Uploaded byFatima Farid
Pediatric Emergencies Mx Approach
This document provides an overview of pediatric emergency management for respiratory issues. It outlines a systematic PALS approach of initial impression, evaluation, identification, and intervention. Key points include using the pediatric assessment triangle for initial evaluation, performing a primary ABCDE assessment, identifying the type and severity of respiratory distress or failure, and appropriate oxygen therapy interventions like low-flow nasal cannula or high-flow non-rebreathing mask. The focus is on recognizing respiratory emergencies and applying a structured approach to evaluation and treatment as a team.
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Pediatric Emergencies Mx Approach
- 1. Pediatric Emergencies Mx Approach ByFatima Farid Ped Resident Yr 4
- 2. Objectives • Identify childrenthat require immediate intervention • Recognize & differentiate between respiratory distress vs failure • Perform early interventions for respiratory distress & failure • Learn how to apply team dynamics Let’s practice together as a team! 2
- 3. Do you knowhow to identify a sick child? 3
- 4. PALS Systematic Approach Algorithm 1.Initial impression 2. Evaluate 3. Identify 4. Intervene 4 (1) Evaluate (2) Identify (3) Intervene Constantly!! Remember!!
- 5. Initial Impression 5 • Yourfirst QUICK observation of the child’s situation • It is accomplished within the first few seconds of seeing the child
- 6. PAT - Ourtool for initial impression • The pediatric assessment triangle (PAT) is used to: 1. Identify the general type of physiological problem 2. Recognize urgency for treatment & transport • Appearance, breathing & colour are concentrated upon 6
- 7. Appearance - TICLS •Indicates the overall physiologic status • T – tone • I – interactiveness • C – consolability • L – look/ gaze/ stare • S – speech/ cry 7
- 8. Breathing • Position/ posture •Tripod/ sniffing • Work of breathing: • Nasal flaring • Retractions • Use of accessory muscles • Increased, inadequate or absent respiratory effort • Breath sounds: • Wheezing/ stridor/ grunting/ gurgling/ etc 8
- 9. Colour • Helps assessthe overall circulatory status • Expose the child enough to appreciate: • Pallor • Mottling • Cyanosis • Flushing • Bruising • Petechiae/ purpura • Bleeding • Look at the skin and mucus membranes 9
- 10. PALS Systematic Approach Algorithm 1.Initial impression 2. Evaluate 3. Identify 4. Intervene 10 (1) Evaluate (2) Identify (3) Intervene Constantly!! Remember!!
- 11. Evaluate- Identify- Intervene •Evaluate: • Primary assessment • Secondary assessment • Diagnostic assessment • Identify: • Respiratory vs circulatory vs combined • Severity (distress/ failure/ shock/ arrest) • Intervene • Continue sequence after each intervention or change in patient condition 11 (1) Evaluate (2) Identify (3) Intervene
- 12. Evaluate - Primaryassessment (ABCDE) Airway 1. Clear 2. Maintainable 3. Non- maintainable Breathing 1. Rate & pattern 2. Effort 3. Chest expansion & air movement 4. Lung & airway sounds 5. O2 saturation by pulse oximetry Circulation 1. Heart rate & rhythm 2. Pulses (peripheral and central) 3. Capillary refill time 4. Skin colour and temperature 5. Blood pressure Disability 1. AVPU 2. GCS 3. Pupil response to light 4. Blood glucose test Exposure 1. Temperature 2. Trauma 3. Skin rash 4. Extremities 12 (1) Evaluate (2) Identify (3) Intervene
- 13. Evaluate continued Secondary assessment •Focused history: (SAMPLE) • S- Signs and symptoms • A- Allergies • M- Medications • P- Past medical Hx • L- Last meal • E- Event leading up to current situation • Focused physical examination Diagnostics assessments • ABG/ VBG/ CBG • Hemoglobin concentration • Central venous O2 saturation • Arterial lactate • Central venous pressure monitor • Invasive arterial pressure monitor • Chest x- ray • ECG • Echocardiogram • Peak expiratory flow rate 13
- 14. PALS Systematic Approach Algorithm 1.Initial impression 2. Evaluate 3. Identify 4. Intervene 14 (1) Evaluate (2) Identify (3) Intervene Constantly!! Remember!!
- 15. Identify Type Severity Respiratory • Upperairway obstruction • Lower airway obstruction • Lung tissue disease • Disordered control of breathing • Respiratory distress • Respiratory failure Circulatory • Hypovolemic shock • Distributive shock • Cardiogenic shock • Obstructive shock • Compensated shock • Hypotensive shock Cardiopulmonary failure Cardiac arrest 15
- 16. Types of respiratorydisease Type Causes Signs Upper airway obstruction (nose, pharynx, larynx) Foreign body aspiration, anaphylaxis, tonsillar hypertrophy, croup, epiglottitis, pharyngeal/ retropharyngeal/ peritonsillar abscess, tumours, congenital airway anomalies, thick secretions, traumatic intubation sequelae • Increased resp rate & effort • Stridor • Change in voice, cry, cough • Drooling, snoring, gurgling • Poor chest rise • Poor air entry Lower airway obstruction (lower trachea, bronchi, bronchioles) Asthma, bronchiolitis • Increased resp rate & effort • Decreased air entry • Prolonged expiratory phase • Wheezing • Cough Lung tissue disease (parenchyma) Pneumonia, pulmonary edema, lung contusion, allergic rxn, toxin, vasculitis, infiltrative dse • Increased resp rate & effort • Grunting • Crackles • Diminished air entry • Tachycardia • Hypoxemia despite administration of O2 Disordered control of breathing Seizure, CNS infections, head injury, brain tumour, hydrocephalus, neuromuscular dse, metabolic anomalies, drug overdose • Variable/ irregular resp pattern & effort • Shallow breathing with inadequate effort • Central apnea • Normal or decreased air movement 16
- 17. Severity of respiratorydisease 17 • Distress: • Increased respiratory rate, effort and work of breathing • Child is trying to maintain adequate gas exchange despite airway obstruction, reduced lung compliance, or lung tissue disease • As fatigue develops, adequate gas exchange cannot be maintained & respiratory failure ensues
- 18. Severity of respiratorydisease • Failure: • Clinical state of inadequate oxygenation, ventilation or both • Can result from any type of respiratory disease • When respiratory effort is inadequate, failure can occur without typical signs of respiratory distress • Respiratory failure is a clinical state that requires intervention to prevent deterioration to cardiac arrest 18
- 19. Distress vs Failure 19 RespDistress 1. Awake, alert 2. Tachypneic 3. Nasal flaring 4. Chest wall retractions 5. Audible grunting Resp Failure 1. Obtunded 2. Marked tachypnea 3. Abdominal breathing 4. Cyanosed
- 20. PALS Systematic Approach Algorithm 1.Initial impression 2. Evaluate 3. Identify 4. Intervene 20 (1) Evaluate (2) Identify (3) Intervene Constantly!! Remember!!
- 21. Team dynamics –they key to good care 21
- 22. Intervention overview • Varies accordingto the underlying cause • Oxygen therapy is a common factor that should be well- understood for correct administration! 22
- 23. Oxygen therapy Indications Respiratory distress,shock, altered mentation (reduced tissue perfusion & increased body demands) O2 delivery to conscious child Ensure child’s comfort & minimize distress O2 delivery to unconscious child Implement airway protection maneuvers Types of delivery Low- flow modes: • Nasal cannula • Simple oxygen mask High- flow modes: • Non-rebreathing mask with reservoir • High flow nasal cannula 23
- 24. Low- flow modes •Not tight fitting to airway, hence FiO2 is lower & cannot be fully controlled as room air mixes during inhalation • Nasal cannula: • FiO2 22- 60% • Flow 0.25- 4 L/min • Simple face mask: • FiO2 35- 60% • Flow 6- 10 L/min 24
- 25. High- flow modes •Reliably delivery oxygen concentration higher than 60% & flow at minimum 10 L/min • Non- rebreathing mask: • FiO2 up to 95% • Flow 10- 15 L/min • High- flow nasal cannula: • Flow 4- 40 L/min as per child’s need 25
- 26. PALS Systematic Approach Algorithm 1.Initial impression 2. Evaluate 3. Identify 4. Intervene 26 (1) Evaluate (2) Identify (3) Intervene Constantly!! Remember!!
- 27.