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Critically ill child (1)
This document provides guidance on evaluating an acutely ill child in 3 stages: primary, secondary, and tertiary assessment. The primary assessment involves a rapid visual survey checking general appearance, breathing, and circulation. It also involves assessing the child's airway, breathing, circulation, disability, and exposure. Abnormal signs include respiratory rates, heart rates, blood pressures outside normal ranges. The secondary assessment obtains a history of signs/symptoms, allergies, medications, past medical history, and event details. The tertiary assessment may include radiography, blood tests, ECG, ultrasound and other tests. Common causes of altered consciousness in children include respiratory, circulatory or infectious issues. The most probable diagnoses are discussed based on
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Critically ill child (1)
- 1. EVALUATION OF ACUTELYILL CHILD Dr. Shyam Kartikey Dwivedi Moderator – Dr. Himanshu Dua
- 2. Approach To TheEmergency Evaluation Of A Child • Rapid Visual Survey – A) Gen. Appearance - Color - Tone - Alertness - Responsiveness
- 3. B) Adequacy OfBreathing – - Distinguishing from Normal - Comfortable Respiration - Respiratory Distress - Apnea
- 4. C) Adequacy OfCirculation - 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 AndSymptoms 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 AirwayPatency 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 AS/O SEVERE HYPOXIA
- 12. Assessment of Circulation S/odecreased perfusion and compromised CO 1) Mottling 2) Pallor 3) Increased CRT 4) Cyanosis 5) Poor Pulse 6) Cool Extremities
- 13. TACHYCARDIA IS EARLIEST ANDMOST 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 achild’s Neurologic Function A) Level of Consciousness B) Cortical Function
- 16. QUICKLY CHECK THE PUPILARYRESPONSE TO LIGHT
- 17. AVPU Scale It measuresthe 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 CAUSEFOR 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 LESSTHAN OR EQUAL TO 8 NEEDS ELECTIVE VENTILATION
- 22. Exposure It is thefinal 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 • AlteredMental 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.