Preparation and Triage
(may occur after the across-the-room observation if not arriving by ambulance)
1.
States the need to activate the trauma
... [Show More] or resuscitation team
2.
- States the need to prepare the trauma or resuscitation room
- Pediatric protocols and dosing guidelines
- Pediatric equipment
- Length-based resuscitation tape
3.
States the need to don PPE
“The patient has just arrived.”
Across-the-Room Observation
4.
Assess for uncontrolled external hemorrhage and the need to reprioritize to ABC
5.
Identifies the three components of the Pediatric Assessment Triangle AND categorizes the patient as “Sick, Sicker, or Sickest”•
Appearance
Work of breathing
Circulation to the skin
Appearance:
- Tone
- Interactions
- Consolability
- Look/gaze
- Speech/cry
Work of breathing:
- tachypnea
- stridor
- grunting
- retractions
- accessory muscle use
- nasal flaring
- head bobbing
- abnormal positioning
Circulation to the skin:
- pallor/flushed
- mottled
- cyanosis
Primary Survey
Airway and Alertness
**6. Assesses level of consciousness using AVPU
**
"alert, verbal, pain, unresponsive"
7. Is trauma suspected?
If trauma is suspected, states the need for a second person to provide manual cervical spinal stabilization AND demonstrates manual opening of the airway using the jaw-thrust maneuver;
if NO trauma is suspected, opens airway with a head tilt/chin lift or jaw thrust or asks patient to open mouth
**8. Demonstrates and describes techniques for determining the patency of the airway, using inspection, auscultation, and palpation (identifies at least FOUR):
**
Is the tongue obstructing?
Is there any edema?
Is there any blood, vomit, or secretions?
Are there any foreign objects?
Are there any loose or missing teeth?
Is there any bony deformity?
Is there any snoring, gurgling, or stridor?
9. Perform appropriate airway interventions if necessary and reassess for effectiveness. These may include but are not limited to the following:
Suction airway
Insert an oral or nasopharyngeal airway
Allow to maintain preferred position
Place folded towel under shoulders/torso
Indicate need for intubation
Breathing and Ventilation
**10. Demonstrates and describes techniques for determining breathing effectiveness using inspection, auscultation, and palpation
**
(identifies at least FOUR):
INSPECT
- Is there spontaneous breathing?
- Is there symmetrical chest rise?
- What are the depth, pattern, and general
rate of respirations?
- What is the skin color?
- Is there increased work of breathing?
○ Abnormal positioning
○ Grunting
○ Retractions/accessory muscle use
○ Head bobbing
○ Nasalflaring
AUSCULTATE
Are breath sounds present and equal?
PALPATE
- Are there open wounds or deformities?
- Is there subcutaneous emphysema?
- Is there any tracheal deviation or jugular venous distention?
11. Perform appropriate interventions if necessary and reassess for effectiveness. These may include but are not limited to the following:
- Apply oxygen
- Provide ventilations with a bag-mask device
- Indicate need for intubation
- Indicate need for needle thoracentesis
- Indicate need for chest tube
Circulation and Control of Hemorrhage
12. Demonstrates and describes techniques to determine the adequacy of circulation (identifies all FOUR if trauma, all THREE if medical):
- Inspects for any uncontrolled external hemorrhage (only indicated in trauma)
- Palpates a central AND peripheral pulse
- Inspects AND palpates the skin for color, temperature, and moisture
- Assess capillary refill
13. Perform appropriate interventions if necessary and reassess for effectiveness. These may include but are not limited to the following:
- Control uncontrolled hemorrhage (trauma
only)
- Initiating chest compressions and advanced life support
- Assess the patency of the prehospital IV line
- Obtain IV or IO access – 2 sites may be needed for traumatic injury or if critically ill
NOTE: If the learner elects to obtain blood samples for typing, credit is given in Get Adjuncts.
- Administer a fluid bolus using the push-pull method
○ 20 mL/kg for infant/child
○ 10mL/kgforneonateorcardiogenicshock
- Apply a cardiac monitor (ONLY if suspected dysrhythmia is causing alterations to the primary survey – otherwise apply a monitor in Get Adjuncts)
Disability (Neurologic Status)
14. Describes the assessment of neurologic status using either the GCS or FOUR score:
NOTE: The FOUR score is indicated for intubated or unresponsive patients
GCS
What is the best eye opening?
What is the best verbal response?
What is the best motor response?
FOUR score
What is the eye response?
What is the motor response?
What are the brainstem reflexes?
What is the respiration status?
15.
Assesses pupils for PERRL
16.
Perform appropriate interventions if necessary and reassess for effectiveness. These may include but are not limited to:
Obtain bedside glucose
Indicate need for intubation
Exposure and Environmental Control
17.
States the need to remove all clothing
AND
inspect for uncontrolled hemorrhage or obvious signs of illness or injuries
18.
States the need to keep the patient warm (identifies at least ONE):
- Blankets
- Warming lights
- Increased room temperature
- Warmed fluids
- Warmed oxygen
Full Set of Vital Signs-Family
19.
Obtains a full set of vital signs and weight in kilograms
Full Set of Vital Signs-Family
20.
States the need to facilitate family presence [Show Less]