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Pediatrics Assessment

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كلي مالحظاتصحنه ديدن با توان مي را بيمار اوليه ارزيابي بخشهاي از بسياري

كه . داد انجام در حادثه جلوي . معاينه شود مي ناميده

بيماري به ماهيت و آسيب انتخاب مكانيسم در كه چرا كنيد توجهاست . كننده كمك مناسب اقدامات

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كلي مالحظات محيطي ساز خطر نفتي،: – عوامل بخاري حفاظ بدون پلكان

... و دارو شیشه

تروما احتمالي كودك: – علل با رفتاري بد تصادف

كنيد صحبت . آرام . كنيد جلب را اعتمادش و بگيريد قرار كودك بينايي ميدان در به اقدام وضعيت بهترين از شما درك و بيمار شرايط

دارد . بستگي

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تنفس

ارزیابی مثلث

ظاهر بیمار

گردشخون

فوری ارزیابیاولیه

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كودكان ارزيابي مثلثبيمار : تون – ظاهر هوشياري

اي ماهيچهتالشتنفسي تنفس : و سرعت

پوست – گردشخون : رنگمويرگي برگشت

وضعيت بررسي برايتكان را كودك هرگز هوشياري

.ندهيد

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Observe Mental Status Is the child alert? Immediate response to parents?

Alert = Non-urgentOther than alert = Urgent

Rapid First Impression: Appearance

Normal for age= Non-urgent

Examples: Young infants lying with flexed arms and legs, Older children sitting comfortably

Anything else (floppy, stiff, unable to sit) = urgent

Observe muscle tone and body position

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Observe and listenIs there visible movement of the chest or abdomen?

Are there audible sounds associated with breathing?

Does the child appear to be making extra effort in order to move air in or out?

Rapid First Breathing

The chest wall moves without extra effort and without audible sounds= Non-Urgent

Chest wall moves with extra effort or audible sounds = Urgent

No chest wall movement = Urgent

درد بيمار 2 ترسو تنفسي تالش توانند مي كه هستند عامليدهند . افزايش را

از ناشي پنه :تاكي ترس ناكافي اكسيژناسيون معرضسرما در گرفتن قرار نوزادان باشد .در

در ديسترستنفسي تظاهر اولين معموًال< پنه تاكياست .شيرخوران

از ناشي است تنفسممكن كاهشسرعتندهد . نشان را بيمار بهبود و باشد بيمار خستگي

بيني هاي پره لرزيدن كودكان درتنفسي تالش نشانه نيز تنفس فرعي عضالت از استفاده

است .

خون گردش

مویرگی رنگ پرشدگی و عالیم

Rapid First :Circulation

Observe the skin color to evaluate the circulation.In children with dark skin look at the lips, tongue, palms or soles.

Pink = Non-urgent

Pale, bluish or mottled color = Urgent

نارسايي در ديررس P نسبتا هاي ازنشانه يكي سيانوزاست تنفسي

شود . مي ديده مخاطي غشاي و ناخن بستر در كه

گردش نارسايي از ناشي ممكن تنهايي به انتها سيانوزباشد . خون

مويرگ مجدد شدن پر كودكان در كه است در بهترپيشاني يا استرنوم نظير مركزي بررسي نواحي را

كنيد.

ديسترس دچار كودك يا شيرخوار در كاردي براديايست بودن الوقوع قريب و هيپوكسي نشانه

. است قلبي

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است . • شوم اي نشانه مركزي نبض رفتنن بين ازمغز – • و ها كليه پوست در گردشخون

. مشخصاست كامال

بيشاز مويرگي مجدد پرشدگي 2زمانقلبي ثانيه ده برون بودن پايين نشانه

.است

ادرار طبيعي سيسي / / مقدار كيلو 1-2ساعتباشد . مي

از كمتر ادرار سيسي / / جريان كيلو 1ساعتكليه كار خونرساني كفايت عدم دهنده نشان

.است .

A child with an urgent condition requires immediate intervention to support

Airway, Breathing or Circulation, , Mental status Immediate intervention

AND Rapid transport are the priority.

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Initial Assessment - Airway

Assessment of the airway is done for two reasons:– To assure that the airway is open (patent)

– To detect and prevent obstructions that can compromise the airway

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Initial Assessment - Airway

• Begin by assuring airway patency:

Is the child effectively moving air?

– Is the child able to speak or cry vigorously?– Ask the parent to lift the child’s shirt.– Look for signs of airway obstruction.– Observe movement of the chest or

abdomen.

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Initial Assessment - Airway

Listen for sounds that indicate airway obstruction or excessive secretions

Stridor: A high or low pitched sound that occurs when the child breathes in.Indicates partial obstruction of the upper

airway Foreign body? Swelling (from disease, poison, etc.)?

If FBAO is suspected, follow guidelines and

transport rapidly.

Provide high concentration oxygen by mask

or blow by oxygen tubing

If airway swelling is suspected, keep the child in the position most comfortable for breathing.

Do not separate from parent or agitate the child

Provide high concentration oxygen

DO NOT examine or insert anything into the oropharynx.

Another sound associated with airway compromise is gurgling, a bubbling sound that indicates excessive secretions.

Provide high concentration oxygen

Position child to maximize drainage from mouth.

Be prepared to suction and ventilate with a bag-valve-mask if mental status deteriorates.

Following the airway assessment and interventions, breathing is assessed.

Is the child breathing adequately?Look for Movement of chest Extra effort used to breathe Skin tonesListen for lung sounds

Count respirations

Initial Assessment-Breathing

Is the chest rising equally on both sides?

The chest should move smoothly with no noticeable difference from left to right.

The depth and rhythm of chest movementshould be regular.

Initial Assessment-Breathing

Look for signs of extra effort:

Retractions -The skin appears to pull in above the sternum or clavicles and/or between or below the ribs.

Head bobbing -The head draws back during inspiration and falls forward during expiration.

Nasal flaring - is seen in infants and toddlers. As the child breathes out, the nostrils widen.

Wheezing is a whistling sound heard in the chest.

Wheezes are caused by air moving through narrowed lower airway passages.

Mucous plugs can cause wheezes.

Spasms of bronchi or bronchioles can cause wheezes.

Wheezes are usually heard on expiration.Wheezes may be audible without a stethoscope.

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Crackles are sounds heard when fluid is present in the alveoli.

Grunting is a sound heard at the end of expiration.

Grunting sounds like a rhythmic whining.

A child who is grunting uses chest, neck and head together to aid breathing.

When EMTs encounter a child who is grunting, they should immediately consider the child’s condition urgent and begin transport without delay.

Provide high concentration oxygen by mask.

Be prepared to assist ventilations with a bag-valve-mask.

Is the rate of breathing adequate?

Count the respirations for 30 seconds and double that number to determine the respiratory rate.

Remember that respiratory rates thatare too fast or too slow for thechild’s development prevent adequate oxygenation.

Look at the skin, lips and tongue for signs of low blood oxygen.

Well-oxygenated skin has a pink.

Poorly oxygenated skin has a blue.

Initial Assessment: Circulation

Circulation is assessed in order to

Find and stop active bleeding.Look and feel for bleeding

Determine if perfusion is sufficient.Compare peripheral and central pulsesskin temperatureskin color

گردشخون ارزیابی

Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier

Inc.

Slide 37

Are there any signs of poor perfusion?

Assess and compare:Central and peripheral pulsesPalpate both at the same time

Strength of pulse should be nearly equal

Central pulses are carotid, femoral, brachial.Peripheral pulses are pedal or radial.

Assess and compare peripheral and central

Color Look for mottling, pallor or blue which indicate poor perfusion.

Temperature

Feel for coolness that may indicate poor perfusion if the environment is warm.

Assess pulses for heart rate.

Assess capillary refill time.

Elevate hand or foot slightly above the level of the heart.

Press firmly and release.Refill time is normal at 2 seconds.

Remember that a cool environmental temp. will increase capillary refill time

کودکان در شوک عالیم

Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier

Inc.

Slide 41

To complete the initial assessment, assess the child’s mental status.

Is the child alert?

Use the AVPU assessment tool.

A = Alert to person, place and time.V = Responsive to verbal stimulusP = Responsive to painful stimulusU = Unresponsive

Initial Assessment: Mental Status

Assess papillary Reflex

Pulse Oximetry

Fontanels

خارجي جسم وسيله به هوايي را انسداد

نسبي انسداد –عالئم – گريه: يا صدا خشونت سرفهاستريدور

كودكان در كامل انسداد پشت 5 سال 1زير در به فشار بارسينه 5و قفسه به بار

كودكان در كامل انسداد بر سال 1باًالي در فشار اعمالشكم

را كودك دهان كوركورانه طور به و ديد بدون هرگزنكنيد معاينه انگشت .با

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به هوايي راه انسدادخارجي جسم وسيله

را هوايي راه الرنگوسكوپ بابا را خارجي جسم و مشاهده

كنيد . خارج و بگيريد فورسپس

با را انتوباسيون صورت اين غير درفضاي طريق از كوچكتر اي لوله

دهيد . انجام انسداد محل اطراف

Rapid interventions to support airway, breathing and circulation

and

Transport are indicated for any child who is not alert or easily awakened by verbal

stimulus.

Delay further examination and history until reach to the hospital.

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