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Assessment of Children

in Emergencies

Committee on Pediatric Resuscitation, TheIndonesian Society of Pediatrician


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1. PAT

2. ABCDE


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The PAT

Circulation to Skin


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Appearance

(Tickles =TICLS)

Tonus

InteractivenessConsolability

Look/Gaze

Speech/Cry


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Young infants


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Work of Breathings

Abnormal airwaysounds

Abnormal positioning

Retractions

Nasal flaring


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Applying The PAT forWOB


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Seesaw Respiration


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Respiratory Effort

Retraction The Sniffing Position The Tripod Position


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Pallor

Mottling

Cyanosis

Circulation to Skin

Circulation to Skin


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Respiratory distress

N

N

N o

Cardiopulmonary failure

o/q

Shock

{N

{N

Primary CNS dysfunction/metabolic abnormality

{N

{NN

N

{N


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The ABCDEs

Airway

BreathingCirculation

Disability

Exposure


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Airway AssessmentClear

MaintainableUnmaintainabl

e without

intubationObstructed


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Breathing Assessment

Rate

Effort / mechanics

Air entry

Skin color


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Respiratory Rate by Age

Age

(years)

Respiratory rate

(breaths perminute)

12

30-40

20-30

15-20

12-16


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Retractionand the use ofAccessory Muscle


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Circulation Assessment

Heart rate

Systematic perfusion

Peripheral pulses

Skin perfusion

Appearance

(Urine output)

Blood pressure


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Heart Rate by Age

Age Range

Newborn 3 mos 85 200 bpm

3 mos 2 yrs 100 190 bpm

2 10 yrs 60 140 bpm


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Central & Distal Pulses


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Skin PerfusionExtremity temperature

Capillary refill

Color

Pink

Mottled

Pale

Blue


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Skin Perfusion Examination


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Minimal Systolic Blood

Pressure by AgeAge Fifth percentile

mmHg

Systolic BP

0 1 Mo 60

> 1 mo 1 yr 70

> 1 yr 70 + (2 x age in

years)


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Disability

(neurologic status)

Cerebral cortex

Brain StemMotor activity


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Level ofConsciousness

A = Awake

V = Responsive to voiceP = Responsive to pain

U = Unresponsive


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Brain StemPosture

Central respirationPupil response

Cranial nerve


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MotorActivitySymmetrical movements

SeizuresPosturing

Flaccidity


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Exposure

Skin rashes

BruisesExcoriation

etc.


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Stable

Respiratory dysfunction

Potential respiratory failureProbable respiratory failure

Shock

Compensated

Decompensated


Classification ofPhysiologic

status


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Decompensated Shock


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Definition of Cardiopulmonary Failure

Deficits in

Resulting in

Ventilation

OxygenationPerfusion

Agonal respiration

Bradycardia

Cardiopulmonary arrest


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Begin further workupProvide specific therapy as indicated

Reassess frequently

Priorities in Initial ManagementofStable

Child


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Potential Respiratory Failure Probable Respiratory Failure

Keep with caregiver

Position of comfortOxygen as tolerated

Nothing by mouth

Monitor pulse oximetry

Consider cardiac monitor

Separate from caregiver

Control airway100 % FiO2

Assist ventilation

Nothing by mouth

Monitor pulse oxymetry

Cardiac monitor

Establish vascular access

Priorities in Initial Managementof

Respiratory Dysfunction


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Keepwith

Caregiver!!


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Administer oxygen (FiO2 = 1.0) and ensure

adequate airway and ventilation

Establish vascular accessProvide volume expansion

Monitor oxygenation, heart rate, and urine output

Consider vasoactive infusions

Priorities in Initial

ManagementofShock


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Oxygenate, ventilate, monitor

Reassess forRespiratory failure

Shock

Obtain vascular access

Priorities in Initial Managementof


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