Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Well, yeah. Okay, so we want to dioca talk just thinking about Hae. Do we recognize a sec? And so really, this is the bad boats. You know, the under five should be sent to share three from reception for a quick able as they arrive in to the e D. On. So these are the Children that are brought through and they stand at the desk on D, and sometimes people are actively trying to avoid, like on that, And But really, it's up to his old and someone needs to go over, and that's a quick able to check of the child. Doesn't try to look sick or not sick. Okay? And we want to talk about what that means. On go, I can. Just Like I said, we better like the rabbit in the headlights and trying to identify a sec child and not missing a sec child, which is really what we're trying to walk. So I suppose what we're talking about is the got in saint cases that that kind of gotten to like when you look at child or any patient on do your got kind of think the, um, about the heart. Second feeling that you know, with this child or this patient is really, really sick. But actually, it's very, very difficult to define what that means or what that is on there for us. Really difficult to teach what it is or what it means. So what, this with em talk it's gonna be about. It's just trying to tease out some of the things that go into that got understand some of the things that we can actually work on and try and improve to improve our got. Understand, um, to make that more structured. Uh, the bottom line here is that never ignore your gotten things. Never, ever ignore it. Okay, so the first time kind of thing to say is to use your eyes. So observation is a real scale, as we all knew on, especially in pediatric and energy investments. So write all that we use our eyes and on probation. Trust what you see. And the history itself might be quite vague. Um, it might be quite vague symptoms that the parents were telling in child's having, and but look at the child in front of you. Use your eyes. They're telling the diet is, um vomiting on anything doing. But they're not like a quiver gentleman. Then they're probably all right. The problem, that's like. And if Mom and Dad have to put him away from the Tories in the waiting room, bring them at it, then they're probably okay. Most Children, when they're seriously oh, gets continually worse and worse. They don't tend to fluctuate between being second, not sick. Yeah, So use your eyes, your eyes Have a look at the child and look at the parents on. Look at the interaction between the parents and the child years. Well, listen to what you're here but also taught you don't hear So you born cry. That's from the waiting room. Um, always practice my ears up because we know we've got a new break, a slightly higher threshold of concern. I try to do with rational to be concerned and listen to what you don't hear. So lesson Teo that time that's getting to be M check and the triage room. That's no crying. That's quite happened. Our triage nurse TOB M. Journey triangle. So this is Ah, it's kind of confusion because it says ABC, and so we think it means a primary survey, which is not really what I was. Okay, Pick Africa and developed by the Americans. And 2000, and it was designed and at for training course for part medics working and again a community. And it was designed as a quick glance, very quick glance. No hands on the hands off assessment to try. And then if I touch Children that were sick, Okay, we're going over three or we've excites think it's quite helpful to try and take some of things that we're trying to see about that. And first look, recognizing that trial is sick. Okay, so a in this one, it's no area. It's a it's for appearance. But B is for breathing and sees for circulation. Okay, so you kind of have to bear with that we because it does get it confused. But this is not a primary survey. This is a honzo off eyes on years only approach. Okay, Once we think about each of these three things in isolation, then we're putting together we get an 80 year off home. Well, child is what might be wrong with, um So your ears, first of all, is splitting. Teo, five of five different things. Okay, I'm gonna go through them each and we got the pill. So it's tone interactive. Nous, controllability, look or g is on speech or cry. Okay, so just just things that we will be probably notice without really thinking about it. I'm overdoing Here is a paper, Okay, but I think it does help the just on. But it's a great lines. The first thing is too old. Are the unusually floated that or they're just hanging limp and moment, That's arms. Can you look in this child? I'm thinking for their age, Really like appropriate, you know? So And if it's two year old, are they unable to hold myself upright? Are they sue and, well, they're just flopping in online by Remember that roughly to develop my stones? We say that six months Sheldon should be able to set up on support their own hands and crawling rains. He, at 9 10 months and then walking by year, told first of all, an interactive us. This's a sounds off assessment. Was a child looking around them? Are they pretty attractive? Unless mommy and daddy or the the the terrified of the triage nurse and remember, but by a 0.2 months of age babies are starting to smile. Um, take you three months return to smile and interact with mom and Dad and probably won't get it. Smiles at that stage. Um, I'm by year. They're able to take an object up full a full around the room with her authorize that people turn their hands to do that. Okay. There's no interacting with running. They're just not interested. Interested in you, Teddy bear that you've given it not impressive than Mom. We're diehard on day, just being quite less less you not. I'm not watching what's going on. Those are the kids that want to be more concerned about. It's all about, like, next case of Children cry a lot time, eh? So for those of you that are parents, even without Children, cry because you brush their hair and they cry because you don't brush their hair and crying because you give them cereal on the crime because you don't give him cereal. Okay, But the normal, the normal cry as a cry. That's consolable so and when they cry because you haven't brushed the hair the way they want to arrest the hair They can get money and have a hug on speaking because of all of them, Like cry stops on. So for these we want to make a mandatory eyes and they get bm check on me cry when the when the blood sugar second, Um, after five minutes or 10 minutes moment that should be able to get that child console. Seldom own Normally haven't taken the food, Onda the child will Will will sell down okay. And if they can't? If If the child comes in and just write from arrival on the at the whole time They're just screaming and crying. Mom and Dad are trying everything the Countess out I'm doing, but I can't get them controlled. Then there's some not something to be worried about It okay, Last quite often. Pee and drives that well, look and years. Okay, So, um yeah, so absolutely your teenager you might expect to just be given often toe the distance and not seem to interest in what's going on. Okay, but no, that that wouldn't be classes number for a three year old. Okay, so the we're ones, the infants are dead. And address that in the show and they were watching everything that's going on. And when that when they're they're well on their in tract. Okay, um, on last, you've got their favorite cartoon on on on the phone Or the reason the fever up food for my dolls. Okay? And so a three year old is on just staring distantly and the end to Medicare. Then be concerned about those ones. Uh huh. And the last part of the appearance. And it's the speech or cry. Okay, So as we said, generally speaking, crying is good unless it's not consolable on down. But for this, what we really talked about it is I really hate pitch squealing, cry. Okay, that kind of means something different to be just being upset, right? So and I supposed to specifically, we were thinking about here as they enter susceptive in on but we ones and where the classic textbook finding is, it's really high pitched squeak on. I remember working a pediatrics on down a A service and very experienced pee graphic surgeon. He he sort of credit herself in the fact that she could walk onto the word on, but she would know there was a child in susceptible because she could tell the difference in the cry. Okay, so all of these things help to make up some of our clinical. Just old are got instinct. These are These are things that you will know what a child without really thinking about them on all pregnant has put them going into some words. And the other elements of the pediatrics has been trying to take a little bit more attention to the breathing of circulation. I take a little but more of Ah, um on intentional on assessment. Okay. Those sex things we talked about evil, the couch, and then you get those feelings about what they're doing. What? They're not doing so in terms of breathing then. So again, this is not meant to be the D off a primary survey. This is meant to be a very quick look. A little snapshot. Look at their breathing. Onda issues can occur anywhere from their news in the mouth. Right. Going to there are other. You lay out the other end. Okay, so for this one, as a matter of looking, looking with your eyes on less thing. Okay, So the things that you might see our what? Possession of the things we think about your your asthmatics. We are popping, and they're setting up on the bed with their arms around follows. Um, because I give him on, opens up the chest for and you might see some nasal flaring is there? And a PSA really struggling for breathing. You might see some feel took just talking them and start on march. You may see some recessions and the chest wall, and it cost us, of course. Still on. Do see some abdominal breathing. You're only last night and we don't mean that's about the staff scoop mean you're listening for audible wheezes from the bad side or stride or or snuffly. Nice prize on us. And so again, this this is this is I Hans off approved. Okay, but idea of breathing as there a problem with their breathing and then we go into circulation. This is probably more harder to spy China. It's on dark. You very collapses is Actually it takes about more than tension. A look again, even even the pretty thing. Okay, the three things that we're gonna be looking at and this one are looking for power. So are they peel and is there mottling of the skin? Um, is there science is okay? Cyanosis is, thankfully, quite quite unusual to see modeling, you'll see. And more like again. It's one of these immediate thing. You see it just like last time. I know. Well, collar again. Sometimes with the pollen and especially this last, this part of the world, You kind of catch your gonna be a peel anyway. But parents will often times, you know, like he's really appeal this much more people in the moment would be. But for these three things the power modeling and cyanosis, the child needs to be undressed. Um, in order toc these things. Okay, so, uh, you know, to straighten sweetness, hands off a quick plants are child, but you might need to get him undressed lot, but just do that test, See? Okay, Okay. So go by Just Teo. Recap, then on this, the the Africa's as triangle, which is an immediate hands off recognition of a child. It's not well, so we're thinking about their appearance. We're looking at their tone. They're interactive nous 30. Is that cry consolable? We could work of breathing or breathing possession a retractions nasal flaring on any noises that we can hear with her 30 years for circulation. You're looking for pollen modeling or cyanosis. Okay, I don't think I don't think we want. We mean for this to be memorized for me, something else for us to remember that we have to go through. But the idea is that it's just trying to put it on paper. Water is, it goes entirely, are got. Instincts are just old when we see side. That's, um, well, so just to kind of expand on that a little bit. So if you like this triangle, the ABC and when it's great, that means they're stable. This is slighting from different bubbles, and it's quite good. I think so. And if you've got a problem, if you ever got some respiratory distress, that's one side. That that that metal one left is respected a stress. It's just to be part that's yellow and but especially feel you're going to start seeing their parents change with that breathing distress. So then you get to sides of the triangle affected you look at on top right. One is meant to be like a hemodynamic collapse or or shock. So you're gonna have a problem with saying that the sign, um, the mold and peel. But they tend to Well, they've been more, more liver this time. To get to that stage will often also have and signs on the appearance in a while. A Children. Let's see an aspirin that bullet problems on be be that sort of early DKA or and procedure or manage itis when they're early on will have just maybe that appearance showing up and you might not see very much of being see until you actually went into your fill a B C D E. Assessment. Children are far end of the scale on peri arrest and cartage virtue. For a year, we'll have things to see all three urines points. I just helps the damage straight where we're talking about. Okay, Yeah, And this talk isn't We're not gonna go into a B c D assessment really in this toe, because I think it was just I just wanted to have a very quick talk about what? What is that you're looking for in the shoulder that come into the reception before they get treated? Ized? What was that you would be looking up. And when you do the eyeball test so clearly if you if you think they run well on the F A a B C is, um, appearance. But, um, the currents breathing and circulation if there are any issues there at all and you might just decide you especially for that card, it's pretty failure when you just mostly under resource apply your option on do your A B C D. Assessment. Um, on them, um, White calling for help. Okay, we want to make sure you get the basics, right. Um, I don't find these kids are. And I was so vitally, vitally important. Okay. Do you know when I find these goods to yars later and the weight room and realized that the really second of course, they might have been ground when the Cayman I have deteriorated in the department, but we want to make sure that we can able front door on gonna fight Children who you need ask with it are okay on that Asmanex point, which is escalation. Okay, so these Children are sec by the time to decompensate that they are various, like sue, because kids will compensate for sure. Too long. And then I fall off the cliff. So and you know the moment. You know, if you're in the situation where you're taking china straight through the results from the front over 40 you guys and you need to ask creatine and then not being is escalate into your e d and your nurse in charge needing your pediatric teams, maybe even your honest I didn't. Okay, what was that? I want you to your a B c d. You may decide that you need a surgical review as well. Okay, So just to start summarizing the take, um, points are usually, um, use that for assessment to on. Then for those that, you know, if I was having a problem with right quickly over into your a b CS aspirins a mask lately? Yeah. Okay, so that's just a quick run. Three. And I think any questions are going to take them. Yeah,