pediatric pediatrics advanced ,pals.pptx

1. Positions of 6 person high performance teams Team leader Airway monitory Medication Compressor Timer recorder

2. Evaluate : -primary assessment -secondary assessment -Diagnostic assessment Intervene Identify

3. Identify type Severity Respiratory : -upper airway obstruction -lower airway obstruction -lunge tissue diseases Disordered control of breathing -Respiratory distress Respiratory failure Circulatory : -hypovolemic shock -distributive shock -Cardiogenic shock -Obstructive shock -Compensated shock -Hypotensive shock Type and severity of potential problems

4. Intervene May include: -position the child to maintain airway -activating the emergency response -Start CPR -placing the child on a cardiac monitor and pulse oximeter -Administering O2 -Supportive ventilation -starting medications and fluids ( eg.nebulizers treatment ,IV/IO fluids bolus)

5. Evaluate -After each intervention -When the child condition changes or deteriorates

6. Initial impression-pediatric assessment triage (your initial observation) Consciousness Abnormal Tone Abnormal speech \cry Appearance abnormal sounds ,abnormal position ,increase work of breathing ,decrease respiratory effort, retraction ,flaring, apnea or gasping) . Work of breathing cyanosis pallor Dusky mottling) Color of the skin

7. Clinical assessment tools Clinical assessment Brief description Primary assessment ABCDE Secondary assessment A focused history and a focused examination Diagnostic assessment -labs -Radiographs -Or any advanced tests that help to identify the child physiologic condition and diagnosis

8. Primary assessment Assessment: • respiratory rate Chest rise Noisy breathing (grunting ,stridor or wheezing ) Effort and using of accessory muscle (nasal flaring ,head bobbing, retraction, apnea ) pulse oximetry . Intervention: -provide high flow oxygen -Bag mask ventilation -Advanced airway -avoid excessive ventilation Air way • if the air way is patent? Is the air way clear ? If no ,intervene : -Maintain air way patency by position -Suction as indicated -Advanced airway ( e,supraglottic airway or endotracheal tube). - Breathing Assessment Hear rate . Peripheral pulses + central Blood pressure Capillary refill Skin color and temp Interventions: -obtain IV/IO access Consider fluids resuscitation Circulation

9. Assessment : -quickly assess for responsiveness ,level of consciousness pupillary response to light . -AVPU pediatric response scale: Alert, Voice, Pain, Unresponsive. - Presence of hypoglycemia (rapid bedside glucose ) -Glasgow Coma Scale: Eye Opening, Verbal Response, Motor Response . Interventions: -spinal motion restrictions Correct hypoglycemia Consider naloxone for acute opioid toxicity. Disability Exposure Assessment : -remove clothing to perform physical examination (anterior and posterior ) -looking for any signs of trauma ,bleeding ,burns, rashes ,unusual markings, medical alert bracelets . -Temperature . Interventions: -ensure normothermia -control bleeding Decontamination

10. Secondary assessment ●This portion of the evaluation includes a thorough head to toe physical examination, as well as a focused medical history that consists of the "SAMPLE" history: •S: Signs and symptoms •A: Allergies (medication ,foods ,latex, etc ) •M: Medications (over the counter ,vitamins ,inhalers, herbal supplements ,medication that can be found in the child environment ) •P : -health history (premature birth ,previous illnesses ,hospitalization ) -significant underlying medical problems (asthma ,COPD , cong.heart diseases , aarythmia ,congenital airway abnormality, seizures ,head injury ,brain tumores,diabetes,hydrocephalus,neuromuscular diseases) . -past surgeries -immunization status

11. •L: Last meal (time and nature of last intake of liquid or food (including breast feeding or bottle feeding in infant ) time between the last meal and presentation of current illness can affect treatment and management of the condition eg.possible anesthesia ,possible intubation . •E: -Events leading to current illness or injury ( eg . onset sudden or gradual ,type of injury ) -treatment during interval from onset of disease or injury until evaluation .

12. Focused physical examination Head to toe examination Illness Areas to evaluate Respiratory distress -Nose /mouth (signs of obstruction, nasal congestion ,stridor ,mucosal edema ) -Chest/lung -Heart (tachycardia ,gallop ,or murmur) -level of alertness ( eg . anxiety secondary to hypoxia ) Suspected heart failure and /or arrhythmias -Heart (gallop or murmur ) -Lungs (crackles ,SOB ,intolerance of supine position ) -Abdomen( hepatomegaly (RHF) -Extremities (peripheral edema ) Trauma -Abdomen -Chest Some examples of areas to assess during physical examination for certain illnesses and injuries

13. Diagnostic assessment -ABG -VBG -CBG -FBC -central venous O2 saturation -central venous pressure monitoring -invasive arterial pressure monitoring -CXR -ECG -ECHO -PEFR

14. References