KEGAWATDARURATAN

PEDIATRIC & TERAPI CAIRAN PADA ANAK

Agus Fitrianto

Divisi Emergensi dan Rawat Intensif Anak (ERIA)

RSMS – FK UNSOED Purwokerto
 Learning Outcomes
 EARLY DETECTION
 EARLY INTERVENTION
 EARLY STABILIZATION ON PEDIATRIC
CRITICALLY ILL

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 GENERAL ASSESSMENT
PEDIATRIC ASSESSMENT TRIANGLE (PAT)
ABC - Hands off - <60 seconds
• Appearance
• Work of Breathing
• Circulation

The Pediatric Assessment Triangle (PAT)

Appearance is assessed as follows:
Tone
Interactivity
Consolability
Look/gaze
Speech/cry
Work of Breathing (WOB) assessment as
follows:
Abnormal breath sounds
Abnormal positioning
Retractions
Nasal Flaring
Circulation assessment includes the following:
Pallor
Mottling
Cyanosis
Bleeding
 Respiratory Effort

Retraction The Sniffing Position The Tripod Position

Frekuensi Nafas menurut Umur

Year RR
(x/minute)
<1 30-40
2-5 20-30
5-12 15-20
>12 12-16
 GENERAL ASSESSMENT
PEDIATRIC ASSESSMENT TRIANGLE

The PAT quickly form a general impression (<60 seconds):

1. If the child is "sick" or "not sick" ?
apparent life-threatening condition or not
2. Determine the underlying physiological abnormality

The general assessment is a critical starting point for

pediatric resuscitation, the PAT helps us make timely
decisions
Distress pernafasan syok

 N N
N

N N
Disfungsi syaraf pusat/
abnormalitas metabolik Gagal nafas

N N N /

N N
 Physiologic Categories

1. Stable

2. Primary Brain Dysfunction

3. Respiratory Dysfunction
Potential respiratory failure
Probable respiratory failure
4. Shock
Compansated
Decompensated
5. Cardiopulmonary Arrest
PRIMARY ASSESSMENT
Hands-on systematic approach
Determining life-threatening abnormalities
Primary Assessment using an ABCDE approach

A - Airway
B - Breathing
C - Circulation
D - Disability
E - Exposure
SECONDARY ASSESSMENT
A more detailed physical exam.
Includes a focused history taught by the
mnemonic SAMPLE:
S - Signs and symptoms
A - Allergies
M - Medications
P - Past medical history
L - Last meal
E - Events leading to current illness
TERTIARY ASSESSMENT
Diagnostic studies to help aid in the identification
and severity of the child's condition.

Laboratory studies such - point-of-care testing

(POCT) blood glucose, arterial blood gas (ABG),
CBC, a basic metabolic panel and a lactic acid level

Imaging studies, include radiography, CT scanning,

and ultrasonography
 General assessment
Pediatric Assessment Triangle
Hands off – only <1 minute

Followed by
Primary Assessment
ABCDE of Resuscitation
Hands on – after 1 minute

SECONDARY ASSESSMENT
Signs and symptoms
Allergies
Medications
Past medical history
PAT Last oral intake
Events leading to the injury or illness
Pediatric Assessment Triangle (PAT)

Signs and
symptoms
Allergies
Medications
Past medical
history
Last oral
intake
Events
leading to the
injury or
illness
Primary Assessment
 Heart Rate

Umur HR
0 – 3 month 85 – 200 x/minute

3 month – 2 yr 100 – 190 x/minute

2 – 10 yr 60 – 140 x/minute
Central & Dystal Pulse
 Minimal Systolic BP

Years Percentil 50 mmHg

Systolic BP

0 – 1 month 60

> 1 month – 1 yr 70

> 1 yr 70 + (2 x n year)
SECONDARY ASSESSMENT
SYSTEMATIC APPROACH
 Evaluate
 Primary Assessment
 Identify
 Secondary Assessment
 Focused Exam SAMPLE
 SAMPLE History SAMPLE History
 Intervene Signs and symptoms
 Diagnostic Tests Allergies
 Tertiary Assessment Medications
Past medical history
Don’t forget PPE Last oral intake
Personal Protective Equipment Events leading to the injury or
Alat Pelindung Diri (APD) illness
 BASIC LIFE SUPPORT
• "Public Access Defibrillation" (PAD)
• Automatic external defibrillators (AEDs) are
now commonly found in many public locations
• High-quality CPR
• The switch from the sequencing of airway,
breathing, compressions (ABC) to
compressions, airway, breathing (CAB).
 BASIC LIFE SUPPORT
High quality CPR
Compression rate at least 100/min
Compression depth to at least one third of the
anterior-posterior diameter of the chest
(approx 4 cm in infants and 5 cm in children)
Complete chest recoil after each compression

Minimized interruptions in chest compressions

Avoidance of excessive ventilation

 Pediatric Basic Life Support
 Foreign Body
 Near Drowning
Pediatric Advanced Life Support
 Vascular Access
 Airway Management
 Pulseless Arrest
 Bradyarrythmias
 Tachyarrythmias
: BROSELOW TAPE
 Syok Pada Anak

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 Oxygent Delivery & Oxygen Content

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 Hemodynamic Orchestration

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 Haemodynamic Assessment Post
Resuscitation

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 Severe dehidration

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 Kejang pada Anak

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 TERIMAKASIH

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