Week 16 (Pediatric Critical Care)

pt.1

Level 1

Resuscitation

Level 2

Emergent

Level 3

Urgent

Level 4

Less Urgent

Level 5

Non-Urgent

Cardiopulmonary arrest, Major Trauma, Severe Respiratory Distress and seizures

Sample condition of Level 1

Head Injury, Chest pain, stroke, asthma, sexual association injuries and poisoning

Sample Condition of Level 2

Signs of infection, non cardiac chest pain, mild respiratory distress and moderate abdominal pain

Sample Condition of Level 3

Strains and sprains, ear ache, upper respiratory symptoms and mild headache

Sample Condition of Level 4

Menstrual cramps and other minor symptoms

Sample Condition of Level 5

Immediate nursing and medical Attention

Level 1: Resuscitation

Immediate nursing assessments and rapid treatment

Level 2: Emergent

Quick attention but can wait as long as 30 mins for assessment and treatment

Level 3: Urgent

Pt can wait up to 1 hr for assessment and treatment

Level 4: Less Urgent

Pt can wait up to 2 hrs (possibly longer)

Level 5: Non Urgent

Triage

A method of prioritizing patients care according to the type of illness or injury and the urgency of the patient's condition

Glassgow Coma Scale

Baseline of Mental Status

Score of 15

This score indicates that the patient is alert and can follow simple commands

7 or less

Indicates severe neurologic damage

Mental status

This assessment begins when you talk to the patient

Level of Consciousness

A measurement of arousability and responsiveness to stimuli form the environment

GCS: Alert (14-15)

Follo commands and responds completely and appropriately to stimuli

GCS: Lethargic (12-13)

Limited spontaneous moveor speech, easy to arouse by normal speech of touch, possible distortion to time, place or time

GCS: Obtunded (10-11)

Mild to moderate reduction in arousal, limited responsiveness to environment, able to fall asleep easily and answer questions within minimum response

GCS: Stuporous (8-9)

State of deep sleep or unresponsiveness, arousable only to vigorous and repeated stimulation and withdrawal or grabbing response stimulation

GCS: Light Coma (4-7)

+ to all forms of painful stimulation

GCS: Deep Coma (3)

- to all forms of painful stimulation

Cardiopulmonary Resuscitation

Life saving techniques useful in many emergencies including heart attack or near drowning

CPRS

Administered to prolong Ventricular fibrillation which is the abnormal rhythm that causes cardiac arrest

0-4 mins

Brain damage unlikely if CPR started

4-6 mins

Brain damage possible

6-10 mins

Brain damage probable

>10 mins

Severe brain damage or brain death is certain

Foreign body airway obstruction

Electric shock

Drowning

Excessive bleeding

Drug overdose

What are considered signs of major emergencies

Child CPR

Hand position

1-2 hands center of breastbone between nipples

Infant CPR

Hand position

2 finger technique

No

Do we do chest compression if the victim has a pulse?

Heart stop beating

What could happen if we do chest compression when there is a normal circulation?

Rigor mortis, evidence of tissue decomposition, lividity, obvious massive head or trunk trauma which is incompatible with life

When NOT to start CPR

Rigor Mortis

Stiffness of the muscle which sets in after death

Lividity

Purple-reddish color shwoing on parts of body closest to ground

Emergency Cart

Hospital tools that are designed to store and transport critical emergency equipment to be used for pt care

Sharp Container, Sp02 probe, portable monitor/defib, cardiopulmonary resuscitation records, emergency crash cart check sheet, list of cart contents, emergency drug information sheets, cardiac board

Contents of Emergency Cart

Acutely III

These pts gas typically developed life threatening, neurologically and cardio respiratory instability

Chest compression combined with mouth to mouth rescue breathing

What are the elements of CPR