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Lou Romig MD, FAAP, FACEP Pediatric Emergency Medicine Miami Children’s Hospital

Lou Romig MD, FAAP, FACEP Pediatric Emergency Medicine Miami Children’s Hospital Medical Advisor, FL DOH EMS for Children Program. Objectives. Recognize how much information children can give you without saying a word Learn the Pediatric Assessment Triangle and its applications.

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Lou Romig MD, FAAP, FACEP Pediatric Emergency Medicine Miami Children’s Hospital

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  1. Lou Romig MD, FAAP, FACEP Pediatric Emergency Medicine Miami Children’s Hospital Medical Advisor, FL DOH EMS for Children Program

  2. Objectives • Recognize how much information children can give you without saying a word • Learn the Pediatric Assessment Triangle and its applications

  3. Goals for the Acute Early Assessment Phase • Filter and focus • Access knowledge and experience • Control the emotional environment

  4. Problems with the Assessment of Children • Physical and cognitive immaturity • Normal vs. abnormal • Dependence on information from caregivers • Dealing with caregivers

  5. Problems with the Assessment of Children They can’t talk to me! Children speak with their bodies. We must listen with our eyes.

  6. Work of Breathing General Appearance Circulation to the Skin The Pediatric Assessment Triangle (PAT) From the AAP’s Pediatric Education for Prehospital Professionals (PEPP) course. www.PEPPsite.com

  7. The PAT • Quick physiological gestalt • Often best done from a distance • Takes seconds • Can be repeated as needed • Answers two questions

  8. How quick? How sick?

  9. The PAT General Appearance Work of Breathing Circulation to the Skin

  10. Work of Breathing General Appearance Circulation to the Skin The Pediatric Assessment Triangle (PAT)

  11. General Appearance TTone IInteractiveness CConsolability LLook/gaze SSpeech/cry

  12. General Appearance • Assesses higher brain function by looking mostly at interaction with the environment • Higher brain function depends on good oxygenation, ventilation and perfusion to the brain • Don’t be fooled by chronic features or dramatic physical findings that don’t affect vital functions

  13. Good general appearanceNormal to well-compensated physiology“Not sick”“Not quick”

  14. Poor general appearanceInadequate physiologic compensation“Sick!”“Quick!”

  15. Sick or not sick?

  16. Sick or not sick?

  17. Sick or not sick?

  18. Sick or not sick?

  19. Sick or not sick?

  20. Work of Breathing General Appearance Circulation to the Skin The Pediatric Assessment Triangle (PAT)

  21. Work of Breathing • More important than respiratory rate • Reflects unique anatomy Small airways Weak intercostals Dependence on diaphragm • Increased WOB is good • Decreased WOB is bad

  22. Work of Breathing General Appearance Circulation to the Skin The Pediatric Assessment Triangle (PAT)

  23. Circulation to the Skin • Decreased circulation to the skin is an early sign of compensation for a circulatory problem in kids (not always true in adults) • Capillary refill is a good measure in kids, especially when done in a serial fashion in a normothermic environment

  24. You don’t need a blood pressure…

  25. Remember these eyes

  26. Work of Breathing General Appearance Circulation to the Skin Putting the PAT together

  27. Respiratory

  28. Circulatory

  29. Central Nervous System Seizure/Post-ictal Head injury Intoxication/Drug effect Metabolic Meningitis/Encephalitis Chronic disability

  30. The Last Chance

  31. Hear here!

  32. Child with a cold and a raised red rash Sick?

  33. Alert • Interacts with toy • Good spontaneous movement • Good coordination and strength

  34. Another blotchy kid Sick?

  35. Not sick

  36. Mottling Sick?

  37. Cutis Marmorata

  38. Child with fever and petechiae

  39. Small red dots Do not blanch Not palpable

  40. More fever and petechiae

  41. Purpurafulminans:Meningococcemia

  42. Purpurafulminans:Meningococcemia

  43. Vomiting and diarrhea x 3 days Dry, sunken eyes Dry oral membranes But is he sick?

  44. Vomiting and diarrhea x 3 days Watching passively Since when does a kid this age stay still? Is he sick?

  45. Compare Which would you treat first?

  46. Before and After

  47. Distress or failure?

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