Beyond the Basics: Pediatric Assessment

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.

Disability
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.

Summary
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.

CEU Review Form
Pediatric Assessment (PDF)Valid until July 3, 2006

Bibliography
American Academy of Pediatrics and American College of Emergency Physicians. APLS: The Pediatric Emergency Medicine Resource, 4th Edition. Sudbury: Jones and Bartlett, 2004.
American Academy of Pediatrics. Pediatric Education for Prehospital Professionals. Sudbury: Jones and Bartlett, 2000.
American Heart Association. PALS Provider Manual, American Heart Association, 2002.
Bledsoe BE, Porter RS, Cherry RA. Paramedic Care: Principles and Practice. Volume 2. Patient Assessment, 2nd Edition. Upper Saddle River: Prentice-Hall, 2006.
Bledsoe BE, Porter RS, Cherry RA. Paramedic Care: Principles and Practice. Volume 5. Special Considerations, 2nd Edition. Upper Saddle River: Prentice-Hall, 2006.
Dietrich AM, Shaner SJ, Campbell JE. Pediatric Basic Trauma Life Support, 2nd Ed. Oak Terrace: Basic Trauma Life Support International, 2002.
Eckstein M. Out-of-hospital pediatric airway management. Ann Emerg Med 44(2):181–182, 1 Aug 2004. Author reply 182-3 retrieved from MDConsult.com, March 13, 2006.
Gershel EF. Clinical Manual of Emergency Pediatrics. New York: McGraw-Hill, 2003.
Jaimovich DG, Dharmapuri V. Handbook of Pediatric and Pediatric Transport Medicine, 2nd Edition. Philadelphia: Hanley and Belfus, 2002.
Krost WS. Deadly defects: Managing the pediatric patient with a congenital heart defect. Emerg Med Serv 32(7):55, 2003.
Krost WS. Pediatric pulmonary emergencies. Emerg Med Serv 33(1):71, 2004.
Levin DL, Morris FC. Pediatric Intensive Care. New York: Churchill-Livingston, 1997.
Limmer DL, Krost WS, Mistovich JJ. Pathophysiology of asthma. Prehospital Pathophysiology. Emerg Med Serv 33(4):48, 2004.
Gausche-Hill M, Lewis RJ, Stratton SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: A controlled clinical trial. JAMA 283:783–790, 2000.
Markenson DS. Pediatric Prehospital Care. Upper Saddle River: Brady-Prentice Hall, 2002.
Martini FH, Bartholomew EF, Bledsoe BE. Anatomy and Physiology for Emergency Care. Upper Saddle River: Pearson Education, 2002.
Park MK. Pediatric Cardiology for Practitioners, 4th Edition. St. Louis, MO: Mosby, 2002.
Siberry GRI. The Harriet Lane Handbook. St. Louis, MO: Mosby, 2000.
Taussig LM, Landau LI. Pediatric Respiratory Medicine. St. Louis, MO: Mosby, 1999.
Tintinalli JE. Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill, 2000.