Pediatric Life Support Assessment Quiz

Pediatric Life Support

• Presented by Yasmeen Karam Hosny Ahmed, Lecturer of Pediatrics, Clinical Nutrition Department, Cairo University
• Focuses on primary and secondary assessment of seriously ill children

Primary Assessment

• Identifying seriously ill children is crucial at initial contact with healthcare services
• Triage is a process of determining urgency for patient assessment and treatment based on illness severity, not order of arrival
• Can begin with telephone or online consultation to a national center, or via primary care or ambulance services
• In an emergency department, a brief history and vital signs (temperature, respiratory and heart rate, and oxygen saturation) form the basis of the assessment

Normal Vital Signs

• Table 6.1 provides normal vital signs for different age groups:
  • Newborn (0-1month): Heart rate 100-160 bpm, Respiratory rate 35-60 bpm, Systolic blood pressure 50-70
  • Infant (1-12 months): Heart rate 80-140 bpm, Respiratory rate 30-40 bpm, Systolic blood pressure 70-100
  • Toddler (1-3 years): Heart rate 80-130 bpm, Respiratory rate 20-30 bpm, Systolic blood pressure 70-110
  • Preschool (3-6 years): Heart rate 80-110 bpm, Respiratory rate 20-30 bpm, Systolic blood pressure 80-110
  • School age (6-12 years): Heart rate 70-100 bpm, Respiratory rate 20-25 bpm, Systolic blood pressure 80-120
  • Adolescents (12+ years): Heart rate 60-90 bpm, Respiratory rate 15-20 bpm, Systolic blood pressure 100-120

Structured Clinical Assessment

• The rapid clinical assessment follows an ABCDE approach:

  • Airway and Breathing: Evaluate effort and efficacy of breathing, airway obstruction, and respiratory distress
    • Look, listen, and feel for breathing
    • Respiratory rate, stridor, wheeze
    • Auscultation for air entry, cyanosis, oxygen saturation
  • Circulation: Assess heart rate, pulse volume, capillary refill time, and blood pressure (if indicated)
    • Heart rate
    • Pulse volume
    • Capillary refill time
    • Blood pressure.
  • Disability: Observe level of consciousness, posture, pupil size and reactivity
    • Level of consciousness (e.g., AVPU)
    • Posture (hypotonia, decorticate, decerebrate)
    • Pupil size and reactivity
  • Exposure: Evaluate for fever, rash and bruising.

• Resuscitation (if necessary) includes basic/advanced life support, considering jaw and neck positioning, oxygen, suctioning, chest compressions and monitoring oxygen saturation and heart rate

• Secondary assessment involves a focused survey for key features.

• History from patients, witnesses, general practitioners, paramedics, and police.

• Examination includes evidence of trauma, rash, smell (e.g., ketones, alcohol), scars, and MedicAlert bracelets.

• Investigations include blood glucose.

• Emergency treatment, detailed review and continued stabilization

Emergency Procedures

• Demonstrates head tilt-chin lift technique for infants, small children, and children.
• Explains jaw thrust technique.
• Details how to check for signs of life (pulsation, movement, cough) by palpating the carotid, brachial, or femoral arteries.
• Outlines the AVPU (Alert, Verbal, Pain, Unresponsive) scale for level of consciousness assessment.
• Explains capillary refill time assessment (press on skin, release, measure time for color return).

Basic Life Support (BLS)

• Early recognition and treatment of sudden cardiac arrest improves survival rates for children and adults
• BLS is a systematic approach involving patient assessment, activation of emergency medical services, and initiation of cardiopulmonary resuscitation (CPR)
• Includes adequate ventilation, chest compressions, and defibrillation.
• BLS can be performed by trained lay people or healthcare providers

Detailed BLS

• Explains a step-by-step procedure for performing pediatric BLS, including stimulation, airway opening (head tilt/chin lift or jaw thrust), breathing checks, chest compressions, and circulation checks.
• Emphasizes positioning for chest compressions, varying based on the child’s size (infant, small children, larger children).
• Includes how to use an Ambu bag / bag-mask device for infants and children if necessary.
• Demonstrates how to check breathing (look, listen, feel) for 10 seconds.

CPR Links

• Provides links to YouTube videos demonstrating CPR techniques for children.