Transcript Recognition of the sick child

Assessment in a systematic
way
Dr Anne Ingram
Objectives
 Assessment
tool for rapid, thorough examination of
children
 Give
information required to use UCP and determine
urgency of care
Information from



History
Physiological observations
Examination
Traffic light System: R A G
Common presenting complaints







Fever
Breathing difficulty
Vomiting / Diarrhoea
Rash
Fits
Accidental ingestion / overdose / intoxication
Injuries – Accidental / Non accidental
Comorbidity





Prematurity
Neuromuscular conditions – CP
Immunocompromised
Metabolic conditions / diabetes
Social concerns
Approach







A – Airway
B – Breathing
C – Circulation
D – Disability
E – Exposure
ENT
Tummy
In an unwell/lethargic child
DEFG-don’t Ever Forget Glucose
Airway
Is it patent – talking, crying
Is it obstructed
Is it at risk

 Swollen
lips/tongue
 Burns to face/neck
 Unconscious
 Drooling
 Biphasic stridor
Breathing
Work of Breathing
Rate
Rhythm
Breath sounds/added sounds
Accessory muscle use
Chest recession
Efficacy of breathing
Air entry
Chest movement
Adequacy of ventilation
Tissue oxygenation
Skin colour
Mental status
Cardiac assessment (HR)
Respiratory rate
Varies with age, fever, pain, anxiety and respiratory failure
Normal values
Age (years)
<1
1–2
2–5
5 – 12
> 12
Resps per min
30 - 40
25 - 35
25 - 30
20 - 25
15 - 20
Work of breathing / Respiratory distress
•
Recessions
–
–
–
•
Subcostal
Intercostal
Sternal
- Suprasternal / Tracheal tug
- Supraclavicular
Use of accessory muscles
–
–
–
–
Abdominal breathing
Prominence of sternomastoid
Head bobbing (in babies)
Flaring of nostrils
Noisy breathing




Blocked nose / snuffles
Stridor – inspiratory noise
Wheeze – expiratory noise
Grunting – expiratory, attempt to maintain end
expiratory lung volume
Auscultation

Air entry – is it equal
Wheeze
Crepitations
Transmitted noises
SILENT CHEST

Heart sounds




Oxygen saturations




Pulse oximetry using appropriate probe
Good wave form essential
Saturations >=92% normal
CYANOSIS ONLY APPARENT WHEN SATURATIONS
LESS THAN 85%
Circulation





Heart rate
Capillary refill time
Pulse volume
Peripheral perfusion
Blood pressure
Heart rate
Varies with age, fever, dehydration, anxiety & pain
Normal values
Age (years)
<1
1–2
2–5
5 – 12
> 12
Pulse per min
110 - 160
100 - 150
95 - 140
80 - 120
60 - 100
Capillary refill time
Peripheral vs central
Press for 5 seconds
Time taken for colour to return
Normal <2seconds
Pulse volume
• Comparison of central and
peripheral pulses
Disability
Assesses neurological status
A – Alert
V – responds to Voice
P – responds to Pain (equivalent to 8 on GCS)
U – Unresponsive to any stimulus
 Posture
 Pupils

Exposure



Rash
Bruises
Temperature
ENT Examination



If febrile child or presenting with symptoms alluding
to ENT
Lymphadenopathy
Positioning really important
Tummy(abdomen)





Distension
Tenderness
Masses
Bowel sounds
Hernia sites
Rapid Examination






Airway
Breathing
 RR, WOB, SaO2, auscultation
Circulation
 Colour, HR, CRT, Temp hands and feet
Disability
 Pupils, Limb tone and movement, AVPU
ENT
T – palpation, auscultation
In an unwell/lethargic child DEFG-don’t Ever Forget
Glucose
Red flags in history






High temperature – risk of bacterial infection
Bilious vomiting
Bloody diarrhoea
Rash which does not disappear on tumbler test
Stopped breathing / gone blue
Abnormal movements or behaviour
Red flags on examination







Apnoea
Biphasic stridor
Silent chest
Non blanching rash
Poor perfusion / Thready pulse
Responds to pain only or unresponsive
Any unexplained injuries / bruises
Investigations


Urine analysis
Blood sugar
Any Questions?
Objectives
 Assessment
tool for rapid, thorough examination of
children
 Give
information required to use UCP and determine
urgency of care
Thank you
References:



www.spottingthesickchild.com
Advanced Paediatric Life Support (APLS)
European Paediatric Life Support (EPLS)