lou romig md, faap, facep pediatric emergency medicine miami children’s hospital
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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. - PowerPoint PPT PresentationTRANSCRIPT
Lou Romig MD, FAAP, FACEPPediatric Emergency Medicine
Miami Children’s HospitalMedical Advisor, FL DOH EMS for Children Program
ObjectivesObjectives
Recognize how much information children can give you without saying a word
Learn the Pediatric Assessment Triangle and its applications
Goals for the Acute Early Goals for the Acute Early Assessment PhaseAssessment Phase
Filter and focus
Access knowledge and experience
Control the emotional environment
Problems with the Problems with the Assessment of ChildrenAssessment of Children
Physical and cognitive immaturity
Normal vs. abnormal
Dependence on information from caregivers
Dealing with caregivers
Problems with the Problems with the Assessment of ChildrenAssessment of Children
They can’t talk to me!They can’t talk to me!
Children speak with their bodies.Children speak with their bodies.
We must listen with our eyes.We must listen with our eyes.
The Pediatric Assessment Triangle (PAT)The Pediatric Assessment Triangle (PAT)
From the AAP’s Pediatric Education for Prehospital Professionals(PEPP) course. www.PEPPsite.com
The PATThe PAT
Quick physiological gestalt
Often best done from a distance
Takes seconds
Can be repeated as needed
Answers two questions
How sick?
How quick?
The PATThe PAT
General Appearance
Work of Breathing
Circulation to the Skin
The Pediatric Assessment Triangle (PAT)The Pediatric Assessment Triangle (PAT)
General AppearanceGeneral Appearance
T Tone
IInteractiveness
C Consolability
L Look/gaze
S Speech/cry
General AppearanceGeneral 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
Good general appearanceGood general appearance
Normal to well-compensated Normal to well-compensated physiologyphysiology
“Not sick”“Not sick”“Not quick”“Not quick”
Poor general appearancePoor general appearance
Inadequate physiologic Inadequate physiologic compensationcompensation
““Sick!Sick!””““Quick!Quick!””
Sick or not sick?Sick or not sick?
Sick or not sick?Sick or not sick?
Sick or not sick?Sick or not sick?
Sick or not sick?Sick or not sick?
Sick or not sick?Sick or not sick?
The Pediatric Assessment Triangle (PAT)The Pediatric Assessment Triangle (PAT)
Work of BreathingWork of Breathing
More important than respiratory rate
Reflects unique anatomy
Increased WOB is good
Decreased WOB is bad
Small airways
Weak intercostals
Dependence on diaphragm
The Pediatric Assessment Triangle (PAT)The Pediatric Assessment Triangle (PAT)
Circulation to the SkinCirculation 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
You don’t need a blood pressure…You don’t need a blood pressure…
Remember these eyesRemember these eyes
Putting the PAT togetherPutting the PAT together
A B C PhysiologicCategory
Sick?
GoodRespiratory Distress
Poor Respiratory Failure
RespiratoryRespiratory
A B C PhysiologicCategory
Sick?
GoodNonspecific Peripheral
Vasoconstriction
Poor Shock
CirculatoryCirculatory
A B C PhysiologicCategory
Sick?
Poor Good GoodCNS
Dysfunction
Central Nervous SystemCentral Nervous System
Seizure/Post-ictal Head injuryIntoxication/Drug effect MetabolicMeningitis/Encephalitis Chronic disability
A B C PhysiologicCategory
Sick?
Cardiopulmonary Failure
The Last ChanceThe Last Chance
Hear Hear herehere
!!
Child with a cold and a raised red Child with a cold and a raised red rashrash
Sick?
o Alert
o Interacts with toy
o Good spontaneous movement
o Good coordination and strength
Another Another blotchy blotchy
kidkid
Sick?
Not sickNot sick
MottlingMottling
Sick?Sick?
Cutis MarmorataCutis Marmorata
Child with fever and petechiaeChild with fever and petechiae
Small red dotsDo not blanchNot palpable
More fever and petechiaeMore fever and petechiae
Purpura fulminans:Purpura fulminans:MeningococcemiaMeningococcemia
Purpura fulminans:Purpura fulminans:MeningococcemiaMeningococcemia
Vomiting and diarrhea x 3 daysVomiting and diarrhea x 3 days
Dry, sunken eyes
Dry oral membranes
But is he sick?
Vomiting and diarrhea x 3 daysVomiting and diarrhea x 3 days
Watching passively
Since when does a kid this age stay still?
Is he sick?
CompareCompare
Which would you treat first?
Before and AfterBefore and After
Distress or failure?Distress or failure?
Distress or failure?Distress or failure?
Kussmaul breathingKussmaul breathing
Respiratory distressRespiratory distress
A known asthmaticA known asthmatic
Respiratory distressRespiratory distress
Two hours laterTwo hours later
Respiratory failureRespiratory failure
The Pediatric Assessment Triangle (PAT)The Pediatric Assessment Triangle (PAT)
From the AAP’s Pediatric Education for Prehospital Professionals(PEPP) course. www.PEPPsite.com
Can you hear them now?Can you hear them now?
