The 'essential' vital signs

It may prove useful to obtain some baseline vital signs in a

child at rest, ie, when the child is settled. As cardiac output

increases to meet the body's increased oxygen demands, an

elevated heart and respiratory rates are early signs of

compromise in a child. This elevation may be due to a variety

of causes, but it is important that it is recognised, k resting

pulse and respiratory rate is a good indicator of how well or

unwell the child is.

Fear, anxiety, shock, hypoxia, hypovolaemia, crying or fever

will all cause an elevation of a child's heart and respiratory

rates which should be acknowledged at triage when

observations are recorded. It is important not to attribute,

however, an elevation in vital signs because the child is crying.

Always attempt to obtain resting vital signs at some stage.

Development

There is very little time at triage to develop a rapport with

children. Having an understanding of basic growth and

development will enhance knowledge of expected normal

behaviour and therefore simplify the triage process. Neonates'

posture is predominantly one of flexion; they lie with arms and

legs slightly drawn up and into their body. They are able to

maintain eye contact from around six weeks of age. Infants

from around 7-9 months develop an awareness of their

caregivers as significant others and may become distressed at

being separated from them. Toddlers, although desiring

independence, have a strong awareness of 'stranger danger' and

will often protest strongly and loudly at the absence of their

main caregiver. Preschoolers are curious about their

environment. School age children will often put on a brave

face for their peers. Adolescents desire independence and

privacy. From this basic overview, it is easy to understand why

knowledge of normal development can guide triage assessment.

This understanding will make it easier to recognise normal and

abnormal behaviour.

Conclusion

Nurses attend to vital signs in paediatrics because they are

afraid of 'missing something'. Those new to triage require

objective reassurance that they allocated the appropriate triage

category. I believe we need to change our thinking and update

triage training programs. We need to rely less on machines and

more on observation. A sick child is often observable. Placing a

hand on the child's head is sufficient to tell whether the child

is hot or not. "Vital signs are not infallible indicators. ''4

The triage process - from the initial assessment to the triage

decision - should take no longer than five minutes. 9 The time

taken to gain a child's trust and co-operation means

ascertaining baseline vital signs within this time frame can be

14 AENJ VOLUME 3 N O . 1 APRIL 2 0 0 0

difficult. We need to consider whether attending vital signs

will change the triage decision. An unwell child is clinically

evident based on observation, therefore blood pressure, pulse

oximetry and temperature are useful adjuncts but not essential

components of paediatric triage.

R e f e r e n c e s

1. Cowan, T 1997 'Pulse oximeters' in Professional Nurse 12(10) pp744-750

2. Durren, M 1992 'Clinical Notebook Getting the most from pulse oximetry' in Journal of Emergency Nursing 18(4) pp 340-342

3. Henker, R 1999 'Evidence-based practice: fever-related interventions' in American Journal of Critical Care 8 (1) pp 481-487

4. Keddington, R.K. 1998 A triage vital sign policy for a children's hospital emergency deparunent in Journal of Emergency Nursing 24 pg 189-192

5. Letizia M and Janusek L 1994 'The self-defense mechanism of fever' in MedSurg Nursing 3(5) pp 373-377

6. Nelson D 1998 'Pediatric Update Emergency treatment of fever phobia' in Journal of Emergency Nursing 24(4) pp 83 84

7. Shan, F 1995 'Paracetamol: use in children' in Australian Prescriber 18(2) pp 33-34

8. Soud TE & Rogers JS 1998 Manual of Pediatric Emergency Nursing Mosby, St Louis

9. Travers, D 1999 'Triage: how long does it take? How long should it take? in Journal of Emergency Nursing 25(3) pp 238-240

10. Walsh, P 1996 'Febrile convulsions' in The Aus~alian Paediatric Review 6(3) pp 1-2

EXTRICATION COLLARS~ WHEN

ARE THEY REMOVED? Pat Barnwell RN, BA, Grad Cert Research, ICU Neuro Cert, TNCC, ENPC and CATN Instructor Westmead Hospital

The use of extrication collars for injured patients has limited the incidence of further injury due to insufficient stabilisation of the cervical spine. Extrication collars are removed when the neck is cleared of injury or definitive treatment is commenced. The problem I have identified is that clearing the cervical spine may be delayed many hours due to various factors and the hard collar stays on causing the patient increasing discomfit and possible pressure areas.

This survey asks you, as nurses, to identify a benchmark time for the replacement of the extrication collar with a treatment type, irrespective of the presence or absence of injury. The trauma guidelines tend to suggest 24 hours; the patient would seem to suggest a much shorter time.

Responses to the survey can be emailed to the Association at enainc@ozemail.com.au or posted to the Association address (PO Box 141 Toongabbie, 2146) marked attention Pat. The results will be published in the Journal at a later date. Thank you for considering the survey: our patients thank you for your advocacy.