Capillary refill time is typically quite accurate in children and considered to be reliable in most cases. Healthy children do not have the vascular disease adults do; therefore, their capillary blood flow is very responsive. Just as in the adult patient, environmental factors like cold ambient temperatures can influence capillary refill times. For this reason, capillary refill time should be assessed closer to the core in areas like the kneecap or forearm. Normal capillary refill time is less than two to three seconds.
The AVPU scale is a universally accepted method for determining the degree of mentation in both adults and children. An additional method of determining mentation in a noncommunicative child is the TICLS (pronounced tickles) scale (Table I).
A final method used for determining mentation is the pediatric Glasgow Coma Score or PGCS (Table II). It is important to note that the standard GCS model must be modified in the noncommunicative child.
Some children, regardless of what is done for them, will get sick and die. Fortunately, this is more rare than regular. An EMS provider who appropriately assesses a sick child with a potential to survive will be able to identify life-threatening conditions and manage those conditions. The most common cause of pediatric death is hypoxia. A hypoxic child without proper intervention will ultimately experience cardiovascular collapse and eventually death.
Most healthy children have no difficulty in maintaining normal cardiovascular function until and unless they become extremely hypoxic. EMS providers must understand that the most effective management processes require an understanding of why children present in the way they do. If an assessment is not thorough and accurate, a child may continue to deteriorate. Assessment is the key to pediatric management.
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Pediatric Assessment (PDF)Valid until July 3, 2006
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