Pokok Bahasan : GAWAT DARURAT ANAK

Prof. Dr. Purnomo Suryantoro

1. Penilaian Anak Gawat Darurat

1. PAT (Appearance, Work of breathing, Circulation of skin)

2. ABCDEs

Appearance (“Tickles”=TICLS)

Tonus

Interactiveness

Consolability

Look/Gaze

Speech/Cry

Work of Breathings

Abnormal airway sounds

Abnormal positioning

Retractions

Nasal flaring

Respiratory Effort: Retraction, Te sniffing Position, The Tripod Position

Circulation to Skin

Pallor

Mottling

Cyanosis

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Respiratory Dystress

N

N

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Shock

�N N

�N

The ABCDEs (Airway - Breathing- Circulation - Disability — Exposure)

1. Airway Assessment

- Clear

- Maintainable

- Unmaintainable without intubation

- Obstructed

2. Breathing Assessment

- Rate

- Effort I mechanics

- Air entry

- Skin color

Respiratory Rate by Age:

Age (years)

<1

2-5

5-12

>12

Respiratory rate (breaths per minute)

30-40

20-30

15-20

12-16

3. Clation Assessment

- Heart rate

- Systematic perfusion

Primary CNS dysfunction/metabolic abnormality

�N N

N

Cardiopulmonary failure

�N

�N

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• Peripheral pulses

• Skin perfusion

• Appearance

• (Urine output)

- Blood pressure

Heart Rate by Age:

Age

Newborn - 3 mos

3 mos - 2 yrs

2 - 10 yrs

Range

85 - 200bpm

100 - 190 bpm

60 - 140bpm

Skin Perfusion

- Extremity temperature

- Capillary refill

- Color :

• Pink

• Mottled

• Pale

• Blue

Minimal Systolic Blood Pressure by Age

Age

0 – 1 Mo

>1 mo – 1yr

>1 yr

Fifth percentile systolic BP (mmHg)

60

70

70 + (2 x age in years)

4. Disability (neurologic status)

- Cerebral cortex

- Brain Stem

- Motor activity

Level of Consciousness

- A = Awake

- V = Responsive to voice

- P = Responsive to pain

- U = Unresponsive

Brain Stem

- Posture

- Central respiration

- Pupil response

- Cranial nerve

Motor Activity

- Symmetrical movements

- Seizures

- Posturing

- Flaccidity

5. Exposure

- Skin rashes

- Bruises

- Excoriation, etc.

Classification of Physiologic status

- Stable

- Respiratory dysfunction:

- Potentially respiratory failure

- Probable respiratory failure

- Shock: compansated, decompensated

- Cardiopulmonary failure

Definition of Cardiopulmonary Faikure

Dificits in:

- Ventilation

- Oxygenation

- Perfusion

Resulting in:

- Agonal respiration

- Br

Priorities in Initial Management of Stable Child

- begin further workup

- provide specific therapy as indicated

- Reassess frequently

Priorities in Initial Management of Respiratory Dysfunction

Potential Respiratory Failure

- Keep with caregiver

- Position of comfort

- Oxygen as tolerated

- Nothing by mouth

- Monitor pulse oximetry

- Consider cardiac monitor

Probable Respiratory Failure

- Separate from caregiver

- Control airway

- 100 % FiO2

- Assist ventilation

- Nothing by mouth

- Monitor pulse oxymetry

- Cardiac monitor

- - Establish vascular access

Priorities in Initial Management of Shock

- Administer oxygen (Fi02 = 1.0) and ensure adequate airway and ventilation

- Establish vascular access

- Provide volume expansion

- Monitor oxygenation, heart rate, and urine output

- Consider vasoactive infusions

Priorities in Initial Management of Cardiopulmonary failure

- Oxygenate, ventilate, monitor

- Reassess for:

- Respiratory failure

- Shock

- Obtain vascular access