2015 Trumbull Memorial Hospital Demo

Pediatric Primary Assessment

Pediatric Primary Assessment

Clinical Indication:  Any child that can be measured with the Broselow-Luten Resuscitation Tape.

Steps

Performed? Yes No

1. Scene size-up  Universal precautions, scene safety, environmental hazards, need for additional resources, by-stander safety, and patient/caregiver interaction. Consider the number of patients, mechanism of injury or nature of the illness. Request additional help if necessary. 2. Priorities of management are established on a life-threatening basis.  Begin an ABC approach to the patient to form a general impression and establish the presence of a life threatening injury or illness. Obtain and record the chief complaint of the patient. Quickly assess level of consciousness using the AVPU method. 3. Evaluate for the presence of increased intracranial pressure.  In the infant, increased ICP may be manifested by a full or bulging anterior fontanel, a weak, shrill, or irritable cry, and poor muscle tone. Pupillary responses, level of consciousness, recognition of parents, and Glasgow Coma Score should also be documented. 4. Assess the airway (protect c-spine if uncertain)  When establishing an airway, remember the differences between the adult and pediatric airway. The young child has a disproportionately large tongue, which can easily occlude the airway. A small amount of blood or vomitus can also obstruct the airway. Deciduous, or “baby teeth”, are poorly anchored and easily dislodged.  If responsive – no intervention needed  If unresponsive – use the appropriate medical or trauma maneuver to open the airway  If airway remains partially or totally obstructed, continue steps to clear the airway  Observe chest rise and fall; auscultate breath sounds, observe for signs of distress – use of secondary muscles, nasal flaring, and tripod position. If oxygen is indicated and the child has a patent airway and good respiratory effort, administer oxygen via NRB.  If the child requires ventilatory assistance, administer 100% oxygen via bag valve mask. It is strongly recommended to use the appropriate size mask for the patient.  When possible, monitory oxygen saturation with continuous pulse oximetry and document findings as appropriate. 6. Assess circulation/perfusion  Assess rate and quality of pulses – peripheral and central pulses. Early signs and symptoms of shock in children include a rapid heart rate and respiratory rate (remember age-related vital signs), agitation, and poor peripheral perfusion (capillary refill >2sec). Hypotension is a LATE and ominous finding. Document vital signs (including temperature and blood pressure if appropriate) and peripheral perfusion.  Stop any active bleeding, assess skin color, temperature, and obtain blood pressure.  If there is no palpable pulse or rate is too slow to maintain cerebral blood flow, begin CPR. 7. Further assessments, go to Patient Assessment – Medical or Patient Assessment – Trauma 5. Assess adequacy of breathing  If patient is not breathing, ventilate patient

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145

EMR

EMT

AEMT

Paramedic

Extended