1) A 3-year-old boy presents with multisystem trauma after an unrestrained motor vehicle crash. He is unresponsive with a heart rate of 172, respiratory rate below 6, blood pressure of 60 mmHg, and oxygen saturation of 75%.
2) The document outlines the Pediatric Advanced Life Support (PALS) approach for assessing and treating the child, including evaluating airway, breathing, circulation, disability, and exposure (ABCDE). It provides guidance on categorizing respiratory and circulatory issues by severity.
3) The PALS approach is demonstrated through examples of treating arrhythmias, including vagal maneuvers and cardioversion, as well as general life-saving interventions for respiratory or cardiac
Advance life support refer to a constellation of interventions needed to support the vital physiological process during a critical illness, while we await response with definitive therapy. These life support measures are instituted to prevent cardiac arrest.
To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
EVALUATE – IDENTIFY – INTERVENE
The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
Always rule out reversible causes of coma, like hypoglycemia, hyperglycaemia and electrolyte imbalance.
Any severe systemic illness can cause altered consciousness as a result of hypoxic ischemic insult, which if on-going can aggravate raised ICT.
Advance life support refer to a constellation of interventions needed to support the vital physiological process during a critical illness, while we await response with definitive therapy. These life support measures are instituted to prevent cardiac arrest.
To recognise physiological derangements that arise out of multiple etiologies and stabilize them first.
EVALUATE – IDENTIFY – INTERVENE
The steps of evaluation are
1.Initial impression
2. Primary assessment
3. Secondary assessment
4. Diagnostic test
Gives insight to overall physiological status and functioning of the brain.
TICLS
Tone: Look for general posture of the child has adopted
Interactive: Is the child responsive and interacting appropriately, unresponsive or lethargic.
Consolable: Irritable, consolable or inconsolable
Look\Gaze: How is the child looking at mother, any vacant gaze
Speech: Is the child able to speak or vocalise as is appropriate for age or is there a paucity\weak\hoarseness of voice.
IDENTIFY = Abnormality in any of these parameters point towards a brain dysfunction
Impaired consciousness is a significant alteration in the awareness of self and environment with varying degree of wakefulness.
Unconsciousness persisting for at lest 1 hr – Coma.
Younger children more likely to have coma or altered sensorium secondary to non-traumatic etiology, where as traumatic brain injury is more common in older children.
Always rule out reversible causes of coma, like hypoglycemia, hyperglycaemia and electrolyte imbalance.
Any severe systemic illness can cause altered consciousness as a result of hypoxic ischemic insult, which if on-going can aggravate raised ICT.
pediatric assessment in emergency rooms , how to pass the PALS exam , part 1 search for the other 3 parts, for any comment send to sayedahmed 1900@ g mail .com
Pediatrics notes about "The critically ill child". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
pediatric assessment in emergency rooms , how to pass the PALS exam , part 1 search for the other 3 parts, for any comment send to sayedahmed 1900@ g mail .com
Pediatrics notes about "The critically ill child". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
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India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. A 3 year old boy presents with multisystem trauma. The child was
an unrestrained passenger in motor vehicle crash. On assessment
he is unresponsive to voice or painful stimulation.
His vitals : RR < 6 / min, HR – 172 /min , Systolic BP – 60mmHg ,
CRT – 5sec and SpO2 – 75%.
how will approach this child ?
8. PRIMARY ASSESSMENT
AIRWAY •Patent
•Patent with maneuvers / adjuncts
•Partially or completely obstructed
BREATHING •Respiratory rate
•Respiratory effort
•Tidal volume
•Lung sounds
•pulse oximetry
CIRCULATION Evaluate cardiovascular function by assessing
•Skin color and temperature
•Heart rate and rhythm
•Pulses ( both peripheral and central )
•Capillary refill time
•Blood pressure including pulse pressure
Evaluate end organ perfusion by assessing
mental status , Skin color , U.O
DISABILITY Establish child’s level of consciousness by
AVPU pediatric response scale , GCS ,
Pupillary responses
EXPOSURE Fever or hypothermia , Skin findings ,
Evidence of trauma
9. SECONDARY ASSESSMENT
Focused history and physical examination
• Signs & symptoms
• Allergies
• Medications
• Past medical history
• Last meal
• Events leading to current illness
TERTIARY ASSESSMENT
Laboratory , radiographic and other advanced tests to
establish child’s physiological condition and diagnosis.
10. CATEGORIZE THE CLINICAL CONDITION
Respiratory insufficiency Circulatory insufficiency
UA Obstruction
LA Obstruction
Lung Parenchymal disease
Disordered control of
breathing
Hypovolemic shock
Distributive shock
Cardiogenic Shock
Obstructive shock
Respiratory distress
Respiratory failure
Compensated shock
Hypotensive shock
Respiratory + circulatory
Cardiopulmonary failure
Cardiac arrest
Initial
Impression
Severity
Type
10/21/2022 IAP - PALS 2011 MODULE 10
11. RESPIRATORY DISTRESS RESPIRATORY FAILURE
A OPEN AND MAINTAINABLE NOT MAINTAINABLE
B •TACHYPNEA
•INCREASED RESPIRATORY EFFORT
•GOOD AIR MOVEMENT
•BRADYPNEA TO APNEA
•DECREASED RESPIRATORY
EFFORT
•POOR TO ABSENT AIR
MOVEMENT
C TACHYCARDIA
PALLOR
BRADYCARDIA
CYANOSIS
D ANXIETY AND AGITATION LETHARGY TO
UNRESPONSIVENESS
E VARIABLE TEMPERATURE VARIABLE TEMPERATURE
CATEGORIZE RESPIRATORY PROBLEMS BY SEVERITY
12. CLINICAL SIGNS HYPOVOLEMIC
SHOCK
DISTRIBUTIVE
SHOCK
CARDIOGENIC
SHOCK
OBSTRUCTIVE
SHOCK
A PATENCY AIRWAY OPEN AND MAINTAINABLE / NOT MAINTAINABLE
B RESPIRATORY
RATE
INCREASED
RESPIRATORY
EFFORT
NORMAL TO INCREASED LABORED
BREATH
SOUNDS
NORMAL NORMAL
( +/- CRACKLES)
CRACKLES , GRUNTING
C SBP COMPENSATED SHOCK HYPOTENSIVE SHOCK
PULSE PRESSURE NARROW WIDE NARROW
PERIPHERAL
PULSE QUALITY
WEAK BOUNDING OR
WEAK
WEAK
HEART RATE INCREASED
SKIN PALE , COOL WARM OR COOL PALE , COOL
CRT DELAYED VARIABLE DELAYED
URINE OUTPUT DECREASED
D LEVEL OF
CONSCIOUSN
ESS
IRRITABILITY EARLY LETHARGIC LATE
E TEMPERATURE VARIABLE
13. If you see a life threatening condition begin life saving interventions
as follows
• Support ABCs ( CPR for cardiac arrest)
• Provide supplementary 100% oxygen
• Provide assisted venilation e.g bag –mask , ET intubation
• Start cardiac and respiratory monitoring e.g ECG, Pulse oximetry , exhaled
CO2 if inubated
• Establish IV / IO access
• Give a bolus of isotonic crystalloid
• Obtain laboratory studies such as bed side glucose and arterial blood gas
• Administer drugs
• Provide electrical therapy
14.
15. CASE SCENARIO -1
1 year old male child with incessant cry , poor feeding brought to ER.
Identify the rhythm ?
Narrow complex tachycardia with absent P wave
what is the treatment ?
vagal maneuvers / adenosine
if no response to adenosine and child is hypotensive what do want to do ?
synchronised cardioversion ( 0.5-2J/kg) +/- amiodarone
16. Case scenario -2
10 yr old male child – 30kg on ventilator has tachycardia,
hypotension with altered sensorium. Pulses felt.
• Read the ECG.
wide complex tachycardia – monomorphic VT
• Treatment ?
Synchronised cardioversion
17.
18. CASE SCENARIO -3
8 year old child on ventilator with HR – 50/min
Identify the rhythm.
sinus bradycardia
What could be the most common cause?
hypoxia
Treatment ?
rule out DOPE ; provide 100% oxygen.
if associated with signs of poor perfusion:
CPR +/- adrenaline / atropine
19.
20. CASE SCENARIO – 4
An 8 month old infant brought to ER for evaluation of severe diarrhoea. On
examination he is unresponsive, gasping , pulseless and BP not recordable.
Cardiac monitor shows following rhythm.
Identify the rhythm.
ventricular fibrillation
Treatment ?
CPR / Defibrillation +/- epinephrine / amiodarone
21.
22. TAKE HOME MESSAGE
• Systematic approach to pediatric assessment
• Assess , categorize , decide and act
• Effective team dynamics
• Know your roles during resuscitation
• If you recognise life threatening condition begin life saving
interventions
• Search for and treat possible contributing factors during life
threatening situation ( H’s & T’s)
• Follow PALS algorithm based on problem identified
