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DR - Reni SpA - Rujuk Pasien Anak

The document discusses pediatric early warning systems (PEWS) and transporting sick children. PEWS provide a standardized assessment of a child's clinical status in the hospital and can help identify those deteriorating who may need ICU care. When referring or transporting a sick child, it is important to fully assess and stabilize the patient, communicate clearly between teams, and provide ongoing care during transport to ensure the safest outcome. Proper preparation, equipment, and following transportation principles are also essential for referring the child to the appropriate level of care.

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Adisyari Puri Handini
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50 views21 pages

DR - Reni SpA - Rujuk Pasien Anak

The document discusses pediatric early warning systems (PEWS) and transporting sick children. PEWS provide a standardized assessment of a child's clinical status in the hospital and can help identify those deteriorating who may need ICU care. When referring or transporting a sick child, it is important to fully assess and stabilize the patient, communicate clearly between teams, and provide ongoing care during transport to ensure the safest outcome. Proper preparation, equipment, and following transportation principles are also essential for referring the child to the appropriate level of care.

Uploaded by

Adisyari Puri Handini
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Pediatric Early Warning System

and Transport for Sick Children


Reni Wigati
Pediatric Intensivist
Secretary of Scientific Affair –
Indonesian Pediatric Society DKI Jakarta
Conflict of Interests
• Nothing to declare
Outlines
• Pediatric Early Warning System
– What is PEWS?
– When and where does PEWS is needed?
– How to do PEWS?
• Transport for Sick Children
– When and why do we refer the patient?
– How do we ideally transport sick children?
Introduction
Children who are clinically deteriorating
• Timely identification
• Accurate treatment
• Referral system
Decreased
numbers of:
Improving Outcomes - Code blue
- Emergent
intubation
Failure to Rescue
• Failure to rescue is defined as inability to save
patient’s life by
– Not recognizing deterioritation
– Failing to take action to reverse changes
Pediatric Early Warning System
• Developed to provide a reproducible
assessment of a child’s clinical status while
hospitalized
• Later studies found that elevated PEW score is
associated with need for ICU admission
directly from ED and as a transfer
Age Respiratory rate Heart rate Systolic BP (mmHg)
Neonate (< 4 weeks) 40-60 120-160 >60
Infant < 1 yo 30-40 110-160 70-90
Toddler 1-2 yo 25-35 100-150 75-95
Preschool 3-4 yo 25-30 95-140 85-100
School 5-11 yo 20-25 80-120 90-110
Adolescent 12-16 yo 15-20 60-100 100-120

APLS, 2007
Pediatric Assessment Triangle
Appearance
• T – one
• I – nteractability
• C – onsolability
• L – ook/gaze
• S – Speech/cry
Work of breathing
• Abnormal airway
sound
• Abnormal
positioning
• Retraction
• Flaring
Circulation
• Pallor
• Mottling
• Cyanosis
Respiratory Distress Shock

Primary Brain Cardiorespiratory Failure


Dysfunction/Metabolic
Disorder
Primary Assessment

Airway • Look, listen, and feel

Breathing • Rate according to age, respiratory effort


• Oxygen saturation

Circulation • Heart rate, blood pressure, pulse quality


• Capillary refill time

Disabilty • (A)alert (V)verbal (P)ain (U)unresponsive / GCS


• Brainstem function, motoric assessment

Exposure • Prevent hypothermia


• Rash, hematoma, jaundice
When Do We Refer?
• Situation: Identify the situation you are calling
about
• Background: Provide pertinent background
information about the situation, diagnosis,
medications, vital signs, lab results, code
status
• Assessment: What is the assessment of the
situation?
• Recommendation: What do you want?
Where to Refer?
• Intensive care unit
• High care unit
• Intermediate ward
• Ward
• INTRA or INTER-HOSPITAL transport
Transportation of Sick Children
A • Assessment
• Accurate and complete information

C • Control
• Team work and clear job description

C • Communication
• Local team, transportation team, and consulted team

E • Evaluation
• Reconfirmation on the urgency and needs

P • Preparation and packaging


• ABCDEs of the patient and safety of the equipments

T • Transportation
• Air, land, or water transportation
Transportation Priciples
• Right patient Important notes
• Right time Stabilized the patient
• Right officers BEFORE transporting him
to the referral care
• Right referral
• Right mode of transportation
• Right care during the whole process
Transportation of Sick Neonates
• S – ugar
• T – emperature
• A – irway
• B – lood pressure
• L – ab work
• E – motional support

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