Recognition of a Sick Child

DR. RAJESH SHAH

MD IDPCCM PDF
Pediatric Intensive Care
Associate Consultant - Pediatric Liver Transplant Program
Global Hospital, Mumbai
 Background

• Initial Impression

• Primary and Secondary Assessment

• Identification of a problem – type and severity

Sick

Child
Whether child differs from adult ??
 How child differs from adult

Anatomical differences Physiological differences

• Less reserve
• Airway
• Intubation • Low absolute volumes
• High metabolic rate
• Vascular access
• Non specific signs

Early recognition has greater benefits

 AHA PALS Guidelines

Appearance

Breathing Color

Initial Impression

At any point life-threatening problem life saving interventions

 AHA PALS Guidelines

Appearance

Breathing Color

Initial Impression

At any point life-threatening problem life saving interventions

Pediatric Assessment Triangle

Appearance

Breathing Color
 Pediatric Assessment Triangle

Appearance / level of consciousness

 Awake
 Alert
 Crying
 Irritable
 Unresponsive
 Pediatric Assessment Triangle

Breathing

 Comfortable

 Increased work of breathing

 Poor efforts for breathing

 Pediatric Assessment Triangle

Color

 Mottled

 Pale color

 Cyanosed
 Pediatric Assessment Triangle

Appearance

Breathing Color

At any point life-threatening problem life saving interventions

AHA PALS Guidelines
 Primary Assessment

-Airway A B

-Breathing
-Circulation
C
E
-Disability
-Exposure D

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 When you need to secure a Airway

• Unconscious child

• No breathing / Gasping

• Active Seizures

• Respiratory Distress

• Shock

• Foreign Body Aspiration

 Classification of Airway

Clear Position
Maintainable With Position
Simple Measures Suction
Head Tilt
Chin Lift
Jaw Thrust
Not Maintainable Needs an Advanced
Airway
How to secure a Airway

AIRWAY ADJUNCTS
Position
Position
 Suction

• Duration <10s

• Risk of bradycardia, bronchospasm, larngospasm

• Risk of bleeding

• Cessation of oxygenation and ventilation can be

detrimental
Head tilt chin lift or Jaw thrust
 How to assess if airway is cleared ?

• Look – Chest rise

• Listen – Breath sounds

• Feel – Air entering

 Primary Assessment

-Airway A B

-Breathing
-Circulation
C
E
-Disability
-Exposure D

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 Primary Assessment

Breathing

 Respiratory rate
 Efforts / work of breathing
 Chest expansion
 Breath sounds
 Saturation
Tachypnea
 Breathing

Lung
Upper Lower Disordered
Clinical Parenchymal
Airway Airway Control of
Signs Disease
Obstruction Obstruction Breathing

Rate/
Increased Variable
Effort
Normal
Breath Grunting
Stridor Wheezing Air
Sounds Crackles
Movement
Air
Decreased
Movement
 Primary Assessment

-Airway A B

-Breathing
-Circulation
C
E
-Disability
-Exposure D

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 Primary Assessment
Circulation

 Heart rate
 Peripheral and central pulses
 Skin color and temperature
 Capillary refill time
 Blood pressure
 Sensorium
 Urine output
Heart rate
 Assessment of pulse

Central Pulses Peripheral Pulses

Brachial
Femoral Radial
Carotid Dorsalis pedis
Axillary Posterior tibial
 Determines the severity of problem

Age Systolic BP ( 5th centile )

Term neonates (0 to 28 days) <60 mmHg

Infants (1-12 Months) <70 mmHg

Children 1-10 years <70 + (age in years x 2)

Children >10 years <90 mmHg

 Primary Assessment

-Airway A B

-Breathing
-Circulation
C
E
-Disability
-Exposure D

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 Primary Assessment

AVPU Scale

Alert Verbal Pain Unresponsive

 Pupils
 Capillary sugar
 Secondary Assessment
SAMPLE
Signs and Cough, tachypnea, increased
Symptoms respiratory efforts
Fever

Allergies Medication or latex allergies

Medications Last dose and time of medications

Past medical Underlying medical problems, Past

history surgeries, Immunization status

Last meal Time of last intake of liquid or food

Events Events leading to the current illness or

injury, treatment received
 Identify
Type Severity
Upper airway
obstruction

Lower airway
obstruction
Respiratory Respiratory distress
problems Respiratory failure
Lung parenchymal
disease

Disordered control of
breathing

Hypovolemic shock
Circulatory Distributive shock Compensated shock
problems Cardiogenic shock Hypotensive shock
Obstructive shock
 Take home messege
• Children are not miniature adults

• Follow PALS approach

• Early recognition is a key to effective management

• Call for help

Thank You !!