 Recognize signs of respiratory

distress/failure, and shock to provide life

saving interventions
 Learn systematic approach to the pediatric
assessment
 Practice throughout the course – the
foundation for all cases
 Assess-Categorize-Decide-Act
 General Assessment
 Primary, Secondary, Tertiary Assessments
 Life-Threatening Conditions
 Rapid visual & auditory assessment (within
seconds)
 Used in triaging (ETAT) – EPQ
 Sick or Not Sick
 Muscle tone
 Interaction
 Ability to be consoled
 Look/gaze or speech/cry
 Importance of mental status!
 Increased
 nasal flaring, retractions, accessory muscle use
 Decreased or absent respiratory effort
 Abnormal sounds
 wheezing, grunting, stridor
 Abnormal skin color (pallor or mottling)
 Blue/gray skin color: poor perfusion, oxygenation or
both
 Flushed: fever or toxicity

 Diaphroesis/sweating
 Significant distress, cardiac problem,
hyperthermia
 Bleeding
 Cases with normal appearance seem but
potentially life-threatening problem
 Ingestion
 Internalbleeding (temporarily maintain BP by
increasing HR and SVR)
 Rapid, hands-on approach
 Evaluation cardiopulmonary and neurologic
function
 Focused physical exam
 Vital signs & pulse oximetry
ETAT PALS
Airway Airway
Breathing Breathing
Circulation Circulation

Coma Disability

Convulsion
Dehydration Exposure
 Assess patency
 Clear
 Maintainable with simple measures
 Cannot be maintained without advanced
interventions
 Respiratory rate
 Respiratory effort
 Tidal volume
 Airway and lung sounds
 Pulse oximetry
 Rate > 60 is a “red flag”
 Tachypnea
 “Quiet tachypnea” (no distress): high fever, pain, mild
metabolic acidosis associated with dehydration, sepsis
(w/o pneumonia)
 Bradypnea
 Ominous sign; fatigue, CNS injury/infection,
hypothermia, medications
 Apnea – central, obstructive, mixed
 Attempt to improve oxygenation, ventilation
or both
 Nasal flaring
 Chest retractions
 Head bobbing or seesaw respirations
 Observe magnitude of chest wall excursion
 Auscultate for distal air movement
 Minute Ventilation = RR x TV
 Stridor
 Grunting
 Gurgling
 Wheezing
 Crackles
 Percentage of hemoglobin saturated with
oxygen
 Can be misleading
 Poor perfusion
 Does not reflect oxygen delivery
 Anemia
 Cardiovascular function
 Skin
color/temperature, HR, rhythm, BP, pulses
(central & peripheral), CRT
 End-organ function
 Brain perfusion (mental status)
 Skin perfusion
 Renal perfusion (urine output)
 Hypotension (minimum SBP by age)
 Term neonates SBP < 60
 Infants SBP < 70
 1 to 10 y/o < 70 + (age in years x 2)
 Ex. 4 y/o child minimum SBP = 70 + (4x2) = 78
 Older than 10 years < 90
 Sudden & severe cerebral hypoxia
 Lossof muscular tone, generalized seizures,
pupillary dilation, unconsciousness
 Gradual cerebral hypoxia
 Alteredconsciousness with confusion, irritability,
lethargy, agitation
 Drugs
 Metabolic conditions (ammonia)
 Increased intracranial pressure
 Assess cerebral cortex & brainstem
 AVPU
 GCS
 Pupillary light response
 Remove clothing
 Close exam of face, trunk, extremities, skin
 Look for signs of trauma (protect spine)
 Treat hypothermia
Airway Complete or severe airway obstruction

Breathing Apnea, significant work of breathing, bradypnea

Circulation Absence of detectable pulses, poor perfusion,

hypotension, bradycardia

Disability Unreponsiveness, depressed consciousness

Exposure Significant hypothermia, bleeding,

petechiae/purpura (shock), distended abdomen
(acute abdomen)
 Focused medical history
 Whatinformation do you need to help explain
impaired respiratory, cardiovascular or
neurologic function?
 Head-to-toe physical exam
 Signs & Symptoms
 Allergies
 Medications
 Past Medical History
 Last Meal
 Events
 Labs: ABG, VBG, Hemoglobin
 Non-labs: Pulse oximetry, exhaled CO2, Chest
x-ray, echocardiography
 Actions appropriate for clinical condition &
severity
 Calling for help
 Starting CPR
 Obtaining code cart & monitor/defibrillator
 Placing on a monitor & pulse oximetry
 Giving oxygen
 Starting treatments (IV fluid bolus etc)
 Transition of care
 REASSESS
 Afterevery
intervention