Pediatric emergency medicine trisk 0131 0131
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (101.3 KB, 1 trang )
survey, and triage decision. Ideally, triage should take no more than 3 to 5
minutes. Documentation of triage findings and interventions as well as
reassessment of patients in the waiting room is also included in triage workflow.
Care of pediatric patients requires a core understanding of developmental stages
and their associated risk factors, injury and illness patterns, and physiologic
compensatory mechanisms. As such, the triage process should be completed only
by ED nurses experienced in caring for pediatric patients who demonstrate sound
assessment, clinical judgment, and decision-making skills. Should the triage
provider’s assessment indicate the need for immediate lifesaving intervention, the
triage process should end and the patient moved to a treatment area for care and
further assessment.
Pediatric Assessment Triangle
Once a child presents to the ED, an initial rapid assessment is conducted to
determine “sick” or “not sick” utilizing the pediatric assessment triangle (PAT).
This assessment should be completed during the first moments of interaction by
any level healthcare provider and is separate from the primary survey. Developed
as a standardized tool for children of all ages, the PAT identifies overall general
severity of illness or injury through focused, hands-off observation of three
components of cardiopulmonary assessment: appearance, work of breathing, and
circulation to the skin. The triage provider should allow the child to remain with
their caregiver, evaluating each parameter without touching the patient.
Examination can be completed within 30 seconds, allowing for prompt
recognition of immediate physiologic needs and their associated level of urgency.
General Appearance
General appearance is considered the most important factor in the assessment of a
pediatric patient. While a child may meet “alert” criteria on the AVPU (Awake,
Verbal, Painful, Unresponsive) responsiveness scale, they can also display subtle
signs of illness, injury, and deterioration through alterations in their general
appearance. The mnemonic “tickles” (TICLS) can be utilized to identify
deviations from normal characteristics through evaluation of tone, interactiveness,
consolability, look/gaze, and speech/cry ( Table 6.3 ).
Work of Breathing
In children, assessment of work of breathing provides accurate insight into the
adequacy of oxygenation and ventilation through identification of abnormal
findings and observation of compensatory mechanisms. The triage provider
should listen from a distance for abnormal sounds including snoring, grunting,
