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Pokok Bahasan : GAWAT DARURAT ANAK

Prof. Dr. Purnomo Suryantoro



1. Penilaian Anak Gawat Darurat

1. PAT (Appearance, Work of breathing, Circulation of skin)
2. ABCDEs
Appearance (Tickles=TICLS)
Tonus
Interactiveness
Consolability
Look/Gaze
Speech/Cry
Work of Breathings
Abnormal airway sounds
Abnormal positioning
Retractions
Nasal flaring
Respiratory Effort: Retraction, Te sniffing Position, The Tripod Position
Circulation to Skin
Pallor
Mottling
Cyanosis











8esplraLory uysLress
Respiratory Dystress
N
N

Shock
N
N
N






















The ABCDEs (Airway - Breathing- Circulation - Disability Exposure)
1. Airway Assessment
- Clear
- Maintainable
- Unmaintainable without intubation
- Obstructed
2. Breathing Assessment
- Rate
- Effort I mechanics
- Air entry
- Skin color

Respiratory Rate by Age:
Age (years)
<1
2-5
5-12
>12
Respiratory rate (breaths per minute)
30-40
20-30
15-20
12-16

3. Clation Assessment
- Heart rate
- Systematic perfusion
Primary CNS dysfunction/metabolic
abnormality
N
N
N
Cardiopulmonary failure
N
N

Peripheral pulses
Skin perfusion
Appearance
(Urine output)
- Blood pressure
Heart Rate by Age:

Age
Newborn - 3 mos
3 mos - 2 yrs
2 - 10 yrs
Range
85 - 200bpm
100 - 190 bpm
60 - 140bpm


Skin Perfusion
- Extremity temperature
- Capillary refill
- Color :
Pink
Mottled
Pale
Blue

Minimal Systolic Blood Pressure by Age
Age
0 1 Mo
>1 mo 1yr
>1 yr
Fifth percentile systolic BP (mmHg)
60
70
70 + (2 x age in years)

4. Disability (neurologic status)
- Cerebral cortex
- Brain Stem
- Motor activity
Level of Consciousness
- A = Awake
- V = Responsive to voice
- P = Responsive to pain
- U = Unresponsive
Brain Stem
- Posture
- Central respiration
- Pupil response
- Cranial nerve
Motor Activity
- Symmetrical movements
- Seizures
- Posturing
- Flaccidity
5. Exposure
- Skin rashes
- Bruises
- Excoriation, etc.
Classification of Physiologic status
- Stable
- Respiratory dysfunction:
- Potentially respiratory failure
- Probable respiratory failure
- Shock: compansated, decompensated
- Cardiopulmonary failure
Definition of Cardiopulmonary Faikure
Dificits in:
- Ventilation
- Oxygenation
- Perfusion
Resulting in:
- Agonal respiration
- Br
Priorities in Initial Management of Stable Child
- begin further workup
- provide specific therapy as indicated
- Reassess frequently
Priorities in Initial Management of Respiratory Dysfunction
Potential Respiratory Failure
- Keep with caregiver
- Position of comfort
- Oxygen as tolerated
- Nothing by mouth
- Monitor pulse oximetry
- Consider cardiac monitor

Probable Respiratory Failure
- Separate from caregiver
- Control airway
- 100 % FiO2
- Assist ventilation
- Nothing by mouth
- Monitor pulse oxymetry
- Cardiac monitor
- - Establish vascular access

Priorities in Initial Management of Shock
- Administer oxygen (Fi02 = 1.0) and ensure adequate airway and ventilation
- Establish vascular access
- Provide volume expansion
- Monitor oxygenation, heart rate, and urine output
- Consider vasoactive infusions
Priorities in Initial Management of Cardiopulmonary failure
- Oxygenate, ventilate, monitor
- Reassess for:
- Respiratory failure
- Shock
- Obtain vascular access

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