PEPP 1: Pediatric Assessment

Question 1

Sick or not sick

Answer 1

Most important question

Question 2

PAT

Answer 2

Pediatric Assessment Triangle. Use first for every single pediatric case.
Rapid VISUAL assessment
Formalizes the general impression

Question 3

PAT elements

Answer 3

Appearance
Work of breathing
Circulation to skin

Question 4

PAT questions

Answer 4

How severe is the injury?
What is the most likely physiologic abnormality?
How quickly do I need to act?

Question 5

Appearance

Answer 5

Single most important factor
Responding to stimulus
Looking around the room
Tells about circulation: look to skin color
Use TICLS
Complete visually from across the room while still in caregivers arms

Question 6

TICLS

Answer 6

Used to quantify Appearance of PAT
Tone: Child moving vigorously, sit or walk, or limp?
Interactiveness: try testing attention with a pen light
Consolability: Yes or No
Look: Looks at your face or track a toy, not vacant start
Speech/cry: strong cry or wimper? Slurring?

Question 7

Tone

Answer 7

Is the child moving vigorously?
Resisting exam? Or lie limp?
Verbalize as normal, decreased or increased

Question 8

Interativeness

Answer 8

Can you draw attention? Turn to a sound?
Listless and disinterested?
Verbalize as Normally active and alert, Listless, Lethargic, or Unresponsive

Question 9

Consolability

Answer 9

Can caretaker console child?

Verbalize as Consolable or Inconsoloable

Question 10

Look or gaze

Answer 10

Fix gaze on face; track movement?

Question 11

Speech or cry

Answer 11

Slurring words? Speak in whole sentences?

Question 12

Respiratory distress

Answer 12

Appearance; normal
Work of breathing: increased
CTC: normal
Not urgent. Since other two elements are ok, pt is successfully compensating with incr work of breating

Question 13

Work of breathing

Answer 13

Assess from across the room
Listen for abnormal sounds
Look for abnormal positioning, retractions or nasal flaring

Question 14

Abnormal airway sounds

Answer 14

Upper airway: snoring or stridor

Lower airway: grunting or wheezing

Question 15

Snoring

Answer 15

Low pitched sound
Caused by loss of tone in upper airway
Partial airway obstruction

Question 16

Stridor

Answer 16

High pitched whistling sound
Upper airway, partial obstruction of trachea or vocal chords
On inspiration or both

Question 17

Upper airway obstruction causes

Answer 17

Loss of consciousness
Loss of muscle tone
Viral or bacterial infection
Foreign body aspiration
Blunt neck trauma

Question 18

Grunting

Answer 18

Lower airway
Caused by pushing air against closed vocal chords
Pneumonia, pulmonary contusion or pulmonary edema

Question 19

Wheezing

Answer 19

Lower airway
High pitched musical sound
Caused by air pushed through small openings in the lungs, usually on expiration
Asthma and bronchiolitis

Question 20

Sniffing position

Answer 20

Severe upper airway obstruction

Question 21

Tripod position

Answer 21

Trying to maximize accessory muscle use

Question 22

Retractions

Answer 22

Seen beneath, between or above ribs, above clavicle or beneath sternum

Question 23

Nasal flaring

Answer 23

Moderate to high hypoxia

Question 24

Urgency

Answer 24

Increased work of breathing with normal appearance: respiratory distress, not urgent transport
Increased WOB with poor appearance, respiratory failure, transport quickly
Poor appearance with low WOB means pt may be fatigued and respiratory arrest is imminent. Be ready to bag.

Question 25

Respiratory failure

Answer 25

Appearance: abnormal Work of breathing: increased or decreased (fatigue) Circulation to skin: normal or abnormal

Question 26

Shock

Answer 26

Appearance: abnormal Work of breathing: normal Circulation to skin: abnormal

Question 27

Skin circulation indicators

Answer 27

Pallor: early sign Mottling: patchy Cyanosis: late finding, always critical unless with normal appearance, may just be cold.

Question 28

CNS disfuntion

Answer 28

Appearance: abnormal Work of breathing: normal Circulation to skin: normal

Question 29

Steps in pediatric assessmetn

Answer 29

1-Scene size up 2-Primary assessment (PAT, hands on ABCDE, transport decision) 3-History taking 4-Secondary assessment: physical exam, monitoring devices 5-Reassessment

Question 30

Immediate transport if

Answer 30

``` Cardiac arrest Complete airway obstruction Impending delivery Decompensated shock Status epilepticus Wheezing Stridor Severe pain with normal blood pressure ```

Question 31

Immediate transport and treatment enroute if

Answer 31

Incomplete airway obstruction Closed head injury with normal breathing Multisystem trauma Inability to treat on scene (equipment failure, safety)

Question 32

Causes of unresponsiveness

Answer 32

Sepsis Seizure Abuse

Question 33

Respiratory Rates

Answer 33

``` Infant 30-60 Toddler 24-40 Preschooler 22-34 School age 18-30 Adolescent 12-16 ```

Question 35

Heart Rates

Answer 35

``` Infant 100-160 Toddler 95-150 Preschooler 80-140 School age 70-120 Adolescent 60-100 ```

Question 35

Blood Pressures

Answer 35

``` Infant >60 Toddler >70 Preschooler >80 School age >90 Adolescent 12-16 ```