Shaken Baby Pediatric Assessment

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					PAT
       PEDIATRIC ASSESSMENT
             TRIANGLE
   RAPID WAY TO ASSESS PHYSIOLOGIC
    STABILITY
   USE TO QUICK LOOK AND THEN PRIMARY
    SURVEY



          BASED ON MATERIAL FROM AAP, Romig, L.
                 The PAT

   Can be considered a “patient size-up”
   Is a pre-primary survey
   Can be done in seconds
   Often best done before getting close to the
    pediatric patient
   Results in assignment of the patient into a
    “physiologic cubbyhole”
   Can be done whenever you’re in the weeds!
       The PAT

General Appearance
Work of Breathing
Circulation to the Skin
   Pediatric Assessment Triangle




Appearance
           APPEARANCE

T   Tone
I   Interactiveness
C   Consolability
L   Look/gaze
S   Speech/cry
Pediatric Assessment Triangle



                   Work of
                   Breathing
          Work of Breathing

   INCREASED OR DECREASED BREATHING
   STRIDOR
   WHEEZING
Pediatric Assessment Triangle




  Circulation to Skin
         Circulation to the Skin

   Inadequate perfusion of vital organs leads
    to compensatory vasoconstriction in non-
    essential anatomic areas, especially the
    skin.
     Pediatric Assessment Triangle




Appearance               Work of
                         Breathing


       Circulation to Skin
           Respiratory

A      B       C   Physiologic
                   Cubbyhole
                                 Sick?


                   Respiratory
Good
                     Distress




Poor               Respiratory
                     Failure
           Circulatory

A      B      C    Physiologic
                   Cubbyhole
                                      Sick?


                     Nonspecific
Good                  Peripheral
                   Vasoconstriction




Poor                  Shock
     NONSPECIFIC CAUSES OF
       VASOCONSTRICTION
 Fever
 Hypothermia

 Medications

 Normal vasomotor lability in infants
       Central Nervous System

A         B      C     Physiologic
                       Cubbyhole
                                     Sick?



Poor     Good   Good      CNS
                       Dysfunction
            CNS PROBLEMS

   Chronic disability
   Head injury
   Intoxication/Drug effect
   Meningitis/Encephalitis
   Metabolic
   Seizure/Postictal
    The Last Chance


A   B   C    Physiologic
             Cubbyhole
                              Sick?


            Cardiopulmonary
                Failure!
         Primary assessment

   AIRWAY
   BREATHING
   CIRCULATION
   DISABILITY
Poor general appearance


Inadequate physiologic
    compensation


        “Sick!”
       “Quick!”
           Work of Breathing
   More informative in children than absolute
    respiratory rate
   Reflects resistance in small air passages,
    dependence on diaphragm and weakness
    of chest wall muscles
   Increased WOB (including tachypnea) is a
    compensatory mechanism
   Decreased WOB (poor effort/slow
    breathing) means decompensation
       Circulation to the Skin
   Decreased circulation to the skin is an
    early sign of compensation for a
    circulatory problem in kids (not always
    true in adults)
   Cap refill is a good measure in kids,
    especially when done in serial fashion in
    a normothermic environment
              SUMMARY

   PAT IS AN EXCELLENT TOOL TO GIVE
    FIRST LOOK “HOW SICK, HOW QUICK”
   USED IN CONJUNCTION WITH PRIMARY
    SURVEY GIVES HIGHLY SENSITIVE
    INFORMATION ON PEDIATRIC STATUS

				
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