2. Pediatric Call

3. Dispatched to 825 E. Augustus St. for a sick child
Dispatched to 825 E. Augustus St. for a sick child. Dispatcher relays that the patient is conscious and breathing.

4. Part I SCENE SIZE-UP
Defined:
Begins with dispatch
We are instructed to go to the side of the house to the garage which faces Blackford Blvd. We know that Augustus is a one way street going West so we are going to have to go to 14th street where it intersects with Blackford Blvd. and take it South to the residence.

5. Initial evaluation of the scene
Enter Slowly
Observe for safety and mechanism of injury
Goals:
Ensure scene safety
Remember you are going to observe as you approach and before you get out of the vehicle
To determine if patient is medical or trauma
If no mechanism of injury, obtain c/c and ask if any injury has occurred. Mom is holding the child in her arms and tells us her 16 month old son has just not been acting himself, has not been eating or drinking much and has a fever of 102.
Determine total number of patients
Simply ask if anyone else is injured or ill and needs medical attention

6. Part II INITIAL ASSESSMENT
Defined:
Discovering and treating life-threatening conditions
PRIORITY PATIENTS:
Poor General Impression
Unresponsive or listless
Does recognize parents or primary care givers
Not comforted when held by parent but becomes calm and quiet when set down
Compromised airway
Respiratory arrest or inadequate breathing
Possibility of shock
Uncontrollable bleeding
Goals:
Determine if the patient is ill or injured
Ill child
Triage
One ill 14 month old male

7. Part II INITIAL ASSESSMENT
Components:
General Impression
Illness or injury- -Ill
Mechanism of injury/Nature of illness- -Fever
Age, sex, race- -16 month white male
Identify life-threatening problems
Well or sick
Ill
Mental status
drowsy
sleepy- -appears to be
inattentive- -appears to be
Mental Status
A lert V erbal Response P ainful Response U nresponsive
Should turn and look or look at you when addressed
Should follow simple commands

8. Part II INITIAL ASSESSMENT
Assess Airway
Depressed mental status- -Yes as he does not respond to your presence or your voice
Secretions- -No
Blood- -No
Vomits- -No. Inquire as this is a pertinent negative
Trauma- -No
Infections- -Inquire as this is a PMHx. As well as a pertinent negatige.
Do not hyperextend neck
Assess Breathing
Effort of breathing- -Rate and quality
Chest expansion
Effort of breathing
Sounds of breathing
Breathing rate
Color
Oxygen therapy
Blow by method

9. Part II INITIAL ASSESSMENT
Skin color
Pale- -Yes
cyanotic
flushed- -Yes
Quality of speech
Strong cry- -Silent
Speak only in short sentences
Meaningful gibberish
grunts
Interaction with the environment or others
Silence- -Quietly in Moms’ arms
Listlessness- -yes
Unconscious- -no
Emotional state
Withdrawn- -No
Emotionally flat- -Yes
Response to you
Inattention to strangers- -Seems to care less that you are there

10. Part II INITIAL ASSESSMENT
Tone and body position
Limpness- -No, not a rag doll or unable to hold head up
Poor muscle tone- -No
Position to indicate respiratory distress- -No

11. Part II INITIAL ASSESSMENT
Assess Pulse/ Circulation- -Rate and quality
Circulation
Skin color
Pulse
Radial in child
Brachial or capillary refill for infants or child <5
Triage
One ill child

12. Part III Focused History and Physical Exam
Defined:
To identify additional serious or potentially life-threatening injuries or conditions
Fever- -febrile to touch
Listless- -not too active, quiet in moms’ arms
Has not had much to eat or drink

13. Part III Focused History and Physical Exam
Components, Trauma
Reconsider Mechanism of injury
Index of suspicion
Rapid Trauma Assessment
Head to toe physical exam quickly conducted
Base-line Vital Signs
Assess S A M P L E history
Not A Trauma

14. Part III Focused History and Physical Exam
Components Medical
History of present illness
O – P – Q – R – S – T
Onset- -noticed didn’t eat much for supper last night,
fever this morning and not been playful.
Provocation- -None
Quality- -fever is high enough to manifest definitive signs
and symptoms
Radiation- -Always inquire if there is or seems to be any
Pain
Severity- -Listless, non-responsive, pale and flush
Time- -Overall time he’s had the fever
Interventions- -What has mom done? Tylenol etc.

15. Part III Focused History and Physical Exam
S A M P L E
S/S- -as determined and observed
Allergies- -None
Medications- -None
PMHx- -prone to ear infections, URI etc.
Last oral intake- -Important to ascertain when and how
much he’s had to eat and drink
Inquire as to his diaper changes and how wet
Rapid Assessment- -Feel forehead and chest
Base-line Vital Signs
B/P- -under 3 yrs. So not takes
Pulse- -128
Respirations- -30
HIGH NORMS
Treat
Blow-by O2 VS
*Transport

16. Part III Focused History and Physical Exam
IF UNRESPONSIVE:
Rapid Assessment
Base-line Vital Signs
Assess S A M P L E
Care
Not Unresponsive

17. Part IV Detailed Physical Exam
In this case, probably not necessary.
Defined
Head to toe physical exam that is performed slower and in a more thorough manner that the rapid assessment
Components
Head to toe
Reassess vital signs
Continue care- -Repeat Vital Signs

18. Part IV Detailed Physical Exam
Toe-to-head exam with infants and small children
Unless injury/illness won’t permit, allow
parent to hold child in lap
Shelter from stares and onlookers
Children loose heat quickly so recover quickly after exposing for exam

19. Part V On-Going Assessment
Defined:
To detect any changes in the patient’s condition
To detect any missed injuries or conditions
To adjust care as needed
Goal:
The initial assessment is repeated
Vital signs are repeated and recorded
Focused assessment repeated for additional complaints

20. Part V On-Going Assessment
Components:
Repeat Initial Assessment
Discovering and treating life-threatening conditions
PRIORITY PATIENTS: Has this changed
General Impression
Illness or injury
Mechanism of injury/Nature of illness
Age, sex, race
Identify life-threatening problems
Well or sick
Ill
Mental status
drowsy
sleepy- -appears to be
inattentive- -appears to be
Mental Status- -Any significant changes
A lert V erbal Response P ainful Response U nresponsive
Should turn and look or look at you when addressed
Should follow simple commands

21. Part V On-Going Assessment
Assess Airway
Depressed mental status- -Yes as he does not respond to your presence or your voice
Secretions- -No
Blood- -No
Vomits- -No. Inquire as this is a pertinent negative
Trauma- -No
Infections- -Inquire as this is a PMHx. As well as a pertinent negatige.
Do not hyperextend neck

22. Part V On-Going Assessment
Assess Breathing
Effort of breathing- -Rate and quality
Chest expansion
Effort of breathing
Sounds of breathing
Breathing rate
Color
Assess Pulse/ Circulation- -Rate and quality
Circulation
Skin color
Pulse
Radial in child
Brachial or capillary refill for infants or child <5

23. Part V On-Going Assessment
Skin color
Pale- -Yes
cyanotic
flushed- -Yes
Quality of speech
*Strong cry- -Silent
Speak only in short sentences
Meaningful gibberish
grunts
Interaction with the environment or others
*Silence- -Quietly in Moms’ arms
*Listlessness- -yes
Unconscious- -no
Emotional state
Withdrawn- -No
*Emotionally flat- -Yes
Response to you
*Inattention to strangers- -Seems to care less that you are there
Tone and body position
Limpness- -No, not a rag doll or unable to hold head up
Poor muscle tone- -No
Position to indicate respiratory distress- -No

24. Part V On-Going Assessment
Repeat focused assessment
To identify additional serious or potentially life-threatening injuries or conditions
Fever- -febrile to touch
Listless- -not too active, quiet in moms’ arms
Has not had much to eat or drink
Repeat Vital Signs
Check interventions
Note trends in patient condition
Changes can occur quickly and dramatically. Don’t take your eyes off of this child for a second