Ill or Injured Child Systematic Approach

When assessing an ill or injured child, your goal is to recognize conditions quickly, especially if they're life threatening or could become life threatening if care and treatment are not provided as soon as possible.

In this lesson, we'll go over this systematic approach to assessing a child in these circumstances. And we'll provide tips and details for this approach. An approach that can best be summed up this way: Evaluate, identify, and intervene.

If you find that the child isn't breathing and doesn't have a pulse, begin full CPR and rescue breathing immediately. If the child has a pulse and is breathing, there are still some important signs to look for including:

• Respiratory distress
• Respiratory failure
• Signs of shock

These are the most common issues for pediatric patients that can quickly deteriorate into respiratory arrest and eventually cardiac arrest.

Evaluate, Identify, Intervene

This is the big picture approach to helping an ill or injured child. It includes recognizing any life-threatening emergencies and intervening with the proper treatment.

However, if there aren't any immediate life-threatening issues, you'll move on to your initial and primary assessment that will focus on medical history and a physical exam to evaluate for any secondary conditions that may need to be addressed.

Evaluation tools you might want to use include lab tests, radiographic tests, and other advanced tests. But to begin your assessment, you'll use a systematic approach in order to be more consistent and to reduce the chances of missing something important.

Form an Initial Impression

The first thing you'll want to do is quickly observe the child for anything obvious. Evaluate their appearance, breathing, and circulation. Doing this should help you determine if there is an urgent need for care and to recognize any life-threatening issues.

Perform a Primary Assessment

When performing your primary assessment, and after your shouts and taps, if the child is still unresponsive, call for help immediately and activate EMS.

Check for Pulse and Signs of Breathing

If the child isn't breathing, but has a pulse, begin rescue breathing – 1 breath every 3 seconds. If the child isn't breathing and has no pulse, begin full CPR.

Overall Appearance

While evaluating the overall appearance of a pediatric patient, there are a few things to look for:

1. Look at the child's ability to interact and level of consciousness.
2. Look at the child's eyes. Do you notice an unusual stare or gaze, like the child isn't all there mentally? Does the child appear to be looking through you, rather than at you?
3. Look at the child's reactions. Does the child appear to be in any pain?
4. Look to see if the child is acting normally. How is their body position, verbal responses, or the reactions we noted above?

Effort When Breathing

Does the child appear to be having trouble breathing? Look first at their body position, then the amount of accessory muscle tone, and finally audible sounds of breathing that can be heard without a stethoscope.

Body Position

Is the child in what we call a tripod position – leaning forward with their hands on their knees. This is usually done to keep pressure off the lungs and diaphragm, which makes labored or inadequate breathing a little more easily accomplished.

Accessory Muscle Tone

Do you see any signs of retractions, nasal flaring, or signs of accessory muscles being used to aid breathing?

Audible Sounds of Breathing

Do you hear stridor or unusually deep or shallow respirations, wheezing, grunting, or crackles? If you see any of these signs of respiratory distress, don't delay. This is an emergency situation that can quickly lead to respiratory arrest in a child.

Circulatory Status

This is the last step of your initial assessment and one that you'll use the child's overall color to determine. Ask yourself, does the child have pale, mottled, or cyanotic looking skin?

If you notice a strange complexion that you suspect may be due to cyanosis, look at the mucous membrane on the inside of the child's lips, their fingertips, or their nailbeds.

Cyanosis of the lips and fingernails are early signs of circulatory compromise and oxygenation issues and symptoms that the child has inadequate oxygen in their blood.

If the child has a flushed appearance, this could indicate fever or shock. If the child has bruising on their skin, this could indicate an injury and/or internal bleeding. The idea of this systematic approach is to quickly assess how well the child is perfusing through your observation.