Identification, Assessment, Stabilization and Transport (IAST) Manual for Acutely Ill Children Kundan Mittal
INDEX
A
Abdomen 32
Acute bronchial asthma 90
Acute bronchiolitis 89
Acute renal failure 115
Advanced communication skills 142
Advantages of effective communication skills 142
Agonal breaths 37
Airway 72
Airway and cervical spine 30, 94
Airway devices 14
Anaphylaxis 87
Antibiotics 62
Arterial oxygen content 58
Assess responsiveness 35
Assessment
airway 23
breathing 23
circulation: 24
degree dehydration 111
Asystole 65
B
Basic life support skills 34
Behavioral considerations 11
Blood glucose 59
Body surface area method 110
Breathing 30,72
oxygenation 30
ventilation 30
Burns 115
C
Calculation
electrolyte deficit in dehydration 111
FiO2 during normal ventilatory pattern 105
fluid deficit 112
fluid deficit therapy 111
life of cylinder in minutes 104
FiO2 during respiratory distress 105
patient inspiratory flow demands 107
Calgary Cambridge guide 143
Cardiac arrest 64
Cardiac output 58
Cardiac tamponade 99
Cardiovascular considerations 7
Categories
communication skills 142
shock 57
Caution 140
Cervical spine injury 95
Check
before transfer 125
breathing 37
signs of circulation 38
Chest 32
Chest compression 39,53
Child with abdominal injury 101
Child with meconium stained amniotic fluid 47
Children 123
Circulation 22,72
Circulation and external hemorrhage control 31
CNS conditions 115
Common injuries and their management 98
Components of PAT 21
Compressed gas cylinders 104
Continue to evaluate the baby 48
Core communication skills 142
Criteria 100,134
transfer 100
tube removal 134
D
Defibrillation/cardioversion 136
Developmental considerations 5
Diabetes ketoacidosis 115
Disability or neurological status 26
Disordered of control of breathing 91, 93
Distribution of water in the human body 109
E
Electrolyte deficit in hypotonic dehydration 111
Endocrinal considerations 9
Equipments for neonatal resuscitation 55
Establish vascular access 59
Evaluation of cervical spine injury 96
Examination of extremities 33
Exposure 27
Exposure/environment 31
F
Flail chest 99
Fluid adjustment in special situations 115
Fluid and electrolytes considerations 10
Fluid refractory hypotension 61
Fluid requirements in neonates 114
Fluid resuscitation 59, 61
Fluid schedule 113
Focused history 27
Foley's catheter insertion 139
Foreign body aspiration 87
Formulation of calcium 119
Formulations 117, 119
Free water deficit in hypernatremia 112
G
Gastrointestinal considerations 9
General differences between children and adults 3
H
Head and face 32
Head injury 101
Hemothorax 99
Hepatic encephalopathy 115
High flow oxygen delivery devices 107
History and physical examination 97
Holiday-Segar method 110
Hyperkalemia 117
Hypocalcemia 119
Hypokalemia 116
Hypomagnesemia 118
Hypoxic or asphyxial arrest 64
I
Identification of cardiopulmonary failure 65
Immunological considerations 10
Initial steps in stabilization 46
Insensible water loss adjustment 114
Intraosseous needle insertion 128
Issues during air transport 125
L
Log rolling 136
Low flow devices 104, 106
Lower airway obstruction 88,92
Lung tissue disease 91
M
Metabolic considerations 9
Minimal requirement of equipments 14
Monitoring devices 14
Monitoring child on intravenous fluid therapy 120
Musculoskeletal injury 100
Myocardial contusion 100
N
Nasogastric/orogastric tube placement 135
Needle thoracostomy 131
Neurological considerations 8
Normal daily fluid requirement 110
Normal ECF and ICF composition 110
O
Objectives of course 1
Open pneumothorax (sucking chest wound) 98
Optimizing oxygen delivery 59
Oxygen concentrators 103
Oxygen delivery 58
Oxygen delivery devices 104
Pxygen delivery sources 103
P
Pediatric airway management 72
Pediatric cardiac arrest 64
Percent of dehydration from ECF and ICF 111
Peripheral venous catheter 127
Physiologic response to injury or acute illness 17
Positioning 59
Positive pressure ventilation 49
Pre/perioperative deficit 116
Preoperative fasting 116
Prerequisite for PPV 52
Primary assessment 22
Primary survey 30,94
Principles of effective communications 142
Problems during transport 122
Pulmonary contusion 100
Pulseless electrical activity 65
Pulseless ventricular tachycardia 66
R
Recognize decreased mental status and perfusion 61
Recognizing children at risk 18
Recognizing different types of shock 58
Renal considerations 10
Respiratory considerations 5
Respiratory distress 71
Respiratory failure 71
Resuscitation 94
S
Secondary assessment 27
Secondary survey 32,97
Shock 57
signs 59
Specific management of septic shock 61
Stabilization of airway 72
Stabilization phase 124
Stroke volume 58
Sudden cardiac arrest 65
T
Target of good transport 123
Tension pneumothorax 98
Tertiary assessment 27
Tertiary survey and definitive care 33
Therapeutic end points after one hour 62
Third space losses 116
Thoracic injuries 98
Thorough physical examination 27
Transfer the child to higher center 59
Transport phase 124
Transport team's responsibility 124
Trauma consideration 12
Treatment beyond first hour 62,87
Tube thoracostomy 132
U
Upper airway obstruction 85,92
Use of automated external defibrillato 41
V
Vascular devices 15
Ventricular fibrillation 66
W
When to stop PPV 53
Work of breathing 21
×
Chapter Notes

Save Clear


1Identification, Assessment, Stabilization and Transport (IAST) Manual for Acutely Ill Children2
3Identification, Assessment, Stabilization and Transport (IAST) Manual for Acutely Ill Children
Kundan Mittal Professor Head of Unit IV and I/C Respiratory Clinic (Paediatric Emergency and Intensive Care Unit) Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences Rohtak, Haryana, India
4
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24, Ansari Road, Daryaganj, New Delhi 110 002, India, Phone: +91-11-43574357
Fax: +91-11-43574314
Registered Office
B-3, EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002, India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672
Rel: +91-11-32558559, Fax: +91-11-23276490, +91-11-23245683
Branches
North America Office
1745, Pheasant Run Drive, Maryland Heights (Missouri), MO 63043, USA Ph: 001-636-6279734
Central America Office
Jaypee-Highlights Medical Publishers Inc., City of Knowledge, Bld. 237, Clayton, Panamá
City, Panamá Ph: 507-317-0160
Identification, Assessment, Stabilization and Transport (IAST) Manual for Acutely Ill Children
© 2010, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2010
9788184488272
Typeset at JPBMP typesetting unit
Printed at Ajanta Press
5Dedicated to
My wife Dr Anupama and children Utkarsh and Anindya67
Dr. S.S. Sangwan
MS, DNB, FICS, IAMS
Vice Chancellor
D.O. No. UHSR/09/
Date
MESSAGE
Childhood mortality is still a big concern in India. Most of our health care service facilities are urban oriented. Number of children die because of lack of basic knowledge and skills of the health care providers especially working in rural areas. Most of the doctors and paramedics are not well trained in Basic Life Support and Communication Skills. The specialized care may not be possible at all level. Dr. Kundan Mittal, Professor of Paediatric Medicine has brought this manual which deals with basic needs of primary health care providers who are critically sick and injured children. This manual has given a special emphasis on Effective Communication Skills of Doctor-Patient relationship. I wish this manual will help in improving the skills of the Primary Health Care Providers and will bring down the childhood mortality. I wish him a great success in his life.
Dr. S.S. Sangwan
89
Dr. Chand S. Dhull
MS, FIAO, DCEH (London)
Director
DO No. spl/I
Date 22.7.2009
MESSAGE
Children are future of any Nation. No country can prosperous without healthy population. Childhood mortality is still an important concern in developing countries. Though, health care facilities are growing but still it is not possible to provide health care by specialist at peripheral centres. So, most of the sick children are attended by MBBS doctors and paramedical staff. These health care professionals need to be updated in handling the critically sick/injured children. It is beyond doubt that children have different needs.
Keeping in view the need of primary health care providers. Dr. Kundan Mittal, Professor in Pediatric Department at PGIMS, Rohtak has developed IAST manual for primary health care providers which will help in building their skills and knowledge. He has also highlighted the issue of effective communication skills for doctors. I wish the efforts put in by Prof. Kundan Mittal may be useful for better management of the sick children at primary care level.
Dr. CS Dhull
1011
Ref. No. …………
Date …………
MESSAGE
Specialist services are still dream in peripheral areas of the State. Children constitute the 40% of total population and number of children die before reaching to Hospital/Specialist. An effort has been made by Dr. Kundan Mittal, Professor in Pediatric Department to enhance the knowledge and skills of primary health care providers, who deal with acutely ill children through IAST manual. This manual gives brief introduction regarding identification, communication skills' between doctor patient has also been highlighted. These efforts will go long way in decreasing the childhood morbidity and mortality.
Dr. VK Jain
DEAN PGIMS Rohtak12
13Preface
Children are future of nation. The status of children has not improved much till date. Many of the children die before second birthday. Majority of population still live in rural areas. The health infrastructure is mainly urban centred. The heath care facilities in rural areas are either not present or inadequate to meet the demand. The primary health centres are also not well equipped. The primary health care providers are not trained to handle the critically ill/injured children. Identification, assessment, stabilization and transport (IAST) manual for acutely ill children have been developed to handle the sick/injured children by primary health care providers within the existing infrastructure so that childhood morbidity and mortality can be brought down. The manual also discusses the issue related to neonatal resuscitation. A special emphasis has also been made on “effective communication skills” between primary health care provider and patient. Attempt has been made to enhance the knowledge and basic skills of primary health care providers who care for sick or injured children. We hope these efforts will improve the outcome of critically ill or injured children.
Kundan Mittal