Week 16: Pediatric Critical Care

• BASIC PHYSICAL ASSESSMENT: Vital Signs


  • Temperature
  • Pulse
  • Respirations
  • BP
• BASIC PHYSICAL ASSESSMENT: State of comfort


  Location and intensity of pain, response to medications given
• BASIC PHYSICAL ASSESSMENT: Emotional responses


  Patient behavior, general mood
• BASIC PHYSICAL ASSESSMENT : Skin


  • Presence/absence of abrasions
  • Erythema
  • Incision line
  • Turgor
• BASIC PHYSICAL ASSESSMENT: Musculoskeletal


  • Activity level
  • General mobility
  • Gait
  • Range of motion
• BASIC PHYSICAL ASSESSMENT : Neurological


  • Pupil; size, response, equality
  • Sensation to all extremities
  • Ability to follow commands
  • LOC
• BASIC PHYSICAL ASSESSMENT: Respiratory


  • Breath sounds
  • Sputum color and consistency
  • Cough
• BASIC PHYSICAL ASSESSMENT: Cardiovascular


  • Heart sounds
  • Presence of pulses
  • Edema
• BASIC PHYSICAL ASSESSMENT: Gastrointestinal


  • Bowel pattern and sounds
  • Presence of nausea
  • Consumption of diet
• BASIC PHYSICAL ASSESSMENt: Genitourinary


  • Voiding
  • Color
  • Odor
  • Vaginal drainage discomfort
  • Penile discharge
• TRIAGE


  a method of prioritizing patient care according to the type of illness or injury and the urgency of the patient’s condition. It is used to ensure that each patient receives care appropriate to his need and in a timely manner.
• TYPES OF TRIAGE

  • Primary Triage - Detect life-threatening situations 
  • Secondary Triage - Detect and treat non-lif—threatening situation
• Primary Triage: Things that is most likely life threatening if affected; 

  • A - Airway

  • B - Breathing

  • C - Circulation

  • D - Disability

  • E - Electrolyte status
• Triage color coding:

  • Green (Minor)- patient with minor injuries that unlikely to deteriorate over days
  • Yellow (Delayed)- patient with serious or potentially life threatening injuries but not expected to deteriorate over several hours
  • Red (Immediate)- compromised ABC; regular medical intervention within minutes
  • Black (Expectant)- patient is unlikely to survive; provide palliative care only
• METHODS OF TRIAGE

  a.START (Simple Triage and Rapid Transport) - determine which categories the casualty should be assigned

  • JUMPSTART (For pediatric patients, able to walk, breathing, RR, palpable pulse, and age appropriate mental status examination)

  b. SALT (Sort, Assess, Life-Saving interventions, Treatment/Transport)- used to treat all types of patients in all types of incidence

  • Hospital Triage (prioritize the most life-threatening; Black to Green)
• GLASGOW COMA SCALE


  In this test of baseline mental status, a score of 15 indicates that the patient is alert, can the follow simple commands, and is oriented to person, place and time.
• Level of Consciousness: Add all the points collected in Glasgow Coma Scale

  • Alert: 14-15 pts
  • Lethargic: 12-13 pts
  • Obtunded: 10-11 pts
  • Stuporous: 8-9 pts
  • Light coma: 4-7 pts
  • Deep coma: <3 pts
• LEVEL OF CONSCIOUSNESS 


  a measurement of arousability and responsiveness to stimuli from the environment.
• CARDIOPULMONARY RESUSCITATION 


  a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone’s breathing or heartbeat has stopped. Ideally, CPR involves two elements: chest compressions combined with mouth-to-mouth rescue breathing.
• Signs of Major Emergencies needing CPR:

  • Stroke
  • Cardiac Arrest
  • Respiratory Arrest
  • FBAO (foreign body airway obstruction)
  • Electric Shock
  • Drowning
  • Excessive bleeding
  • Drug overdose
• Precautions to remember in order to protect the victim and get the best result from CPR

  1. Do not leave the victim alone

  2. Do not chest compressions if the victim has a pulse

  3. Do not give the victim anything to eat or drink

  4. Avoid moving the victim's head or neck if spinal injury is a possibility

  5. Do not slap the victim's face, or throw water on the face, to try and revive the person

  6. Do not place a pillow under the victim's head
• Administering CPR


  1. Check Responsiveness

  2. Activate EMS system for help

  3. Roll the person onto back

  4. Quick check for pulse

  5. IF NO PULSE DETECTED GIVE CHEST COMPRESSIONS
• CPR 1 : Check Responsiveness


  • If head or neck injury is suspected, move only if absolutely necessary
  • Tap or gently shake victim's shoulder
  • Speak in a loud voice near the victim, "are you ok?"
• CPR 2 : Activate EMS system for help

  1. Ask a bystander to call the local emergency telephone number and ask for him/ her to come back to you

  2. If alone, shout for help. If no one quickly, call the local emergency phone number
• CPR 3 : Roll the person onto back


  Gently roll the victim's head, body and legs over at the same time. Do this without further injuring the victim.
• CPR 4: Quick check for pulse

  • Feel for carotid pulse (within 5-10 seconds). Carotid artery is used because it lies close to the heart and is accessible
  • Do not use your thumb because you may feel your own pulse
  • ADULT: carotid, CHILD (1yr- puberty); Carotid/ Femoral, INFANT: Brachial/Femoral
• DEPTHS OF COMPRESSION IN DOING CPR

  • Adults: 2 inches
  • Child: (1 yr- puberty): approximately 1/3 to 1⁄2 depth of the chest or 1 to 1 1⁄2 inch
  • Infant: approximately 1/3 to 1⁄2 of the depth chest or 1⁄2 to 1 inch
• CPR: How many chest compression in a minute?

  100 to 120 compressions per minute.
• CPR: How many compressions should perform before giving slow breaths?

  Do 30 chest compressions, and give 2 slow breaths afterwards
• CPR: How many slow breaths should be given in a minute?

  a.Give 2 slow breaths (1 second/breath):

  • Adult: 8-10 breaths/min
  • Child (1yr-puberty) & Infants: 12-20 breaths/min
• CPR: How many compressions and slow breaths in 1 cycle?

  • Adult: 30:2 (30 chest compression: 2 slow breaths)
  • Child (1 yr-puberty) & infant: 15:2 (15 chest compression: 2 slow breaths)
• CPR: Complete 5 cycles. If there is still no pulse, restart CPR with chest compressions.
• When to Stop CPR

  • Victim’s revives (regains pulse and breathing). Though most victims also require advanced cardiac procedures before they regain their heart and lung functions.
  • Replaced by either another trained rescuer or EMS system.
  • Too exhausted to continue
  • Scene becomes unsafe
  • A physician tells you to stop
• Do not start CPR when positive signs of death appear such as:

  • Severe injury and/ or decapitation
  • Rigor mortis (stiffness of the muscles which sets in after death)
  • Evidence of tissue decomposition
  • Lividity (purple-reddish color showing on parts of body closest to ground)
  • Obvious massive head or trunk trauma which is incompatible with life (provided the patient does not have vital signs).
• DEFIBRILLATOR USE

  • Shock only when pulseless ventricular tachycardia and ventricular fibrillation is observed
  • DO NOT SHOCK if patient is asystole; administer Epinephrine to jumpstart heart every 3-5 mins 0.01mg/kg (0.1mL/kg of the 0.1mg/ml concentration) max dose is 1mg
  • Amiodarone IV/IO: 5mg/kg bolus during cardiac arrest; may repeat 3x
  • Lidocaine IV/IO: initial dose 1mg/kg loading dose