Pediatric Early Warning System

and Transport for Sick Children

Reni Wigati
Pediatric Intensivist
Secretary of Scientific Affair –
Indonesian Pediatric Society DKI Jakarta
 Conflict of Interests
• Nothing to declare
 Outlines
• Pediatric Early Warning System
– What is PEWS?
– When and where does PEWS is needed?
– How to do PEWS?
• Transport for Sick Children
– When and why do we refer the patient?
– How do we ideally transport sick children?
 Introduction
Children who are clinically deteriorating
• Timely identification
• Accurate treatment
• Referral system
Decreased
numbers of:
Improving Outcomes - Code blue
- Emergent
intubation
 Failure to Rescue
• Failure to rescue is defined as inability to save
patient’s life by
– Not recognizing deterioritation
– Failing to take action to reverse changes
 Pediatric Early Warning System
• Developed to provide a reproducible
assessment of a child’s clinical status while
hospitalized
• Later studies found that elevated PEW score is
associated with need for ICU admission
directly from ED and as a transfer
Age Respiratory rate Heart rate Systolic BP (mmHg)
Neonate (< 4 weeks) 40-60 120-160 >60
Infant < 1 yo 30-40 110-160 70-90
Toddler 1-2 yo 25-35 100-150 75-95
Preschool 3-4 yo 25-30 95-140 85-100
School 5-11 yo 20-25 80-120 90-110
Adolescent 12-16 yo 15-20 60-100 100-120

APLS, 2007
Pediatric Assessment Triangle
 Appearance
• T – one
• I – nteractability
• C – onsolability
• L – ook/gaze
• S – Speech/cry
 Work of breathing
• Abnormal airway
sound
• Abnormal
positioning
• Retraction
• Flaring
 Circulation
• Pallor
• Mottling
• Cyanosis
 Respiratory Distress Shock

Primary Brain Cardiorespiratory Failure

Dysfunction/Metabolic
Disorder
 Primary Assessment

Airway • Look, listen, and feel

Breathing • Rate according to age, respiratory effort

• Oxygen saturation

Circulation • Heart rate, blood pressure, pulse quality

• Capillary refill time

Disabilty • (A)alert (V)verbal (P)ain (U)unresponsive / GCS

• Brainstem function, motoric assessment

Exposure • Prevent hypothermia

• Rash, hematoma, jaundice
 When Do We Refer?
• Situation: Identify the situation you are calling
about
• Background: Provide pertinent background
information about the situation, diagnosis,
medications, vital signs, lab results, code
status
• Assessment: What is the assessment of the
situation?
• Recommendation: What do you want?
 Where to Refer?
• Intensive care unit
• High care unit
• Intermediate ward
• Ward
• INTRA or INTER-HOSPITAL transport
Transportation of Sick Children
A • Assessment
• Accurate and complete information

C • Control
• Team work and clear job description

C • Communication
• Local team, transportation team, and consulted team

E • Evaluation
• Reconfirmation on the urgency and needs

P • Preparation and packaging

• ABCDEs of the patient and safety of the equipments

T • Transportation
• Air, land, or water transportation
 Transportation Priciples
• Right patient Important notes
• Right time Stabilized the patient
• Right officers BEFORE transporting him
to the referral care
• Right referral
• Right mode of transportation
• Right care during the whole process
 Transportation of Sick Neonates
• S – ugar
• T – emperature
• A – irway
• B – lood pressure
• L – ab work
• E – motional support