Week 12.1 Pediatric Assessment PDF

HEM - 2123 HARMIYA HAKKIM PEDIATRIC ASSESSMENT Sunday, November 17, 2024  WEEK 12.1- PEDIATRIC ASSESSMENT 3...

HEM - 2123 HARMIYA HAKKIM PEDIATRIC ASSESSMENT Sunday, November 17, 2024  WEEK 12.1- PEDIATRIC ASSESSMENT 3 INTRODUCTION Children differ from adults in their anatomy, physiology, and emotions. Your approach to pediatric patients:  Must be based on age  Must accommodate developmental and social issues  WEEK 12.1- PEDIATRIC ASSESSMENT 4 NEONATE & INFANT Neonatal period: First month (Birth up to 28 days) Infancy: first 12 months ( From 1st month till 1 year)  WEEK 12.1- PEDIATRIC ASSESSMENT 5 NEONATE & INFANT During assessment:  Keep child warm.  Support a young infant’s head and neck.  If child is quiet, listen to heart and lungs first.  WEEK 12.1- PEDIATRIC ASSESSMENT 6 TODDLER Age group: 1 to 3 years  WEEK 12.1- PEDIATRIC ASSESSMENT 7 TODDLER  Use the Pediatric Assessment Triangle (PAT) to assess the child.  Strategies for examination:  Examine on parent’s lap.  Get down to the child’s level.  Have a parent assist when possible.  Be flexible.  WEEK 12.1- PEDIATRIC ASSESSMENT 8 PRESCHOOLER  Ages 3 to 5  Becoming verbal and active  Respect modesty.  Let child participate.  Set limits on behavior if the child acts out.  WEEK 12.1- PEDIATRIC ASSESSMENT SCHOOL AGE CHILD 9 (MIDDLE CHILDHOOD)  Ages 6 to 12  Greater understanding may increase fear.  By age 8, anatomy and physiology is similar to adults.  Explain steps in simple language.  WEEK 12.1- PEDIATRIC ASSESSMENT 10 ADOLESCENCE  Ages 13 to 17  With respect to CPR, once secondary sexual characteristics have developed, treat as an adult.  Address and reassure patient.  Offer as much control as appropriate.  WEEK 12.1- PEDIATRIC ASSESSMENT 11 ADOLESCENCE  Ages 13 to 17  With respect to CPR, once secondary sexual characteristics have developed, treat as an adult.  Address and reassure patient.  Offer as much control as appropriate.  WEEK 12.1- PEDIATRIC ASSESSMENT GENERAL PEDIATRIC CONSIDERATIONS  WEEK 12.1- PEDIATRIC ASSESSMENT 13 THE HEAD  Infant’s and young children’s heads are large relative to the rest of their bodies.  Take care when positioning airway.  Cover head to prevent heat loss.  During infancy, the anterior and posterior fontanelles are open.  WEEK 12.1- PEDIATRIC ASSESSMENT 14 THE NECK AND AIRWAY  Short neck, smaller airway  More prone to obstruction  Epiglottis is long and floppy.  Difficult to see vocal cords during intubation  WEEK 12.1- PEDIATRIC ASSESSMENT 15 THE NECK AND AIRWAY  Keep nares clear with suctioning.  Avoid hyperextension of neck.  Keep the airway clear of all secretions.  Use care when managing the airway.  WEEK 12.1- PEDIATRIC ASSESSMENT 16 THE RESPIRATORY SYSTEM  Smaller tidal volume  Double metabolic oxygen demand  Smaller functional residual capacity  Faster breathing  WEEK 12.1- PEDIATRIC ASSESSMENT 17 THE RESPIRATORY SYSTEM  Infants use diaphragm during inspiration.  Experience muscle fatigue quicker  Highly susceptible to hypoxia  Can spiral into cardiovascular collapse  WEEK 12.1- PEDIATRIC ASSESSMENT 18 THE CHEST AND LUNGS  Chest wall is quite thin.  Ribs are more pliable.  Risk of pneumothorax during bag-mask ventilation  Signs are often subtle.  WEEK 12.1- PEDIATRIC ASSESSMENT 19 THE CARDIOVASCULAR SYSTEM Children rely on pulse rate to:  Compensate for decreased oxygenation.  Maintain cardiac output.  WEEK 12.1- PEDIATRIC ASSESSMENT 20 THE CARDIOVASCULAR SYSTEM  Limited but vigorous cardiac reserves  Injured children can be in shock and maintain blood pressure for long periods.  More blood loss before hypotension  Hypotension is an ominous sign.  WEEK 12.1- PEDIATRIC ASSESSMENT 21 THE HEART  ECG: Large right-sided forces are normal in young infants.  Cardiac output is rate dependent in infants and young children.  Mediastinum is more mobile.  High risk of injury to mediastinal organs  WEEK 12.1- PEDIATRIC ASSESSMENT 22 THE NERVOUS SYSTEM  Neural tissue and vasculature are fragile.  Brain, spinal cord is not as well protected  Pediatric brain: nearly twice the blood flow  Makes even minor injuries significant  Increases risk of hypoxia  WEEK 12.1- PEDIATRIC ASSESSMENT 23 THE SPINAL COLUMN  Fulcrum is higher; it descends with age.  Vertebral fractures and spinal cord injuries in young children are uncommon.  With a significant mechanism of injury:  Assume cervical spine injury.  Transport with spinal immobilization.  WEEK 12.1- PEDIATRIC ASSESSMENT 24 THE ABDOMEN & PELVIS  Organs are situated more anteriorly and are relatively large.  Liver and spleen extend below rib cage.  Even seemingly insignificant forces can cause serious internal injury.  WEEK 12.1- PEDIATRIC ASSESSMENT 25 THE MUSCULOSKELETAL SYSTEM  Adult height requires bone growth.  Most growth plates will be closed by late adolescence.  Growth plate fractures can be seen with low-energy MOIs.  Immobilize all sprains or strains.  WEEK 12.1- PEDIATRIC ASSESSMENT 26 THE INTEGUMENTARY SYSTEM  Thinner and more elastic skin  Larger BSA/weight ratio  Less subcutaneous tissue  WEEK 12.1- PEDIATRIC ASSESSMENT 27 METABOLIC DIFFERENCES  Limited stores of glycogen and glucose  Newborns lack the ability to shiver.  Keep warm during transport.  Newborns requiring aggressive resuscitation should not be overly warmed.  WEEK 12.1- PEDIATRIC ASSESSMENT 28 APPROACH TOWARDS PARENTS OF ILL/INJURED CHILDREN  Rapport with parents is critical.  Approach in a calm, professional manner.  Transport with the child.  Remember that your first priority is the child.  WEEK 12.1- PEDIATRIC ASSESSMENT 29 PEDIATRIC PATIENT ASSESSMENT  Differs from adult assessment  Adapt your assessment skills.  Have age-appropriate equipment.  Review age-appropriate vital signs.  WEEK 12.1- PEDIATRIC ASSESSMENT 30 SCENE SIZE-UP  Take appropriate standard precautions.  Note child’s position.  Note pills, medicine bottles, alcohol, drug paraphernalia, or household chemicals.  Do not discount the possibility of abuse.  WEEK 12.1- PEDIATRIC ASSESSMENT 31 PRIMARY ASSESSMENT Use the Pediatric Assessment Triangle to form a general impression. Used with permission of the American Academy of Pediatrics, Pediatric Education for Prehospital Professionals, © American Academy of Pediatrics, 2000  WEEK 12.1- PEDIATRIC ASSESSMENT 32 PRIMARY ASSESSMENT Appearance A child with a grossly abnormal appearance requires immediate life-support interventions and transportation. Used with permission of the American Academy of Pediatrics, Pediatric Education for Prehospital Professionals, © American Academy of Pediatrics, 2000  WEEK 12.1- PEDIATRIC ASSESSMENT 33 PRIMARY ASSESSMENT Work of breathing Reflects attempt to compensate for abnormalities in oxygenation, ventilation Used with permission of the American Academy of Pediatrics, Pediatric Education for Prehospital Professionals, © American Academy of Pediatrics, 2000  WEEK 12.1- PEDIATRIC ASSESSMENT 34 PRIMARY ASSESSMENT Circulation to skin Determine adequacy of cardiac output and core perfusion Used with permission of the American Academy of Pediatrics, Pediatric Education for Prehospital Professionals, © American Academy of Pediatrics, 2000  WEEK 12.1- PEDIATRIC ASSESSMENT 35 PRIMARY ASSESSMENT Stay or go Use findings from PAT to determine whether the patient requires urgent care.  Assess ABCs.  Treat life threats.  Transport. If condition is stable, finish assessment.  WEEK 12.1- PEDIATRIC ASSESSMENT 36 Hands On-ABC  Manage threats to ABCs as you find them.  Steps are the same as with adults.  Estimate child’s weight.  Best method is pediatric resuscitation tape measure.  WEEK 12.1- PEDIATRIC ASSESSMENT 37 Hands On-ABC Airway (A)  Determine whether airway is open and patient has adequate chest rise with breathing.  If there is potential obstruction, position airway and suction as necessary. Breathing(B)  Calculate the respiratory rate.  Auscultate breath sounds.  Check pulse oximetry for oxygen saturation.  WEEK 12.1- PEDIATRIC ASSESSMENT 38 Hands On-ABC Circulation (C)  Integrate information from PAT.  Listen to the heart or feel pulse for 30 seconds.  Double the number to get pulse rate.  After checking the pulse rate, do a hands-on evaluation of skin CTC. Disability (D)  Use the AVPU scale or Pediatric Glasgow Coma Scale to assess level of consciousness.  Assess pupillary response.  Evaluate motor activity.  Assessment of pain must consider age.  WEEK 12.1- PEDIATRIC ASSESSMENT 39 Hands On-ABC  WEEK 12.1- PEDIATRIC ASSESSMENT 40 Hands On-ABC Exposure (E)  Perform a rapid exam of the entire body.  Avoid heat loss, especially in infants.  Cover child as soon as possible.  WEEK 12.1- PEDIATRIC ASSESSMENT 41 TRANSPORT DECISION Transport immediately for trauma with:  Serious MOI  Physiologic abnormality  Significant anatomic abnormality  Unsafe scene Attempt vascular access en route.  WEEK 12.1- PEDIATRIC ASSESSMENT 42 HISTORY TAKING Can conduct en route if condition is unstable. Goals:  Elaborate on chief complaint.  Obtain history.  WEEK 12.1- PEDIATRIC ASSESSMENT 43 SECONDARY ASSESSMENT May include a full-body examination or a focused assessment Head Chest Pupils Back Nose Abdomen Ears Extremities Mouth Capillary refill Neck Level of hydration  WEEK 12.1- PEDIATRIC ASSESSMENT 44 SECONDARY ASSESSMENT  Attempt to take the child’s blood pressure on the upper arm or thigh. Minimal systolic blood pressure = 80 + (2 × age in years)  WEEK 12.1- PEDIATRIC ASSESSMENT 45 REASSESSMENT Includes the following:  PAT  Patient priority  Vital signs  Assessment of interventions  Reassessment of focused areas  WEEK-2.1 ,GYNECOLOGICAL EMERGENCIES 46 [email protected] Thank You