peds : criticaly ill child *

What are the 3 components of the Pediatric Assessment Triangle?

Appearance, Work of Breathing, Circulation to Skin.

What acronym is used to assess "Appearance" in PAT?

TICLS: Tone, Irritability, Consolability, Look (gaze), Speech/cry.

What does abnormal "Tone" indicate in PAT?

Limp, rigid, or absent muscle tone → suggests abnormal appearance.

What is the normal finding for "Tone" in PAT?

Good muscle tone with good movement of extremities; infants resist limb straightening.

What does abnormal "Irritability" indicate in PAT?

Absent/abnormal cry, cannot be stimulated to cry → possible altered mental status or airway obstruction.

What is the normal finding for "Irritability" in PAT?

Strong, normal cry (indicates clear airway).

What does abnormal "Consolability" indicate in PAT?

Child cannot be comforted by caregivers or fails to respond normally to stimuli.

What is the normal finding for "Consolability" in PAT?

Child is comforted by usual caregivers and responds normally to environment.

What does abnormal "Look (gaze)" indicate in PAT?

Vacant stare, lack of eye contact, failure to recognize caregivers.

What is the normal finding for "Look (gaze)" in PAT?

Makes eye contact with caregivers.

What does abnormal "Speech/cry" indicate in PAT?

Absent or abnormal speech/cry → may What does abnormal "Speech/cry" indicate in PAT?; Absent or abnormal for age → may indicate airway obstruction or altered mental status.

What is the normal finding for "Speech/cry" in PAT?

Age-appropriate speech or strong, normal cry (reliable sign of clear airway).

What does "Work of Breathing" assess in PAT?

Respiratory effort and visible signs of respiratory distress.

What are normal findings for "Work of Breathing"?

Breathing is noiseless, effortless, and painless.

What do abnormal findings in "Work of Breathing" indicate?

Increased, decreased, or absent respiratory effort.

What are signs of increased work of breathing?

Noisy breathing, retractions, accessory muscle use, nasal flaring, seesaw breathing in infants.

What are signs of decreased work of breathing?

Bradypnea or weakness too severe to use breathing muscles.

What does "Circulation to Skin" assess in PAT?

Skin color, capillary refill, and obvious bleeding as indicators of perfusion.

What are normal findings for circulation to skin?

Usual skin color, no obvious bleeding, capillary refill <2 seconds.

What abnormal findings suggest impaired circulation to skin?

Pallor, cyanosis, mottling, or obvious blood loss.

Does PAT use a scoring system?

No, it is a rapid assessment tool without numerical scores.

What condition is suggested by increased work of breathing with normal appearance and circulation?

Respiratory distress.

What condition is suggested by increased work of breathing with abnormal appearance or circulation?

Respiratory failure.

What condition is suggested by abnormal appearance and abnormal circulation?

Shock.

What condition is suggested by abnormal appearance, abnormal breathing, and abnormal circulation?

Child is in extremis (e.g., imminent collapse).

What step follows the Pediatric Assessment Triangle?

Primary survey, then secondary survey.

In the primary survey, what is the first assessment?

Airway.

What questions are asked in airway assessment?

Is airway patent? Can child ventilate/oxygenate with positioning? Any abnormal airway sounds or signs of obstruction?

Why is airway management crucial in children?

Respiratory failure is the most frequent cause of cardiac arrest in children.

What are initial interventions for an obstructed or compromised airway?

Airway adjunct insertion (oropharyngeal/nasopharyngeal) or tracheal intubation.

What is assessed under "Breathing" in primary survey?

Signs of hypoxia, respiratory effort, chest movement, tidal volume, symmetry, and respiratory rate.

What respiratory rate is always abnormal in children?

>60 breaths/minute.

What does bradypnea in a child indicate?

Severe fatigue, impending respiratory failure, worsening hypoxia.

What is the goal of "Circulation" in the primary survey?

Assess cardiovascular function, tissue perfusion, and organ perfusion.

What is an early sign of hypoxia or poor perfusion?

Tachycardia.

What circulation findings suggest inadequate cardiac output?

Prolonged capillary refill (>2 sec), abnormal skin color, hypotension.

What is the normal capillary refill time in children?

<2 seconds after pressing skin for 5 seconds.

What challenge is often faced in pediatric circulation assessment?

Obtaining venous access.

What does "Disability" assess in the primary survey?

Neurological function and level of consciousness.

What scale is used for rapid neurological assessment in children?

AVPU: Alert, responds to Verbal, responds to Pain, Unresponsive.

What is the more detailed neurological scale used in children?

Pediatric Glasgow Coma Scale (PGCS).

What does the Pediatric GCS evaluate?

Eye response, verbal response, motor response.

What does "Exposure" mean in pediatric primary survey?

Fully exposing the child to detect hidden injuries, rashes, bleeding, or infection signs.

What is an example of a finding revealed by exposure?

Meningococcal septicemia rash.

What follows the primary survey and resuscitation if needed?

Secondary survey with focused history and physical exam