IDENTIFICATION OF SICK CHILD Anand Shandilya SICK CHILD

IDENTIFICATION OF SICK CHILD Anand Shandilya

SICK CHILD or CRITICALLY ILL CHILD v 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.

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

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

Selected conditions require a rapid cardiopulmonary assessment v RR >60 v HR: >180 or <80(under 5 yrs) >160 or <60(over 5 yrs) v Respiratory distress-increased work of breathing (retractions, nasal flaring, grunting). v Trauma , Burns totaling >10% of surface area. v Cyanosis

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

Simple & quick way of assessment v. Appearance of child v. Airway v. Breathing v. Circulatory status

APPEARANCE OF CHILD v Basically denotes NEUROLOGICAL STATUS. v It is determined by the o 2 & blood supply to the brain which is dependent on cardiopulmonary status and structural integrity of the brain.

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

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

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

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

BREATHING v 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. v WORK OF BREATHING v AIR ENTRY.

CIRCULATORY STATUS HEART RATE: Tachycardia Bradycardia in a critically ill child OMINOUS. v PULSES: Central/Peripheral present/absent volume pulse pressure Loss of central pulse is a premorbid sign is to be treated as cardiac arrest. v

v SKIN PERFUSION: Temperature color CFT

v ORGAN PERFUSION: Brain perfusion Renal perfusion v BLOOD PRESSURE

v PULSE OXIMETRY: o 2 saturation assessment is an important adjunct to identify oxygenation state in acutely ill child.