IDENTIFICATION OF SICK CHILD

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IDENTIFICATION OF SICK CHILD

• Anand Shandilya

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SICK CHILD or CRITICALLY ILL CHILD

• Is a child who is in a clinical state which may
  result in respiratory or cardiac arrest or severe
  neurological complication , if not recognized
  treated promptly.

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• It is important to identify a child with
  physiological derangement in its early stages
  when signs are subtle.
• GOLDEN HOUR concept applies to all children with
  illness presenting as EMERGENCY

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• Early recognition of a critically ill child
  requires a systematic rapid clinical
  assessment with background knowledge of age
  appropriate physical signs developmental level.
• The process of examining a child is known as
  RAPID CARDIOPULMONARY ASSESSMENT.
• 30 secs with practice.

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Selected conditions require a rapid
cardiopulmonary assessment

• RR gt60
• HR gt180 or lt80(under 5yrs)
• gt160 or lt60(over 5yrs)
• Respiratory distress-increased work of breathing
  (retractions,nasal flaring,grunting).
• Trauma ,Burns totaling gt10 of surface area .
• Cyanosis

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• Failure to recognize parents
• Diminished level of consciousness unusal
  irritability, or lethargy.
• Seizures
• Fever with petechiae

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Simple quick way of assessment

• Appearance of child
• Airway
• Breathing
• Circulatory status

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APPEARANCE OF CHILD

• Basically denotes NEUROLOGICAL STATUS.
• It is determined by the o2 blood supply to the
  brain which is dependent on cardiopulmonary
  status and structural integrity of the brain.

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• 1 ALERTNESS Changes in level of conscious can
  also be rapidly assessed by
• A wake
• Responsive to V oice
• Responsive to P ain
• U nresponsive

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• Distractibility or consolability by parent.
• Eye contact with parent or physician normally at
  2mon .failure to do this is an EARY OMINOUS SIGN
  of cortical hypoperfusion brain dysfunction.
• SPEECH /CRYnormal/moaning/high pitched.
• MOTOR ACTIVITY normal movements of
  limb,trunk,neck

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• COLOR of SKIN pink,pale/cyanosed/mottled/ashen
  grey.
• SEIZURE activity
• POSTURING
• MUSCLE TONE-limp child bad sign.
• Pupil size

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AIRWAY

• Whether it is open clear or maintainable with
  adjuncts like airways suction ,positioning or
  unmaintainable without intubation.

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BREATHING

• RESPIRATORY RATE
• Tachypnoea is an early sign of resp distress.
• Tachypnoea with out IWB shock,heart disease
  acidosis.
• Slow/irregular RR in a acutely ill child is
  OMINOUS.
• WORK OF BREATHING
• AIR ENTRY.

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CIRCULATORY STATUS

• HEART RATETachycardia
• Bradycardia in a
  critically ill child OMINOUS.
• PULSESCentral/Peripheral
• present/absent
• volume
• pulse pressure
• Loss of central pulse is a premorbid sign is to
  be treated as cardiac arrest.

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• SKIN PERFUSIONTemperature
• color
• CFT

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• ORGAN PERFUSIONBrain perfusion
• Renal
  perfusion
• BLOOD PRESSURE

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• PULSE OXIMETRYo2 saturation assessment is an
  important adjunct to identify oxygenation state
  in acutely ill child.

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THANK YOU