Pediatric Simulation - Approach to the Critically Ill Child.pdf

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1. Approach to the
Critically Ill Child
Dr. Manal Halwani / Dr. Fahad Mansouri
Assistant Professor of Pediatrics & Pediatric Emergency
Consultant
Department of Emergency Medicine
King Abdulaziz University
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2. OBJECTIVES
•Describe assessment techniques for the critically ill/injured child
•Utilize the appropriate assessment technique to rapidly identify
treatment priorities to prevent progression to cardiac arrest
•Achieve best pediatric care in the critically ill patient
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3. What is PAT?
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4. @KAUEmerg

5. Pediatric Assessment Triangle (PAT)
•Brief visual and auditory assessment of the child’s over all
appearance, work of breathing, and circulation.
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6. Pediatric Assessment Triangle (PAT)
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Consciousness Level of Consciousness
•Unresponsive
•Irritable
•Alert

7. Pediatric Assessment Triangle (PAT)
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Breathing •Increased work of breathing
•absent or deceased respiratory
effort
•abnormal sounds heard without
auscultation

8. Pediatric Assessment Triangle (PAT)
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Color Abnormal skin color
•cyanosis
•pallor
•mottling

9. EVALUATE-IDENTIFY-INTERVENE (EII)
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Evaluate
•Primary assessment
•Secondary assessment
•Diagnostic tests
Identify
Intervene

10. Cardiorespiratory Monitor
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11. PRIMARY ASSESSMENT
•Rapid evaluation of cardiopulmonary and neurological function
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12. PRIMARY ASSESSMENT
Airway
Breathing
Circulation
Disability
Exposure
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13. PRIMARY ASSESSMENT:
AIRWAY
Identification:
•Patent
•Patent with maneuver/ adjuncts
•Partially or completely obstructed
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14. Head Tilt Chin Lift
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15. Jaw Thrust
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16. Airway Adjuncts
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17. Bag Mask Ventilation
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18. PRIMARY ASSESSMENT:
BREATHING
•Respiratory rate
•Effort
•Tidal volume
•Lung sound
•Pulse oximetry
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19. PRIMARY ASSESSMENT:
CIRCULATION
•Skin color and temperature
•Heart rate and rhythm
•Blood pressure
•Pulse (peripheral and central)
•Capillary refill time (normal is <2 seconds)
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20. Capillary Refill Time
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21. PRIMARY ASSESSMENT:
DISABILITY
•AVPU pediatric response scale:
-Alert
-Voice
-Pain
-Unresponsive
•GCS coma scale
•Pupils
•Blood Glucose
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22. Glasgow Coma Scale (GCS)
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GLASGOW COMA SCALE
EYE OPENING (TOTAL POSSIBLE POINTS 4)
Spontaneous 4
To voice 3
To pain 2
None 1
VERBAL RESPONSE (TOTAL POSSIBLE POINTS 5)
OLDER CHILDREN INFANTS AND YOUNG CHILDREN
Oriented 5 Appropriate words; smiles, fixes, and follows 5
Confused 4 Consolable crying 4
Inappropriate 3 Persistently irritable 3
Incomprehensible 2 Restless, agitated 2
None 1 None 1
MOTOR RESPONSE (TOTAL POSSIBLE POINTS 6)
Obeys 6
Localizes pain 5
Withdraws 4
Flexion 3
Extension 2
None 1

23. PRIMARY ASSESSMENT:
EXPOSURE
•Weight
•Fever or hypothermia
•Skin findings
•Evidence of trauma
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24. SECONDARY ASSESSMENT
•History assessment: S A M P L E
•Physical examination: head to toe
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25. SECONDARY ASSESSMENT:
SAMPLE
•S: Signs and symptoms
•A: Allergies
•M: Medications
•P: Past medical history
•L: :Last meal
•E: Events leading up to the current illness
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26. TERTIARY ASSESSMENT:
DIAGNOSTIC TESTS
ABG
VBG
HgB
Central venous O
2saturation
Arterial lactate
Central venous pressure monitoring
Invasive arterial pressure monitoring
Chest X-ray
ECG
Echocardiography
Peak expiratory flow rate
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27. EVALUATE
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Clinical
Assessment
Brief Description
Primary
assessment
A rapid, hands-on ABCDE approach to
evaluate respiratory, cardiac and neurologic
function; this step includes assessment of vital
signs and pulse oximetry
Secondary A focused medical history and a focused
physical examination
Diagnostic
Test
Laboratory, radiological and other advanced
tests that help to identify the child’s physiologic
condition and diagnosis

28. IDENTIFY
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Type Severity
Respiratory •Upper airway obstruction
•Lower airway obstruction
•Ling tissue disease
•Disordered control of
breathing
•Respiratory distress
•Respiratory failure
Circulatory •Hypovolemic shock
•Distributive shock
•Cardiogenic shock
•Obstructive shock
•Compensated shock
•Hypotensive shock
Cardiopulmonary failure Cardiac arrest

29. INTERVENE
On the basis of identification of the child’s problem, intervene with the
appropriate action:
•Positioning the child to maintain a patent airway
•Activating emergency response
•Starting CPR
•Obtaining the code cart and monitor
•Placing the child on a cardiac monitor and pulse oximeter
•Supporting ventilation
•Starting medications and fluids
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30. EQUIPMENT IN PEDIATRIC ER
Non-Rebreather Mask
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31. EQUIPMENT IN PEDIATRIC ER
Oxygen Device Face Mask
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32. EQUIPMENT IN PEDIATRIC ER
Nasal Prongs
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33. EQUIPMENT IN PEDIATRIC ER
Nebulizer
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34. EQUIPMENT IN PEDIATRIC ER
Endotracheal Tube (ETT)
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35. EQUIPMENT IN PEDIATRIC ER
Laryngeal Mask Airway (LMA)
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36. EQUIPMENT IN PEDIATRIC ER
Laryngoscope
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37. EQUIPMENT IN PEDIATRIC ER
Glidescope
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38. EQUIPMENT IN PEDIATRIC ER
Aero Chamber
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39. EQUIPMENT IN PEDIATRIC ER
Fluids
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40. Fiction Contract & Confidentiality
•What happens in SIM stays in SIM
•We believe that everyone participating in this simulation scenario is
intelligent, capable, cares about doing their best, and wants to
improve
•This is not an assessment
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41. KAUEmerg

42. KAUEmerg