Critically ill child (1)

1. EVALUATION OF ACUTELY ILL
CHILD
Dr. Shyam Kartikey Dwivedi
Moderator – Dr. Himanshu Dua

2. Approach To The Emergency
Evaluation Of A Child
• Rapid Visual Survey –
A) Gen. Appearance
- Color
- Tone
- Alertness
- Responsiveness

3. B) Adequacy Of Breathing –
- Distinguishing from Normal
- Comfortable Respiration
- Respiratory Distress
- Apnea

4. C) Adequacy Of Circulation
- Pallor
- Cyanosis
- Mottling

5. ANY CHILD WITH
HR < 60/ MIN, START CPR
IRRESPECTIVE TO AGE

6. Primary Assessment
A) Airway
B) Breathing
C) Circulation
D) Disability
E) Exposure

7. Abnormal Signs And Symptoms
1) RR > 60 breaths/ min for a sustained period
2) Normal HR > 2-3 time of Normal RR for
particular age
3) Low BP – Neonate Systolic < 60 mm Hg.
1 month – 1 yr < 70 mm Hg.
1 yr – 10 yr < 70 + ( 2 x Age ) mm Hg
> 10 yr < 90 mm Hg

8. To Assess Airway Patency
Look for –
1) Breathing movements of the child, Chest
and Abd
2) Feel the movement of air on Mouth and Nose
3) Listen for Breath sounds
4) Abnormal breathing sounds like – Snoring or
Stridor
5) Increased work of breathing and apnea

9. Abnormal RR
• Bradypnoea
• Tachypnoea

10. S/o Respiratory Effort
1) Nasal Flaring
2) Grunt
3) Chest and Neck Muscle Retraction
4) Head bobbing
5) See-saw respiration

11. CENTRAL CYANOSIS
IS A S/O
SEVERE HYPOXIA

12. Assessment of Circulation
S/o decreased perfusion and compromised CO
1) Mottling
2) Pallor
3) Increased CRT
4) Cyanosis
5) Poor Pulse
6) Cool Extremities

13. TACHYCARDIA IS EARLIEST
AND MOST RELIABLE S/0
SHOCK
But is itself fairly non-specific and
should be co-related with other
component of exam i.e. weakness,
threadiness, absense of pulse.

14. • Skin Color
• Temperature
• HR
• Heart rhythm
• Pulse
• BP

15. Disability
Refers to a child’s Neurologic Function
A) Level of Consciousness
B) Cortical Function

16. QUICKLY CHECK THE
PUPILARY RESPONSE TO
LIGHT

17. AVPU Scale
It measures the level of both, level of consciousness
and cerebral cortical function
A --------------------- Alert
V --------------------- Verbal
P --------------------- Pain Stimuli
U -------------------- Unresponsive to any stimuli

18. GCS Scale
E4 -------------- Eye opening
V5 ------------- Verbal response
M6 ------------- Motor response
Electronic Voting Machine

19. MOST COMMON CAUSE FOR
ALTERED CONSCIOUS LEVEL
IN CHILDREN
Respiratory or Circulatory or
Both

20. Others
• Hypoglycemia
• Poisoning
• Drug Overdose
• Trauma
• Seizures
• Infection
• Shock
• Meningitis
• Encephalitis

21. GCS SCALE LESS THAN OR
EQUAL TO 8 NEEDS
ELECTIVE VENTILATION

22. Exposure
It is the final component of Primary Assessment
Look for –
- Burning
- Bruising
- Joint Laxity
- Fracture

23. Secondary Assessment
S ---- Signs and Symptoms
A ---- Allergies
M ---- Medication
P ---- Past Medical History
L ---- Time of last Meal
E ---- Event leading this situation
History

24. Tertiary Assessment
• Radiography
• Blood Investigation
• ABG
• ECG
• 2D ECHO
• EEG

25. System wise Assessment
• Recognition of Brady Arrhythmia
• Sinus Bradycardia
• Relative Bradycardia
• Clinically significant Bradycardia
• Symptomatic Bradycardia
• Cardiac pacing is required for Refractory
Bradycardia

26. Treat Causative Factor
6 ‘H’
• Hypoxia
• Hypovolemia
• H+
• Hypokalemia
• Hyperkalemia
• Hypothermia
4 ‘T’
• Toxin
• Tamponade
• Tension Pneumothorax
• Trauma

27. History Basis
• Altered Mental Status
• Vomiting
• Respiratory Distress
• Fever
• Abd pain

28. Most Probable Diagnosis
1) Inc. Urination + Recurrent Vomiting + Inc. RBS
DIABETES MELLITUS
2) Billous Vomiting + Abd. Distension
Suggestive INTESTINAL OBSTRUCTION
3) Wheezing after cough or choking in older child
FOREIGN BODY
4) Fever + Involvement of 1 joint + Peudoparalysis
of that joint
SEPTIC JOINT

29. 5) Pain + Stiffness + Swelling + Warmth +
Involvement of Several Joints
JRA
6) Appendicitis < 3 yr, very rare.
7) Continuous Tachycardia + Poor Perfusion
MYOCARDITIS

30. THANK-YOU