1. Effective pediatric emergency teams have clear roles and responsibilities defined for team leaders and members. Team members should seek assistance early if a patient's condition deteriorates. 2. Team leaders should encourage knowledge sharing and suggest alternative interventions if needed. Team members should suggest changes confidently and question potential mistakes. 3. Teams should continuously evaluate patients after each intervention or if their condition changes, clearly communicating any significant changes.

1. By
DR.NIHAL ABDEEN
PEIDATRIC REISDENT

3. Apply team dynamic
Clear roles and responsibilities -Team leader: Clear define all tem -members roles in clinical setting
.
-Team Members: seek out and perform clearly defined tasks
appropriate to the level of competence
Know your limitation -call for assistance early rather than waiting until patient
deteriorate to the point that help is critical.
-seek advice from more experienced personnel when the patient
condition worsen despite primary treatment.
Construction intervention -team leader: ask that a different intervention be started if has a
higher priority .
Team member: suggest alternative drug or dose in a confident
manner.
-question a colleague who is about to make a mistake .
Knowledge sharing Team leader: Encourage sharing information and ask for suggestions
.
Team member: share information with other team members.
Summarizing and reevaluating Team leader :the patient statue, intervention that have been
performed ,assessment finding .
-Team member: clearly draw attention to significant changes in the
patient condition .

4. Positions of 6 person high
performance teams
Team leader
Airway
monitory
Medication
Compressor
Timer recorder

5. Evaluate :
-primary assessment
-secondary assessment
-Diagnostic assessment
Intervene
Identify

6. Identify
type Severity
Respiratory :
-upper airway obstruction
-lower airway obstruction
-lunge tissue diseases
Disordered control of breathing
-Respiratory distress
Respiratory failure
Circulatory :
-hypovolemic shock
-distributive shock
-Cardiogenic shock
-Obstructive shock
-Compensated shock
-Hypotensive shock
Type and severity of potential problems

7. Intervene
May include:
-position the child to maintain airway
-activating the emergency response
-Start CPR
-placing the child on a cardiac monitor and pulse oximeter
-Administering O2
-Supportive ventilation
-starting medications and fluids (eg.nebulizers treatment
,IV/IO fluids bolus)

8. Evaluate
-After each intervention
-When the child condition
changes or deteriorates

9. Initial impression-pediatric assessment triage
(your initial observation)
• Consciousness
• Abnormal Tone
• Abnormal speech cry
Appearance
• abnormal sounds ,abnormal
position ,increase work of
breathing ,decrease respiratory
effort, retraction ,flaring, apnea
or gasping) .
Work of breathing
• cyanosis
• pallor
• Dusky
• mottling)
Color of the skin

10. Clinical assessment tools
Clinical assessment Brief description
Primary assessment ABCDE
Secondary assessment A focused history and a focused examination
Diagnostic assessment -labs
-Radiographs
-Or any advanced tests that help to identify
the child physiologic condition and diagnosis

11. Primary assessment
Assessment:
• respiratory rate
• Chest rise
• Noisy breathing (grunting
,stridor or wheezing )
• Effort and using of accessory
muscle (nasal flaring ,head
bobbing, retraction, apnea )
• pulse oximetry.
Intervention:
-provide high flow oxygen
-Bag mask ventilation
-Advanced airway
-avoid excessive ventilation
Air way
• if the air way is patent?
• Is the air way clear ?
• If no ,intervene :
-Maintain air way patency by
position
-Suction as indicated
-Advanced airway
(e,supraglottic airway or
endotracheal tube).
-
Breathing
Assessment
• Hear rate .
• Peripheral pulses + central
• Blood pressure
• Capillary refill
• Skin color and temp
Interventions:
-obtain IV/IO access
Consider fluids resuscitation
Circulation

12. Assessment :
-quickly assess for responsiveness ,level of
consciousness pupillary response to light .
-AVPU pediatric response scale: Alert, Voice,
Pain, Unresponsive.
-Presence of hypoglycemia (rapid bedside
glucose )
-Glasgow Coma Scale: Eye Opening, Verbal
Response, Motor Response .
Interventions:
-spinal motion restrictions
Correct hypoglycemia
Consider naloxone for acute opioid toxicity.
Disability Exposure
Assessment :
-remove clothing to perform physical
examination (anterior and posterior )
-looking for any signs of trauma ,bleeding
,burns, rashes ,unusual markings, medical
alert bracelets .
-Temperature .
Interventions:
-ensure normothermia
-control bleeding
Decontamination

13. Secondary assessment
●This portion of the evaluation includes a thorough head to toe physical examination, as well as a
focused medical history that consists of the "SAMPLE" history:
•S: Signs and symptoms
•A: Allergies (medication ,foods ,latex, etc )
•M: Medications (over the counter ,vitamins ,inhalers, herbal supplements ,medication that can
be found in the child environment )
•P: -health history (premature birth ,previous illnesses ,hospitalization )
-significant underlying medical problems (asthma ,COPD ,cong.heart diseases ,aarythmia
,congenital airway abnormality, seizures ,head injury ,brain
tumores,diabetes,hydrocephalus,neuromuscular diseases) .
-past surgeries
-immunization status

14. •L: Last meal (time and nature of last intake of liquid or food (including breast feeding or bottle
feeding in infant )
time between the last meal and presentation of current illness can affect treatment and
management of the condition eg.possible anesthesia ,possible intubation .
•E: -Events leading to current illness or injury (eg. onset sudden or gradual ,type of injury )
-treatment during interval from onset of disease or injury until evaluation .

15. Focused physical
examination
Head to toe examination
Illness Areas to evaluate
Respiratory distress -Nose /mouth (signs of obstruction,
nasal congestion ,stridor ,mucosal
edema )
-Chest/lung
-Heart (tachycardia ,gallop ,or murmur)
-level of alertness (eg. anxiety secondary
to hypoxia )
Suspected heart failure and /or
arrhythmias
-Heart (gallop or murmur )
-Lungs (crackles ,SOB ,intolerance of
supine position )
-Abdomen( hepatomegaly (RHF)
-Extremities (peripheral edema )
Trauma -Abdomen
-Chest
Some examples of areas to assess during physical examination for certain illnesses
and injuries

16. Diagnostic assessment
-ABG
-VBG
-CBG
-FBC
-central venous O2 saturation
-central venous pressure monitoring
-invasive arterial pressure monitoring
-CXR
-ECG
-ECHO
-PEFR

20. References