A--如何做好儿童评估.ppt

兒童評估三角:中樞神經系統/代謝異常 外觀 異常 呼吸 正常 循環 正常 * 第三十一页，编辑于星期二：十七点 三十二分。 病情進展 臆斷: 中樞神經或代謝異常 處置順序: 給氧, 密切監視換氣狀況. 打針輸液, 快速血糖測試. 執行理學檢查. 抽血檢驗, 培養, 代謝方面的檢驗. 安排腦部電腦斷層, x光. * 第三十二页，编辑于星期二：十七点 三十二分。 產生臆斷 應用兒童評估三角結果 - 對應急診常見疾病 小兒與成人的疾病不同 * 第三十三页，编辑于星期二：十七点 三十二分。 運用兒童評估三角結果對應急診常見疾病 整體外觀 呼吸功能 循環功能 生理狀態整體考量 可能病因 異常 正常 正常 原發性腦功能障礙 代謝問題 嬰兒晃動徵候;腦傷;敗血症;低血糖;中毒 正常 異常 正常 呼吸窘迫 輕微氣喘;細支氣管炎;哮吼;肺炎;異物梗塞 異常 異常 正常 呼吸衰竭 嚴重氣喘;肺銼傷;胸部穿刺傷 正常 正常 異常 代償性休克 腹瀉;失血 異常 正常 異常 非代償性休克 嚴重腸胃炎;嚴重燒傷;嚴重鈍傷;顏重腹部穿刺傷 異常 異常 異常 心肺衰竭 心肺停止 * 第三十四页，编辑于星期二：十七点 三十二分。 * * Pediatric assessment is an integral part of the evaluation of a pediatric patient. It is the assessment that determines initial and subsequent management. * * Distinguish the three components of the Pediatric Assessment Triangle (PAT). Assess pediatric-specific features of initial assessment. Integrate findings to form a general impression. Describe the focused history and physical exam (PE). * * The Pediatric Assessment Triangle (PAT) is an observational first impression before touching the patient. What you see and hear as you first encounter the patient can allow you to formulate a visual and auditory first impression. It tells the experienced clinician how to prioritize further assessment. It determines life-threatening emergencies that need immediate attention. Identifies the general category of physiologic abnormality, which formalizes the general impression Establishes severity of illness Determines urgency of interventions The PAT can be completed in seconds and is based on three categories of observations: Appearance (mental status) Work of Breathing Circulation to the Skin * * Appearance reflects adequacy of ventilation, oxygenation, brain perfusion, body homeostasis, and central nervous system (CNS) function. The “tickles” (TICLS) mnemonic helps to recall observations that give a general impression of appearance. Tone: Is there normal motor movement? Is the infant/child limp and listless, or moving vigorously? Interactiveness: Is the p