1. Pediatric Assessment BY: Fidel O. Garcia EMT-P Co-Owner ProEMSeducators.com fidel@proemseducators.com

2. Survival Following Respiratory Arrest vs Cardiopulmonary Arrest in Children 100% 50% 0% Respiratory arrest Cardiopulmonary arrest Survival rate

3. General Impression Sick Sick vs vs Not Sick Not Sick

4. Appearance T. I. C. L. S. Breathing W. O. B. Circulation to Skin

5. Appearance: Normal Breathing: Increased Circulation to Skin: Normal

6. Appearance: Abnormal Breathing: Increased or decreased Circulation to Skin: Normal to abnormal

7. Appearance: Abnormal Breathing: Normal Circulation to Skin: Abnormal

8. Appearance: Abnormal Breathing: Normal Circulation to Skin: Normal

9. The ABC’s provide maintenance of normal vital function Airway Ventilation BreathingOxygenation CirculationPerfusion

11. Physical Examination - Airway Rapid Assessment Clear Maintainable Unmaintainable Pediatric vs adult airways BVM considerations Intubation considerations Check D.O.P.E

12. Physical Examination - Breathing Effort Mental Status Skin Color Rate:Neonate40 – 60 Infant40 – 50 Toddler30 – 40 Child20 – 30 Adolescent12 - 20 Air Entry

13. Common Upper Airway Emergencies Croup:EpiglotitisFBAO 6 months -3 yrs3yrs – 6 yrsall ages Slow onsetrapid onsetrapid onset “Seal bark”quiethigh pitched squeal Usually quick fixlong term fixusually quick fix Fall or winteranytimeanytime Usually not lifelife threateningUsually not lifethreatening Viralbacterialneither Mild secretionsdroolingmay drool Hx URIno hx URINo hx URI Moderate feverHigh feverno fever

16. Common Lower Airway Emergencies Asthma: Hyper - reactive airways RSV : Virus causing bronchiolitis

17. Common Lowewr Airway Emergencies AsthmaRSV Air trapping diseaseVirus causing bronchiolitis Rapid OnsetSlow onset AfebrileFebrile Under 2 years of age3 years and older Previous historyNo history WheezesWheezes / rhonchi No drainageRhinorrhea May be life threateningLess life threatening

19. Assessment of Shock Mental Status:Altered or decreased Warm or cold Extremity temp:Warm or cold Determine Pulses:Infant:100 – 160 Toddler:90 – 150 Preschooler:80 – 140 Child:70 – 120 Adolescent:60 – 100 Internal Pulse Quality: Color / Cap refill:Central vs peripheral Renal output:1 – 2 ml/kg/hr

20. Blood pressure Low end of normal systolic pressureAge >600 to 1 month >701 month to 1 yr >70 + (2 x age in yrs)Older than 1 What information does blood pressure provide ?

21. Hemodynamic Response to Shock Vascular resistance Blood pressure Cardiac output Compensated shock Decompensated shock

22. Review of the Physical Finding in Shock Early signs (compensated) increased rate poor systemic perfusion altered mental status Late signs (decompensated) weak central pulses decreased mental status decreased urine output hypotension

23. Phases of Pediatric Shock Early Late (hypotension) Survival Immediate arrest Delayed death intact Multiple organ dysfuntion

24. Physical Finding in Shock Early signs (compensated) increased rate poor systemic perfusion altered mental status Late signs (decompensated) weak central pulses decreased mental status decreased urine output hypotension

25. Etiologies of Pediatric Shock Hypovolemic Distributive Septic Anaphylactic Neurogenic Cardiogenic Obstructive

26. Child dying with Multiple Organ Dysfunction Syndrome (MODS), despite resuscitation efforts

27. Etiologies of Cardiopulmonary Failure Many Etiologies Respiratory Failure Shock Cardiopulmonary Failure

28. Definition of Cardiopulmonary Failure Global Deficitis in : Ventilation Oxygenation Perfusion Resulting in : Agonal Respirations Bradycardia Cardiopulmonary arrest

29. Priorities of Initial Management Cardiopulmonary failure oxygenate, ventilate, monitor reassess for: respiratory failure shock obtain vascular access

30. Many Etiologies Respiratory FailureShock Cardiopulmonary Failure Cardiopulmonary arrest Death Cardiopulmonary recovery Impaired neurologic recovery Unimpaired neurologic recovery