PALS algorithm and approach to sick child

1. Physical assessement of a sick
child
Dr. Shafini Beryl

2. Disclaimer
• This presentation covers only a snapshot of the subjects
presented-
• each topic could be lecture of its own!
• You are encouraged to do further research and dive
deeper into each topic.
• Not all pediatric emergencies are covered in this
presentation- only some common conditions.

3. Aim of the presentation
• Recognize and manage life threats based on simple
assessment findings for a child while awaiting additional
emergency response.

4. Important considerations
• Differs from adult assessment
• Adapt your assessment skills
• Have age-appropriate equipment
• Review age-appropriate vital signs

5. • Sudden illness and medical emergencies are common in
children and infants.
• Anatomical differences exist between adults and children.
• Respiratory care for children is extremely important

6. Managing a pediatric emergency can be one of the most
stressful situations you face as an EMR.
– You must remain calm and professional.
– Unless you are prepared, your anxiety and fear may interfere
with your ability to deliver proper care

7. • The parents can be either allies or a potential problem.
• Talk to both the parents and the child as much as
possible.
• Try to develop a rapport with the child.

8. Pediatric anatomy- Children are not small
adults
• A child’s airway is
smaller in relation to
the rest of the body
compared to an
adult’s airway.
• A child’s tongue is
relatively larger than
an adult’s.

10. Steps in structured assessement

11. Recognition of a sick child
• Paediatric Assessment
Triangle
• Primary Assessment-
Pentagon

12. The pediatric asseseement triangle
• The PAT helps you quickly form a general impression of the child
using only your senses of sight and hearing.
• Can be used to assess a child from a distance

13. Appearance
Lethargic
Active
Decreased interactiveness
Interactive child

14. Tone abnormalities- hypotonia
Gaze abnormality- strabismus
Normal baby- Good tone, normal gaze and is consolable
Inconsolable cry

15. Work of breathing
Intercostal retraction
subcostal retraction
substernal retraction

16. Circulation
Pallor Mottling Cyanosis

18. Initial impression- Pediatric assessement triangle(PAT)
UNRESPONSIVE
APNEA/GASPING
CYANOSIS
Life threatening conditions

19. • If Life-threatening on initial impression
• ⚬ Activate the Emergency response system
• ⚬ Initiate life-saving measures based on the scope of practice
• ￭ Open The Airway and provide oxygen
• ￭ Attach monitor and AED
• ￭ Check for pulse
• ￭ Provide CPR if needed (central pulse absent/<60) ￭ I.V. / IO Access,
Fluids, and medications
• • Proceed for further evaluation after initial stabilization/ all parameters
normal

21. Initial impression
PAT

22. • The ‘PAT’ functions as a rapid initial assessement to
determine, “sick” or “not sick” and should be immediately
followed by the ABCDE’s

23. Further evaluation- primary assessement

24. A

26. Airway Management- simple measures

27. Airway management- advanced

28. B

46. CASE 1
• 8 YEAR OLD FEMALE CHILD
• • COUGH X 1 DAY
• • BREATHING DIFFICULTY SINCE EVENING RAPIDLY WORSENING
• • DIFFICULTY IN SPEAKING
• • PAST HISTORY – H/O NEBULIZATION 4-6 TIMES NOT ON REGULAR MEDICATIONS
• • MOTHER HAVING HISTORY OF ASTHMA

48. • Respiratory failure
• Lower airway disease
• Status asthmaticus

49. Case 2
• 3YEAR OLD MALE CHILD
• • Fever x 3 day high grade
• • No rashes
• • Decrease activity 1 day
• • No past significant history

51. • Hypotensive shock
• Sepsis

52. Case 3
• • 1 YEAR OLD MALE CHILD
• • Diarrhea x 3 day , 8- 10 episodes/day
• • Vomiting x 4 episodes non bilious
• • Decrease activity 1 day
• • On bottle feeding
• • No past significant history

54. • Hypotensive shock
• AGE with severe dehydration

74. Appearance
• Tone : general posture
• Interactive : responsive/ unresponsive/ lethargic
• Consolable : crying
• Look : looking at mother/ vacantgaze
• Speech : able to/ paucity/ weak/ hoarseness of
voice

81. THANK YOU