Question

•Nada is an Emergency Medical Responder. She is socializing with some friends when a woman nearby is knocked to the ground by a person on a bicycle. The woman was carrying her small child (approximately two years of age), who has been knocked out of her arms and has landed on the ground. The woman asks for help and Nada responds

1· Demonstrate the initial assessment of the pediatric casualty.

2· Demonstrate the secondary assessment of the pediatric casualty

3· Demonstrate the assessment of complaint, history and pain of the pediatric casualty

Answer 1

Ans:

1. Initial assessment of pediatrics casualty-

-children havewas fat, more elastic connective tissues and a pliable skeleton protecting tightly packed abdominal and thoracic structure.

-The force of an impact is transmitted widely through a child's body , resulting in multisystem injuries in almost 50% of children with serious trauma.

- Initial assessment include assessment of(ABCDE)-

1). Airway-

It involves determine the ability of air pass unobstructed into the lungs. If the level of consciousness ii s depressed the child may not be able to maintain airway and having risk of aspiration because of loss of gag reflex due to trauma.

2). Breathing

Evaluate breathing to determine the child ability to ventilate and oxygenate.

Anticipate respiratory failure if any of the following sign present- tachypnea

- bradiapnea

- cyanosis

3). Circulation-

Vascular access , hearing heart sound for checking condition of heart is important.

4). Neurological response-

Many trauma cause for severe neurological loss of child, hence neurological response check by evaluating reflexes.

5). Identification of disability-

According to the assessment and type of injury identification of disability is important, it helps to carry out further management.

2. Secondary assessment of pediatrics casualty-

Secondary assessment consists of a medical history and a physical assessment.

The medical history is obtained using the SAMPLE mnemonic looking for information on what caused the pediatric emergency.

S stand for signs and symptoms

A stand for allergies

M stands for medicines that the patients is currently taking

P stands for past medical history

L stand for last meal

E stands for the event leading up to this emergency.

A complete but rapid physical assessment is then performaned to look for and begin to treat additional causes of the illness or injuries.

This is complete secondary assessment.

3). Assessment of complaints, history and pain of the pediatric casualty-

*Assessment of complaints-

- With complete physical examination, checking neurological responses we can find out complaints of child.

- if child able to speak then he can explain his complaint but if child unable to speak then we can find out his complaint with his behaviour, crying pattern and physical examination.

* Assesment of history-

- It includs general medical history, pediatric medical history, birth and development history, immunization history, and further social details.

- History can collected by parents or guardians, child who able to give information.

* Assessment of pain in child-

- pain is difficult to measure accurately and reliably in children.

- to help determine the presence and level of pain the following should be observed in conjunction with self report.

a. Behavioural signs

b. Physiological signs.

- pain assessment tools -

1. Numerical rating scale

Self reporting pain tool used 5year age and above. On a scale 0-10 , with 0 no pain and 10 worst pain.

2. The faces pain scale revised-

Self report tool for children ages 3 years and above . In that point to the face shows how much u hurt.

3. FLACC-

Face , Legs, Cry ,Consolability

-It shows how much child feel pain with these parameters.

4. The revised FLACC-

The nurse should review the section in italics with parents for additional behaviour and indications of the child's pain.