Pediatric emergency medicine trisk 4064 4064
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Clinical Pathway for Evaluation and Treatment of Child With
Community-Acquired Pneumonia
URL: />Authors: J. Gerber, MD, PhD; T. Metjian, PharmD; M. Siddharth, MD; D.
Davis, MD, MSCE; T. Florin, MD; J. Zorc, MD; T. Kaur, MD; T. Blinman,
MD; D. Mong, MD; X. Bateman, CRNP; E. Pete Devon, MD; Ron
Keren, MD, MPH; L. Bell, MD; L. Utidjian, MD; E. Moxey, RN, MPH
Posted: September 2012, revised December 2019
CLINICAL MANIFESTATIONS
Physical Examination
Evaluation of the child with a thoracic emergency requires a calm, orderly
assessment of airway, breathing, and circulation (ABCs). In assessing the airway,
the physician must evaluate the adequacy of air movement and gas exchange.
Pulse oximetry should be performed upon the patient’s arrival. Anxiety or
confusion in a patient with a thoracic emergency may be evidence of hypoxemia.
Increased work of breathing may indicate partial airway obstruction and can be
evaluated by assessing the use of intercostal, subcostal, and supraclavicular
accessory muscles. Prolonged use of these accessory muscles may result in
fatigue and the most common cause of cardiac arrest in children—respiratory
arrest.
Breathing is best evaluated by palpation and auscultation of the chest. The
trachea should be palpated to ensure it is midline. Any lateralization of the
trachea is suggestive of either unilateral volume loss or a lateral space-occupying
process, such as a pneumothorax, pleural effusion, or mass. The neck and chest
should be palpated for signs of subcutaneous emphysema, suggestive of a
pneumothorax or airway injury with an air leak. Finally, breath sounds should be
assessed via auscultation for symmetry and adequacy of inspiratory and
expiratory airflow.
Evaluation of the cardiovascular system should include an assessment of the
patient’s pulse for quality, rate, and regularity. The peripheral skin should be
assessed for color, temperature, and capillary refill. Signs of poor perfusion often
precede that of pressure instability. The neck should be assessed for signs of
jugular venous distension. Finally, the heart should be examined for signs of
