Pediatric Emergencies & Assessment

Pediatric Assessment Triangle (PAT)

Structured assessment tool to form a general impression of the infant w/out touching them. Assess appearance, work of breathing, circulation.

LOC, AVPU, interactiveness, muscle tone. Indicates cerebral perfusion and overall function of the CNS

PAT: Appearance

tone, interactiveness, consolability, look/gaze, speech/cry

TICLS (tickles)

• Abnormal airway noise - grunting, wheezing. 

• Accessory muscle use - supraclavicular contractions

• Retractions - intercostal/substernal during inspiration 

• Head bobbing - head lifting, tilting back during inspiration, moving forward during expiration

• Nasal flaring - during inspiration

• Tachypnea

• Tripod position

PAT: work of breathing

• Vasoconstriction - shunts blood from areas of lesser need (skin) to areas of greater need (brain, heart, kidneys)

• Paleness, ashen, gray 

• Mottling - constriction of peripheral blood vessels

• Cyanosis - last sign of respiratory failure/shock.

PAT: circulation

X = exsanguination

A = airway

• Position the airway in a neutral sniffing position - keeps the trachea from kinking and maintains proper alignment. 

B = breathing

• Child becomes tired - retractions become weak, ineffective - accessory muscle use less prominent 

• Bradypnea - impending respiratory arrest

C = circulation

• Tachycardia = early sign of hypoxia or shock

D = disability

E = exposure

XABCDE assessment

• Brachial pulse, femoral pulse

• Children >1 yo, palpate carotid pulse

Where should you feel for a pulse on children?

assess level of pain using pictures of faces

Wong-Baker FACES scale

• Scene is unsafe  

• Significant MOI

• Any fall from a ht equal to or greater than a pediatric pt’s ht

• Bike crash (no helmet)

• Hx of serious illness

• Physical abnormality

• Significant pain

• Abnormal LOC, s/sx of shock. 

Rapid transport scenarios

40 lbs

Children weighing less than_______ that don’t require spinal motion restriction can be transported in a car seat

• BP

• LOC

• Skin - color/temp/moisture

• Cap refill

• Pulse - rate/rhythm/strength

• RR - effort/quality

BLS CPR

2

If the pt is younger than ______ yo, transport them in a rear-facing position

meningitis, encephalitis, intracranial bleeding

Causes for increased intracranial pressure

bruising behind the ear over the mastoid process

Battle sign

3

BP is not assessed in pts <_______ yo. Instead check cap refill (<2 secs)

70 + (2 x child’s age in years) = lowest expected SBP

Formula to determine BP for children 1-10 yo.

3

In infants <_______ yo, record RR by watching the rise and fall of the abdomen

partial upper airway obstruction

Type of obstruction: hoarse voice, decreased or absent breath sounds, stridor

Swelling of the area surrounding the vocal cords in the upper airway

What causes stridor?

Complete airway obstruction

Type of obstruction: absent breath sounds, rapidly cyanotic

ineffective cough, can’t speak/cry, increasing respiratory difficulty (stridor), cyanosis, LOC

Signs of a severe airway obstruction