Assessment of Children in EmergenciesCommittee on Pediatric Resuscitation, The Indonesian Society of Pediatrician1. PAT2. ABCDECirculation to SkinAppearance(Tickles =TICLS)TonusInteractivenessConsolabilityLook/GazeSpeech/CryYoung infantsWork of BreathingsAbnormal airway soundsAbnormal positioningRetractionsNasal flaringApplying The PAT for WOBSeesaw RespirationRespiratory EffortRetraction The Sniffing Position The Tripod PositionPallorMottlingCyanosisCirculation to SkinRespiratory distressNNN Cardiopulmonary failure/ShockNNPrimary CNS dysfunction/ metabolic abnormality NNNNNThe ABCDEsAirwayBreathingCirculationDisabilityExposureAirway Assessment Clear Maintainable Unmaintainable without intubation ObstructedBreathing Assessment Rate Effort / mechanics Air entry Skin colorRespiratory Rate by AgeAge(years)Respiratory rate(breaths per minute)1230-4020-3015-2012-16Retraction and the use of Accessory MuscleCirculation Assessment Heart rate Systemic perfusion Peripheral pulses Skin perfusion Appearance (Urine output) Blood pressureHeart Rate by AgeAge RangeNewborn 3 mos 85 200 bpm3 mos 2 yrs 100 190 bpm2 10 yrs 60 140 bpmCentral & Distal PulsesSkin Perfusion Extremity temperature Capillary refill Color Pink Mottled Pale BlueSkin Perfusion ExaminationMinimal Systolic Blood Pressure by AgeAge Fifth percentile mmHgSystolic BP0 1 Mo 60> 1 mo 1 yr 70> 1 yr 70 + (2 x age in years)Disability (neurologic status) Cerebral cortex Brain Stem Motor activityLevel of Consciousness A = Awake V = Responsive to voice P = Responsive to pain U = UnresponsiveBrain Stem Posture Central respiration Pupil response Cranial nerveMotor Activity Symmetrical movements Seizures Posturing FlaccidityExposure Skin rashes Bruises Excoriation etc.StableRespiratory dysfunctionPotential respiratory failureProbable respiratory failureShockCompensatedDecompensatedCardiopulmonary failureClassification of Physiologic statusDecompensated ShockDefinition of Cardiopulmonary FailureDeficits inResulting inVentilationOxygenationPerfusionAgonal respiration BradycardiaCardiopulmonary arrestBegin further workupProvide specific therapy as indicatedReassess frequentlyPriorities in Initial Management of Stable ChildPotential Respiratory Failure Probable Respiratory FailureKeep with caregiverPosition of comfortOxygen as toleratedNothing by mouthMonitor pulse oximetryConsider cardiac monitorSeparate from caregiverControl airway100 % FiO2Assist ventilationNothing by mouthMonitor pulse oxymetryCardiac monitorEstablish vascular accessPriorities in Initial Management of Respiratory DysfunctionKeep with Caregiver !!Administer oxygen (FiO2 = 1.0) and ensureadequate airway and ventilationEstablish vascular accessProvide volume expansionMonitor oxygenation, heart rate, and urine outputConsider vasoactive infusionsPriorities in Initial Management of ShockOxygenate, ventilate, monitorReassess forRespiratory failureShockObtain vascular accessPriorities in Initial Management of Cardiopulmonary failure