Components in the prioritization of pediatric emergency care (4)
PAT, Focused Assessment (objective information), Focused pediatric Hx(subjective
... [Show More] information), assignment of an acuity rating decision
Pediatric Assessment Triangle : (3) components
Forms the "general impression".
Appearance. Work of Breathing. Circulation to the skin.
If there is an acute disruption in 1 component, child is "sicker".
If there is an acute disruption in 2+ components the child is "sickest" Pg 54
Pediatric Assessment Triangle : Appearance
Most important. Reflects adequacy of ventilation, oxygenation, brain perfusion, & central nervous system function.
Assess for : tone, interactiveness, consolability, look/gaze, & speech/cry.
Pediatric Assessment Triangle : Breathing
More accurate indicator of oxygenation & ventilation than RR or auscultation of chest sounds.
Look and listen for abnormal airway sounds, abnormal positioning, retractions, and nasal flaring.
Pediatric Assessment Triangle : Circulation to skin
Allows assessment of adequacy of CO & core perfusion or perfusion of vital organs.
Inspect skin color in central areas, lips, & mucous membranes.
Look for pallor, mottling, & cyanosis
Mottling skin
Patchy skin color. Areas where the skin color is irregular. Refers to blood vessel changes that cause a patchy appearance in skin.
Sick pt
Consider lower-acuity rating, observe for change in PAT, provide comfort measures and reassurance to child and caregiver
Sicker pt
Consider higher-acuity rating, provide focused clinical intervention ( i.e. O2 in distress).
Sickest pt
Immediate transport to treatment area, resuscitation efforts to support oxygenation, ventilation, & circulation, ped team activated.
Avoid rectal temp in ped pts _____
Potential or actual immunocompromised, rectal surgery, chronic illness-no bacterial through abrased wall
Neutropenic pt with a temperature
Don't take rectal temp.
No invasive procedures if not necessary
Axillary temperatures
May be considered for neo-nate well-baby checks or isues like bilirubin checks.
Weight measurement
Only in Kg and use length-based only in critical pts
Other factors which could influence acuity
Fever, pain, or skin rash
PQRST for Pain
Precipitating and palliating factors
Quality
Radiation
Severity, symptoms, and site
Time or triggering factors (pg86)
Verbal Report for pain
Self-report is the most reliable indicator of pain; however not all pediatric pt are capable or wiling to verbalize their discomfort. (pg86)
Assessment for life-threatening rash
Most important-does the rash result in normal or abnormal PAT? If abnormal pt considered seriously ill so treat quickly.
Suspicion of child maltreatment
Priorities are to identify injuries & provide stabilization. Document Hx described by child & caregiver. Initiate investigation & preserve forensic evidence.
Pediatric Pt Hx
Format CIAMPEDS, goal to obtain accurate info, discourage friends/family for translators.
Acuity Rating Decision
Interpretation of pt's assessment & provides urgency and order of care. Don't change initial triage acuity score. [Show Less]