• Use of anxiolytic medication for
young children
• Family presence during invasive
procedures and resuscitations

21. REFERENCES
• FLEICHERS AND LUDWIGS PEDIATRIC EMERGENCY BOOK FOR
PRESENTATION
• SUCHITRA BOOK ON PEDIATRIC EMERGENCY MEDICINE BOOK
• ROSEN’S