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
Rapid General Assessment
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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
Rapid General Assessment
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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