Rapid General Assessment

Rapid General Assessment Recognition of Respiratory Failure and Shock

Objectives

At the end of this session, participants will be able to: • Perform a rapid cardiopulmonary assessment • Recognize signs of distress or respiratory failure and shock

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Respiratory failure and shock Variables

Respiratory failure

Shock

Cardiopulmonary failure Cardiovascular arrest

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Survival after cardiovascular arrest in children 100%

50%

0%

Respiratory arrest

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Cardiovascular arrest

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General assessment: systematic approach

Appearance

Respiratory work

Circulation

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PAT: Appearance

• • • • •

Rapid General Assessment

Muscle tone Interactivity Consolability Looks and follows with gaze Talks or cries

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PAT: Respiratory work

• Increased respiratory work: nasal flaring, intercostal retractions • Decreased or absent respiratory work • Abnormal respiratory sounds: wheezing, grunting or stridor

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PAT: Circulation

• Abnormal skin colour: pallor and mottled skin • Bleeding

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Is the condition life-threatening?

If yes, at any time Start the resuscitation manoeuvres

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Primary assessment Airways

Breathing

Circulation

Exposure

Disability

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Airways

The airways are patent: • spontaneously • with simple manoeuvres • with advanced manoeuvres

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Breathing

• Respiratory rate: tachypnoea – bradypnea – apnoea • Respiratory effort: nasal flaring, intercostal retractions, head movements and abdominal breathing • Tidal volume: amplitude of rib cage excursions and thoracic auscultation • Abnormal sounds: stridor, grunting, gurgling, hissing, crackling.

• Pulse oximetry

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Circulation

• Cardiovascular function: skin colour and temperature, heart rate, heart rhythm, blood pressure, central and peripheral pulses and capillary refilling time • Perfused organs function: cerebral perfusion, skin perfusion, and renal perfusion

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Disability

• AVPU scale • Glasgow coma scale • Pupillary light reflex

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Exposure

• Undress the child and evaluate every single part of the body • Assess internal and external temperature • Complete the clinical examination

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Secondary assessment

• Targeted history • Targeted clinical examination

S. A. M. P. L. E.

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SAMPLE

• Signs and symptoms: difficulty breathing, fever, diarrhoea and vomiting, fatigue…

• Allergies: drugs, latex and food…

• Past medical history: physiological and pathological history…

• Last meal: time and type…

• Events: causative and co-occurring events

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To sum up

• PAT: general assessment • ABCDE: primary assessment • SAMPLE: secondary assessment

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