Transcript Lou Romig MD, FAAP, FACEP Pediatric Emergency Medicine Miami Children’s Hospital Medical Advisor, FL DOH EMS for Children Program.

Lou Romig MD, FAAP, FACEP
Pediatric Emergency Medicine
Miami Children’s Hospital
Medical Advisor, FL DOH EMS for Children Program
Objectives
Recognize how much information
children can give you without
saying a word
Learn the Pediatric Assessment
Triangle and its applications
Goals for the Acute Early
Assessment Phase
Filter and focus
Access knowledge and
experience
Control the emotional environment
Problems with the
Assessment of Children
Physical and cognitive immaturity
Normal vs. abnormal
Dependence on information from
caregivers
Dealing with caregivers
Problems with the
Assessment of Children
They can’t talk to me!
Children speak with their bodies.
We must listen with our eyes.
The Pediatric Assessment Triangle (PAT)
From the AAP’s Pediatric Education for Prehospital Professionals
(PEPP) course. www.PEPPsite.com
The PAT
Quick physiological gestalt
Often best done from a distance
Takes seconds
Can be repeated as needed
Answers two questions
How
sick?
How
quick?
The PAT
General Appearance
Work of Breathing
Circulation to the
Skin
The Pediatric Assessment Triangle (PAT)
General Appearance
T
Tone
I
Interactiveness
C
Consolability
L
Look/gaze
S
Speech/cry
General Appearance
Assesses higher brain function
by looking mostly at interaction
with the environment
Higher brain function depends
on good oxygenation, ventilation
and perfusion to the brain
Don’t be fooled by chronic
features or dramatic physical
findings that don’t affect vital
functions
Good general appearance
Normal to well-compensated
physiology
“Not sick”
“Not quick”
Poor general appearance
Inadequate physiologic
compensation
“Sick!”
“Quick!”
Sick or not sick?
Sick or not sick?
Sick or not sick?
Sick or not sick?
Sick or not sick?
The Pediatric Assessment Triangle (PAT)
Work of Breathing
More important than
respiratory rate
Reflects unique anatomy
Small airways
Weak intercostals
Dependence on
diaphragm
Increased WOB is good
Decreased WOB is bad
The Pediatric Assessment Triangle (PAT)
Circulation to the Skin
Decreased circulation to the skin
is an early sign of compensation
for a circulatory problem in kids
(not always true in adults)
Capillary refill is a good measure
in kids, especially when done in
a serial fashion in a
normothermic environment
You don’t need a blood pressure…
Remember these eyes
Putting the PAT together
Respiratory
A
B
C
Physiologic
Category
Good
Respiratory
Distress
Poor
Respiratory
Failure
Sick?
Circulatory
A
B
C
Physiologic
Category
Good
Nonspecific
Peripheral
Vasoconstriction
Poor
Shock
Sick
?
Central Nervous System
A
Poor
B
Good
C
Physiologic Sick?
Category
CNS
Good
Dysfunction
Seizure/Post-ictal
Intoxication/Drug effect
Meningitis/Encephalitis
Head injury
Metabolic
Chronic disability
The Last Chance
A
B C
Physiologic
Category
Cardiopulmonary
Failure
Sick
?
Hear
here!
Child with a cold and a raised red
rash
Sick?
o Alert
o Interacts with toy
o Good
spontaneous
movement
o Good
coordination and
strength
Another
blotchy
kid
Sick?
Not sick
Mottling
Sick?
Cutis Marmorata
Child with fever and petechiae
Small red dots
Do not blanch
Not palpable
More fever and petechiae
Purpura fulminans:
Meningococcemia
Purpura fulminans:
Meningococcemia
Vomiting and diarrhea x 3 days
Dry, sunken
eyes
Dry oral
membranes
But is he sick?
Vomiting and diarrhea x 3 days
Watching
passively
Since when does
a kid this age stay
still?
Is he sick?
Compare
Which would you treat first?
Before and After
Distress or failure?
Distress or failure?
Respiratory distress
Kussmaul breathing
A known asthmatic
Respiratory distress
Two hours later
Respiratory failure
The Pediatric Assessment Triangle (PAT)
From the AAP’s Pediatric Education for Prehospital Professionals
(PEPP) course. www.PEPPsite.com
Can you hear them now?
[email protected]
www.jumpstarttriage.com