As the leafs start to change color and kids are going back to school, a lot of emergency services agencies usually shift gears back into a :”training mod” (rectification time is coming.) A lot of training is performed from hose testing, to live fire evolutions, and ever changing and progressing emergency medical t training, including pediatric emergencies.
With the start of school pediatric calls start to become prevalent due to team sports children walking to and from school most of the time alone and allergic reactions in the classroom. Thus it is time to get back to basics what do in pediatric emergencies and your initial assessment of a pediatric patient.
Everyone who has been certified in a any CPR class remembers saying “the scene is safe” well with pediatric (with really any patient) it is important to remember your own safety, cause with any pediatric emergency, the care provider will be stressed and that can cause you to act in a way that is not safe and could result in an injury to the provider or worse to both you the provider and the patient.
Once you have made sure the scene is safe, it is time to start your initial assessment. For trauma, the assessment is straightforward, because there is usually a known cause, and the child’s pain or deformity is usually easily identified. The child still requires careful evaluation for less obvious injuries but it is straightforward. For medical issues, the assessment can be much more difficult because of the amount of time that a child can compensate. This is why many providers myself included use something called, the “Pediatric Assessment Triangle” (PAT.) Functionally, the PAT brings together three key features of the overall pediatric assessment that are more accurate for initial assessment than just traditional vital signs:
2) Work of breathing
3) Circulation to the skin
With these three key points it is possible to make an initial decision of what needs to be done and how critical the patient is. Also this assessment can be performed from across a room so when a provider is walking into a call.
Lets dive deeper into the PAT; Appearance reflects the basics of CNS function and oxygenation of the body and brain. There are many components of appearance, but one easy mnemonic that summarizes some of the most important ones is “tickles” (TICLS): Tone, Interact ability, Consolabilty, Look/Gaze, and Speech/Cry.
Work of breathing is easy to assess and is a better assessment tool then just oxygenation than conventional adult measures, such as counting respiratory rate or lung sounds.
The Rapid circulatory assessment is easy and fast to perform the goal of this part of the triangle is to determine if the child is perfusing properly. Now if the child was in shock the body would shunt blood core to keep major organs alive. Thus if the skin is being perfused and there skin is pink then the child is possibly sick but is not a major emergency
This is assessment is fast easy and works, the assessment of pedantic patients is extremely difficult due to how well they compensate and that is the key difference besides size that makes them so much more different then adult patients. With that said, with proper training and exposure to these patients any provider can become comfortable with this type of call.
- Dieckmann RA, Gausche M, Brownstein D: Textbook of Pediatric Education for Prehospital Professionals, Jones and Bartlett, 2005
- Zitelli B, Davis H: Atlas of Pediatric Physical Diagnosis, 4th Edition. Philadelphia, Mosby, 2002
- AnneM,Agur A, Dalley A:Grant’s Atlas of Anatomy,11th Edition, Lippincott Williams & Wilkins, 2004
- Hazinski M, Zaritsky A, Nadkarni Vital: PALS Provider Manual, American Heart Association, 2002
- American Academy of Pediatrics and the American College of Emergency Physicians. Textbook for APLS: The Pediatric Emergency Medicine Resource. 4th ed. Sudbury, MA. Jones and Bartlett Publishers. 2004.
- Ronald Dieckmann, MD, PEDIATRIC EMERGENCIES, UC Regents