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Pediatric Emergency Assessment

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alejandro kitzis

on 16 March 2016

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Transcript of Pediatric Emergency Assessment

Pediatric Emergency Assessment
Pediatric Assessment Triangle
Appearance
Breathing
Circulation
T
one
I
nteractiveness
C
onsolability
L
ook/gaze
S
peech/cry
Initial assessment (ventilation/oxygenation/ brain perfusion)
Easy:
Sick or Not Sick?

Work of Breathing:
Sounds (Grunting,stridor,hot potato voice)
Position (tripod, sniffing)
Retractions (head bobbing)
Flaring

Cyanosis
Pale
Ashen
Mottled
Vital signs





Pulse Oximetry
Look at the kid, not the # (O2 sats may be unreliable)

In a Neonate with respiratory distress:

Check pulse oximetry in right arm (pre-ductal) and either foot (post-ductal)
If O2 sats are different -- consider cardiac causes
Foreign Body Aspiration
Nuts 1/3 of FB aspiration
complete obstruction of airway: hot dogs/grapes/nuts/candies/balloons
Obstruction hx: sudden respiratory distress, followed by inability to speak or cough



If Stable, observe-- but always the
Potential for Decompensation
Conscious Child
Infant: 5 back blows/5 chest thrusts
Child > 1: Heimlich manuever
attempt ventilation
continue while child is conscious

Unconscious Child
Direct laryngoscopy/ Magill
May need succinylcholine
BMV
high pressure
Endotracheal Intubation
Cricothyrotomy
most common cause of upper airway distress/obstruction in children
range 6 months to 6 years, peak at 2
Parainfluenza (>50%), RSV, influenza, rhinovirus
Caused by edema of tissues of
subglottic space


Barky cough, hoarse voice, high-pitched,
inspiratory
stridor
Severe croup is rare--
impending airway obstruction/respiratory failure/ fatigue, hypoxia, AMS, stridor.

Treatment:
O2 to >94%
Nebulized epi (for resting stridor)
Dexamethasone

ETT usually 0.5 to 1mm smaller, cric may be needed
ASTHMA
bronchoconstriction, airway edema, pulmonary secretions

Treatment:
O2 to >94%
Albuterol/ atrovent
Steroids

Severe exacerbations:
Albuterol continuous/Ipratropium
IM or SQ 1:1000 Epi 0.01mg/kg
Consider IV magnesium

Status Asthmaticus/ Imminent Respiratory Failure
somnolence, tiring of breathing muscles, cyanosis, silent chest
impending cardiac arrest:
bradycardia, severe hypoxia and hypercapnia

BRONCHIOLITIS
most common lower respiratory dz in children <2 years
peak age 2-6 months
viral infection: RSV 50-80%

Signs/Symptoms
dry wheezy cough
low grade fever
tachypnea, increased WOB, wheezing
apnea in infants
Severe exacerbations
severe resp distress, AMS, cyanosis, sepsis

Treatment
suctioning
supplemental O2
IV fluids
Albuterol/ epi
studies show no benefit for bronchiolitis--, but sometimes reactive airway component and will respond. Slight benefit with epi in RSV bronchiolitis
Alejandro Kitzis MD
Providence St. Vincent Medical Center

Goals:
1. Learn to identify and describe signs of pediatric respiratory distress

2. Learn to recognize and treat common and life-threatening pediatric respiratory diseases
NPA more trouble in peds
Adapted from
Walls et al.
Manual of
Emergency
Airway Management.
2nd Ed. 2004.

Positioning

2 person better
Click on each video below.
1) Describe the respiratory symptoms that you see.
2)What is the most likely physiological abnormality?
3) What is the urgency for treatment?


grunting--- exhale against a partially closed glottis
trying to increase PEEP
lower respiratory tract disease
Transient Tachypnea of Newborn
head bobbing
seen in respiratory distress-- accessory muscle use
also seen in cardiac patients (Ie. Aortic insufficiency)

severe respiratory distress
retractions: subcostal, intercostal, suprasternal
accessory muscle use (note sternocleidomastoid involvement
Prolonged expiratory phase...Asthma?
well appearing
inspiratory and expiratory stridor
not
wheezes... if you are unsure- listen on the suprasternal area and the noises will be louder than over the lungs
croup
(also always think about foreign body, angioedema)
another croup
upper airway, inspiratory and expiratory stridor
paroxymal coughs
inspiratory whoop
post-tussive emesis
Pertussis
prolonged expiratory phase
subcostal and intercostal retractions
Asthma
tachypneic
subcostal and intercostal retractions
diffuse crackles?
Bronchiolitis
Pulse rate/ respiratory rate:
be wary of bradycardia, bradypnea
#1 Cause of cardiac arrest in kids is respiratory arrest


BP: Kids compensate--> until they don't
can lose up to 30% of total blood and maintain BP
Foreign body maneuvers
croup
Final thoughts
pediatric respiratory distress is scary

recognize signs and symptoms of a sick child

be prepared-- anticipate when they might decompensate and what tx child needs

remember that children are usually easy to bag!

thanks. presentation is available on
prezi.com







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