Bonner County EMS SystemAssessment and Documentation Guidelines

Pediatric Assessment- 2050

Pediatric assessment

Scene Size-up and General approach

A. Scene Size-Up

1. Note anything suspicious at the scene (i.e. medications, household chemicals,

other ill family members etc.

2. Assess for any discrepancies between the history and the patient presentation

(e.g. infant fell on hard floor but there is carpet throughout the house).

B. General Approach to the Stable/ Conscious Pediatric Patient

1. Utilize the PAT (Pediatric Assessment Triangle) to gain a general impression

of the child.

2. Assessments and interventions must be tailored to each child in terms of age,

size and development.

  1. Smile, if appropriate to the situation.
  2. Keep voice at an even, quiet tone- do not yell.
  3. Speak slowly. Use simple age appropriate terms.
  4. Keep small children with their caregiver(s) whenever possible and complete assessment while the caregiver is holding the child.
  5. Kneel down to the level of the child if possible.
  6. Be cautious in the use of touch. In the stable child, make as many observations as possible before touching (and potentially upsetting) the child.
  7. Adolescents may need to be interviewed without their caregivers present if accurate information is to be obtained regarding drug use, alcohol use, LMP, sexual activity or child abuse.
  8. Observe general appearance and determine if behavior is age appropriate.
  9. Observe for respiratory distress and evidence for pain.
  10. Evaluate the position of the child.
  11. Evaluate the level of consciousness.
  12. Evaluate muscle tone (normal vs. limp).
  13. Assess movement (spontaneous, purposeful, symmetrical).
  14. Evaluate color (pink, pale, cyanotic, mottled).
  15. Observe obvious injuries, bleeding, bruising, deformities etc.
  16. Determine weight (ask caregiver or use Broselow tape).

INITIAL ASSESSMENT

A. Airway access/ maintenance with C-Spine control

1. Maintain with assistance/ positioning.

2. Maintain with adjuncts (nasal or oral airway).

3. Maintain with endotracheal tube.

4. Listen for audible airway noises (stridor, snoring, gurgling, wheezing).

5. Patency: suction secretions as necessary.

B. Breathing

1. Rate and rhythm of respirations; compare to normal rate for age and situation.

2. Chest expansion-is it symmetrical?

  1. Breath sounds-compare both sides and listen for normal and abnormalsounds.
  2. Positioning-evaluation of possible sniffing position, tripod position
  3. Work of breathing-evaluate retractions, nasal flaring, accessory muscle use, head bobbing, grunting.

C. Circulation

1. Heart Rate- compare to normal rate for age and situation.

2. Central pulses (e.g. brachial, carotid, femoral)- strong, weak or absent.

3. Distal/ Peripheral pulses (radial)- present or absent, thready, weak or strong.

  1. Color- pink, pale, flushed, cyanotic, mottled.
  2. Skin temperature- hot, warm, cool, or cold.
  3. Blood pressure- use appropriately sized cuff and compare to normal for age.
  4. Hydration status- observe anterior fontanel in infants, mucous membranes, skin turgor, crying tears, urine output, history to determine recent intake.

D. Disability- Brief neurological examination:

1. Assess responsiveness- APGAR or TICLS

2. Assess pupils

3. Assess for transient numbness/ tingling

E. Expose and Examine

1. Expose the patient as appropriate based on age and severity of illness.

2. Initiate measures to prevent heat loss and keep the child from becoming

hypothermic.

RAPID ASSESSMENT VS. FOCUSED HISTORY AND PHYSICAL ASSESSMENT

A. Tailor assessment to the needs and age of the patient.

B. Rapidly examine areas specific to the chief complaint.

C. Responsive medical patients:

1. Perform focused assessment based on chief complaint.

2. A full review of systems may not be necessary. If the chief complaint is

vague, examine all systems and proceed to detailed exam.

D. Unresponsive medical patients:

1. Perform rapid assessment (i.e. ABCs & a quick head-to-toe exam).

2. Render emergency care based on signs and symptoms, initial impression and

standard operating procedures.

3. Proceed to detailed examination.

E. Trauma patients with no significant mechanism of injury:

1. Focused examination is based on specific injury site.

F. Trauma patients with significant mechanism of injury:

1. Perform rapid assessment of all body systems and then proceed to detailed

examination.

DETAILED ASSESSMENT

A. Sample Assessment

1. SAMPLE history- acquire/ incorporate into physical examination.

2. Vital Signs (pulse, BP, respirations, skin condition, pulse oximetry)

3. Assessment performed (usually enroute) to detect non life-threatening

conditions and to provide care for those conditions or injuries.

ONGOING ASSESSMENT

A. To effectively maintain awareness of changes in the patient’s condition

1. Repeated assessments are essential and should be performed at least every 5

minutes on the unstable patient, and at least every 15 minutes on the stable

patient.

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BCEMS Medical Director

Effective: 01/01/16final 10/2/2018 page 1of 3