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Paediatrics (Assessing A Sick Child)

This document provides guidance on assessing a sick child in the pediatric ICU. It emphasizes taking a thorough history and performing a systematic clinical examination following the ABCs approach. The ABCs assess airway, breathing, circulation, disability, and other body systems. Key steps involve determining the child's clinical state, identifying potential infections, monitoring for deterioration, and ensuring safety by asking for help if unsure. Distracting children during examination can help obtain important clinical findings.

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Jeffrey Xie
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196 views12 pages

Paediatrics (Assessing A Sick Child)

This document provides guidance on assessing a sick child in the pediatric ICU. It emphasizes taking a thorough history and performing a systematic clinical examination following the ABCs approach. The ABCs assess airway, breathing, circulation, disability, and other body systems. Key steps involve determining the child's clinical state, identifying potential infections, monitoring for deterioration, and ensuring safety by asking for help if unsure. Distracting children during examination can help obtain important clinical findings.

Uploaded by

Jeffrey Xie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Assessing a Sick Child

Kacey Murphy, PA-C


Paediatric ICU
St George’s Hospital
Initial Review
• Aim of assessing a sick pt is to determine the clinical state
and find the source of infection.

• Sometimes you can tell how well a child is just by standing


at the end of the bed.

• Will be essential to quickly determine how unwell a child is.

• Are they active & playful, crying & irritable, drowsy/lethargic,


or obtunded?

• This places them into well/compensated/peri-


arrest/decompensated states.
Quantifying Clinical State

• History is invaluable. Can give hints to issues or illness going on and may
lead to disease progression.

• Aim to find focus, severity, duration, worsening/static/improving.

• Kids are a good source of information for own illness as well as parents.

• Background history including;

• Birth history (gestation + ante/post-natal complications)

• Co-morbidities & Development

• Immunisations status

• Allergies
ABC Systematic Approach
• Important to be systematic so your approach is
organised, concise and thorough.

• ABCs is a helpful proforma-like tool to ensure all


systems are reviewed in history-taking, clinical
examination and in management plan making.

• A-I is commonly used in ITU but can be


adapted/consolidated for less intense areas
including A&E and GP.
ABC…HI
• A - airway

• B - breathing

• C - cardiovascular

• D - disability/neurology

• E - exposure/everything else/lines. *Though will be adapted as ENT for this scenario.

• F - fluids/renal

• G - gastro

• H - haematology. *May or may not be required.

• I - infection/mirco/rash
History Taking
• A - noisy breathing, (etc barking cough)

• B - issues with breathing?

• C - perfusion issues, (etc wet nappies)

• D - activity level, ?usual self

• E - tugging ear, pain on eating

• F/G - E+D well?, any nausea/vomiting/diarrhoea

• I - Pyrexia, ?respond to anti-pyretics, rash.


Clinical Examination
• A - patent/stridor/grunting/crying

• B - talking/babbling/wheeze/cough/WOB/recession/tug/tiring

• Sats, RR

• C - CRT, mucous membranes, ant fontanelle

• HR, BP (late sign)

• D - AVPU/GCS, pupils, high five test, ?distractible, ant fontanelle

• E - ears & throat (if you haven’t made at least 1x child gag/cough in your face on shift you aren’t properly doing
this)

• F/G - abdo exam.

• I - Pyrexia, rash (blanching/nonblanching, macpap)


Management
• A - steroids, secure airway

• B - Nebs (salbutamol/atrovent/saline/adrenaline), Suctioning, O2

• C - Fluid challenge (PO/IV), IV access (bloods, gas)

• D - Monitor GCS (fluctuating, falling), BM

• E - Swab (*Must do if suspect Strep A)

• F/G - dioralyte (with squash) as challenge, Urine dip

• I - anti-pyretics, monitor rash, Abx


Re-assess
• Always re-assess if clinical picture changes or after
establishing management.

• Monitor for trend of illness, deterioration. *Some illnesses (like


common cold, bronchiolitis) will get worse before they get better, usually peaking around day 3-
4.

• Always safety net.

• If unsure of findings, level of severity always ask for help.

• Help comes from colleagues, senior colleagues, local protocol,


specialist support (paediatrics/anaesthetics/retrieval/ITU)
Extra tidbits for successfully examining the unexaminable

• Babies;

• Place stethoscope in their hand to warm up prior to using

• Place tummy, finger in their mouth for distraction

• Toddlers;

• Warm up stethoscope, start auscultating low (leg) and work way up to chest

• Pen torch good distraction

• Children;

• Always warm up stethoscope, have them listen afterwards

• Challenge them, kids are very competitive

• “Play tummy like a drum”

• Examine teddy bear first


Summary
• Remember your ABCs

• Airway patent

• Breathing okay

• Warm & Well perfused

• Alert & active

• E+D, PU

• Pyrexia responding to meds


Thank You

• Any questions?

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