ETAT for pediatric nursing students.pptx

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1. 8/31/2023 By Bogale C. 1 E mergency T riage A ssessment and Treatment (ETAT)

2. Objectives 8/31/2023 By Bogale C. 2 At the end of the discussion you are expected to Triage all sick children into Emergency P riority Q ueue cases (non urgent) cases Assess a child based on ABCD of life

3. Introduction 8/31/2023 By Bogale C. 3 Triage is the process of rapidly examining all sick children when they first arrive in health facility in order to place them in one of the following categories based on their need and resources available: Emergency signs Priority signs and Queue (non-urgent) signs. Deaths in hospital often occur within 24 hours of admission which can be prevented if triage is applied properly .

4. Intro… 8/31/2023 By Bogale C. 4 Using the ETAT guideline allows for the immediate identification of children with life-threatening conditions such as Obstruction of the airway, Breathing problems, Circulatory emergencies (shock, dehydration), and Neurologic emergencies (coma, convulsions )

5. 8/31/2023 By Bogale C. 5 Patients with Emergency signs require immediate emergency treatment with the following actions. Start to give appropriate emergency treatment Call for help from a senior or other health workers Carry out emergency laboratory investigations. Patients with Priority signs should be given priority in the queue, so that they can rapidly be assessed and treated without delay Patients who have no emergency or priority signs can wait their turn in the queue for assessment and treatment .

6. Emergency Signs 8/31/2023 By Bogale C. 6 Emergency signs can be remembered with the acronym “ABCDO” A: Airway problem B: Breathing problem C: Circulation or shock Cm: Coma or Unconscious Cn: Convulsion D: Dehydration, Severe Ds: Disability O: Bleeding child, poisoning (immediate) open fracture

7. Priority signs Priority signs can be remembered with the symbols 3 TPR - MOB: 8/31/2023 By Bogale C. 7 T iny baby : (≤ 2 months) T emperature : Very hot or very cold T rauma or other urgent surgical condition P allor (severe) P oisoning (other than emergency ones) P ain (severe) R espiratory distress R estless , continuously irritable, or lethargic R eferral (urgent) M alnutrition : Visible severe wasting O edema of both feet B urns

8. Airway and Breathing 8/31/2023 By Bogale C. 8 The letters A and B in “ABCDO” represent “airway and breathing”. An airway or breathing problem is life-threatening. Common causes of airway obstructions Excessive secretions Anatomic obstruction (e.g. tongue fall) Foreign body Upper airway infections Anaphylaxis Injuries (burn, trauma)

9. 8/31/2023 By Bogale C. 9 Signs of airway or breathing problem Abnormal respiratory sounds Lack of breath sounds despite respiratory effort (i.e. complete airway obstruction) Increased inspiratory effort with retraction and central cyanosis (severe respiratory distress)

10. 8/31/2023 By Bogale C. 10 Assessment of an obstructed Airway LOOK Is the chest moving? LISTEN Listen for any breath sounds. FEEL Can you feel the movement of air through nose or mouth ?

11. 8/31/2023 By Bogale C. 11 1. Simple techniques to open the airway Head tilt–chin lift for non-trauma patients or jaw trust for trauma or suspected trauma patients Clear the airway by suctioning the mouth and nose Perform techniques to remove foreign body obstructing the airway

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14. 8/31/2023 By Bogale C. 14 2. Advanced intervention to open the airway This will be done in a setting where experts are available Endotracheal intubation Removal of foreign body with direct visualization by laryngoscope Application of positive airway pressure (CPAP)

15. 8/31/2023 By Bogale C. 15 Management of breathing problem Bag mask ventilation Give oxygen by different ways depending on the child condition.

16. Proper Bag and Mask ventilation 8/31/2023 By Bogale C. 16

17. Sources of oxygen and Delivery 8/31/2023 By Bogale C. 17

18. Circulation 8/31/2023 By Bogale C. 18 The letter C in “ABCDO” stands for Circulation (shock); coma ; and Convulsions . These assessments will be done if The assessment of airway and breathing was normal or After emergency treatments have been given for any airway or breathing problems. Common causes of shock are Fluid loss-due to severe diarrhea or vomiting, Bleeding and Capillary leak (sepsis or burn)

19. 8/31/2023 By Bogale C. 19 Assess shock using those questions. Does the child have warm hands? If not, is the capillary refill time ≥ 3 seconds? And is the pulse weak and fast? BP???

20. 8/31/2023 By Bogale C. 20 Treatment of shock Treatment of shock requires teamwork. If the child has any bleeding, stop the bleeding Give oxygen Make sure the child is warm Select an appropriate site for administration of fluids Establish IV or intraosseous access Take blood samples for emergency laboratory tests Begin giving fluids for shock . Before giving the IV fluids, check for severe malnutrition (Visible severe wasting or pitting edema)

21. 8/31/2023 By Bogale C. 21 If the patient has no severe acute malnutrition Infuse 20 ml/kg NS or RL as rapidly as possible Assess for improvement: warmer hands, pulse slows and capillary refill faster. If no improvement: repeat the bolus for 3 times or more depending on the underlying cause. Consider blood transfusion , unless there is profuse watery diarrhea.

22. 8/31/2023 By Bogale C. 22 If the patient has Severe Acute Malnutrition Give IV Fluid 15ml/kg RL or NS with 5% glucose over 1hr (if available use half strength Darrow solution with D5W) Assess every 5-10 min and discontinue if any evidence of congestion If there is improvement repeat 15ml/kg over 1hr, then change the IV fluid with oral Resomal. If there is NO improvement give IV fluid 4ml/kg/hour while waiting for blood transfusion.

23. Coma and convulsion 8/31/2023 By Bogale C. 23 Initial assessment of level of consciousness should be done by AVPU , using Glasgow Coma Scale (GCS) is time taking. A …Is the child Alert? If not, V …Is the child responding to Voice? If not, P …Is the child responding to Pain? U … The child who is Unresponsive to Voice (or being shaken) and to pain is Unconscious. A child who is not alert, but responds to voice, is lethargic. A child with a coma scale of “P” or “U” will receive emergency treatment

24. 8/31/2023 By Bogale C. 24 GCS can be used for follow up of the child’s progress.

25. 8/31/2023 By Bogale C. 25 Treatment of coma and convulsion Give 5 ml/kg of 10% glucose IV, repeat if needed. When the blood glucose cannot be measured, hypoglycemia should be assumed and treated in all convulsing or comatous children. Feed the child as soon as conscious or put on MF.

26. 8/31/2023 By Bogale C. 26 Any unconscious child who is breathing and keeping the airway open should be placed in the recovery position to avoid aspiration.

27. 8/31/2023 By Bogale C. 27 If the child is having a convulsion, do not attempt to hold him/her down or put anything in the child’s mouth Diazepam is the first drug to stop convulsions that can be given by the rectal or intravenous route. Rectal dose: 0.5mg/kg (0.1 ml/kg) IV dose: 0.25mg/kg (0.05 ml/kg) Repeat dose can be given every 5-10 minutes, three times After the third dose consider giving phenytoin 20mg/kg IV/PO loading dose followed by maintenance dose. Phenobarbital is the drug of choice in infants <2 weeks of age o if phenytoin is not available

28. 8/31/2023 By Bogale C. 28 Diazepam and phenobarbital can affect the child’s breathing, so it is important to reassess the airway and breathing regularly and a bag and mask should be ready. Sponge the child with room-temperature water to reduce the fever. Do not give oral medication until the convulsion has been controlled (danger of aspiration)

29. Dehydration (severe) 8/31/2023 By Bogale C. 29 The letter D in the “ABCDO” stands for Dehydration. Severe dehydration can be assessed in patients with diarrhea using Is the child lethargic? Does the child have sunken eyes? Is the child unable to drink? Does a skin pinch take longer than 2 seconds to go back?

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31. 8/31/2023 By Bogale C. 31 If severe dehydration with no severe acute malnutrition Give Ringer's lactate 100ml/kg For infants: 30 ml/kg in the first hour 70 ml/kg in the next 5 hours For children( >1yr) 30 ml/kg in the first 30 min 70 ml/kg in the next two and half hours Assess the child every 1-2 hours and if not improving give fluid more rapidly. As soon as child can drink: add ORS 5 ml/kg/hr

32. 8/31/2023 By Bogale C. 32 Dehydration with severe acute malnutrition Do not give IV fluids For all children: Give ReSoMal 5ml/kg every 30 minutes for the first 2 hrs Then 5-10ml/kg/hour for the next 4-10 hours Give more ReSoMal if child wants more or has loss Check blood glucose and Treat if <54mg/dl

33. 8/31/2023 By Bogale C. 33 Thank you!!!