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Tips/tricks regarding peds and triage

NickiLaughs specializes in Emergency, Trauma, Critical Care.

So I've worked in adult level I trauma ER for the last two years. Prior to that I did Adult critical care. I'm now starting at a Level II ER and will be encountering peds for the first time in my life. Any tips you can suggest? Kids make me nervous, I don't know what to do with them.

Also, I'm sure they'll train me in triage (it took 3 years or longer to get trained in triage at my prior job). I'd appreciate any sage advice from my more experienced comrades. I've been studying for the CEN, so hopefully some of that info will be useful.

I'm appreciative of any help!

PedsED-RN specializes in Pediatric ED;previous- adult Ortho/Neuro.

If you can, take ENPC, that is a helpful class. Will help narrow down the things you should watch for, true emergencies. Our #1 CC is fever, so for 85-90% of our fever patients, that is something that could have gone to their PCP.

Try not to let them scare you =). Definitely get used to normal VS ranges for different age groups, that will make it easier. Try to see what the kid was acting like while in the waiting room, will give you a more accurate assessment, since most little ones freak out once you pull them into triage and are messing with them.

Upper airway congestion noises refer all over in little ones, so get used to distinguishing that from actual "course" lungs. Also, heading into respiratory season, nasal suction is your best friend, and will work miracles. =)

That's what I have at the moment, sure I will think of more. =) good luck with the new job!

Esme12 specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Welcome to the snake pit...LOL......get the ENPC course book and read it. Pediatrics is a specialty all it's own.

Pediatric airways are different....smaller and structurally....they can eat and breathe. Remember that 1mm of swelling on an adult airway that is 5mm wide is completely different than 1mm of swelling on a 1mm airway. Vital signs are not a predictor of how sick the child is....they will compensate forever and by the time their vital signs reflect a problem they are ready to code. The cap refill/urine output is a great indicator on the younger pedi population as an indicator of distress and end organ perfusion.

That is why asking when did they last pee and how many wet diapers in x amount of time is huge!!!! using accessory muscle is a huge sign of distress.

They need fluid, O2, and keep them warm. A crying (with tears) and screaming kid is a stable kid....it's the quiet ones that will/should scare you. If the child has a congenital/chronic illness listen to the parent.....they have done this before and can help you.

Rhythms for kids....slow, fast, and absent. familiarize yourself with the normal vital signs for the age group!

Infants....was the baby full term, what was birth weight, weigh all babies regardless of what the parents say...emphasize how important it is as that is how the medicines are given. Small mistakes have huge consequences for the pedi population. If they are small so should the dose be as all doses are weight based.

The ENPC (emergency nursing peds course) has a terrific pets triage standard that should be used by all emergency departments.

ciiamppedds: c is chief complaint, i is immunizations, i is isolation (has the child been exposed to any communicable diseases), a is allergies, m is medications,p is past medical history, p is parents impression of the child's condition, e is the event surrounding the illness or injury, d is diet, d is diapers (voids) and s is signs and symptoms

great power point triage assessment

http://webmedia.unmc.edu/bioprepare/2010symposia/goesch-pediatric%20triage.pdf

[TABLE]

[TR]

[TD=align: left]age group[/TD]

[TD=align: left]respirations[/TD]

[TD=align: left]heart rate[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]systolic blood pressure[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]newborn[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]30-50[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]120-160[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]50-70[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]infant (1-12 mo)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]80-140[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]70-100[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]toddler (1-3 y)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]80-130[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]80-110[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]preschooler (3-5 y)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]20-30[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]80-120[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]80-110[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]school age (6-12y)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]18-25[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]70-110[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]85-120[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]adolescent (13y +)[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]12-20[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left]55-110[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]100-120[/TD]

[/TR]

[TR]

[TD=width: 27%, bgcolor: #ffffff, align: left]adult[/TD]

[TD=width: 23%, bgcolor: #ffffff, align: left]16-20[/TD]

[TD=width: 24%, bgcolor: #ffffff, align: left] 70-100[/TD]

[TD=width: 26%, bgcolor: #ffffff, align: left]

[/TR]

[/TABLE]

triage course - nursing continuing education (ce) - nurse ce - ceufast.com

pews.....the pediatric early warning (pew) score system can help nurses assess pediatric patients objectively using vital signs in the pediatric intensive care unit. the scoring system takes into account the child's behavior, as well as cardiovascular and respiratory symptoms.

ahrq innovations exchange | pediatric early warning (pew) score system

this is another great assessment tool for assessment short and sweet but informative.

http://www.ucdenver.edu/academics/colleges/nursing/documents/pdf/sim_pews_tch.pdf

PedsED-RN specializes in Pediatric ED;previous- adult Ortho/Neuro.

Esme, I figured you would post this =) I need to actually remember where I post to be able to copy from previous. =) great info there!

NickiLaughs specializes in Emergency, Trauma, Critical Care.

Thank you to all who have replied. Esme you went the extra mile with that information. Ill definitely be going over it this week before i start on the floor.

NickiLaughs specializes in Emergency, Trauma, Critical Care.

I think I may need to go one step further and buy a book, I was looking at pediatric nursing made incredibly easy. Any recs? I'd rather not buy a complete text book, but more a book that provides a lot of essential information to make sure the care I provide is safe.

My pathophys isn't bad and I'm familiar with a lot of diseases (I was a kid with multiple congenital diseases myself). It's more assessment/ IV placement, etc. My biggest fear is putting an IV in a kid,took me a long time to get the hang of adults!

Thanks again guys!

A few tips-

They crash quick but with a little treatment they bounce back quick.

Take note of parental concern... they know what their child is usually like

Always check their BSL if they're tired/lethargic/vomiting/decreased oral intake and almost every child with have one or more of those symptoms

They dehydrate quickly

Be vigilant with

Triple check their medication doses... don't trust the dose the doctor prescribes, always check it yourself and triple check the calculations, medication errors in kids can happen easily

Where I work only the doctors do kids IVs so maybe you'll be saved from doing that (although you'll need to learn how to hold them down while they get their IV)

Check out SMACC Chicago and have a listen to the paediatric related podcasts... pretty sure there are a couple there that are full of tricks!

But the most important tip.... carry bubbles, a fun toy on your ID or stickers... you'll never get through taking a toddlers vital signs without them!

NeoPediRN specializes in Pediatrics, ER.

Whenever possible, butterfly over angiocath if your facility has them. I find butterfly IVs much easier to thread into little spaghetti veins. Also, thinking like a child goes a long way when interacting with them. Don't tower over them, use language they can understand (blow out birthday candles as an example to get them to take a deep breath). If they are old enough to understand choices, give them one. Use mommy or daddy to demo things they're going to be afraid of. Let them listen to your heart first. Don't lie to them. This is difficult, especially when you have to do things you know will cause pain. I always get asked if the IV will hurt, and I find something to compare it to...i.e. has your brother/sister ever pinched you? Have you ever been stung by a bee (it hurts less than that!)? And finally, a quiet kid is a kid you don't let out of your sight for long. Screaming, kicking, fighting? Fantastic. Pale and quiet? You better keep a close eye on vitals and make sure they're hydrated. Pedi ER patients are my absolute favorite. Once you feel comfortable with the truly sick ones (which are less than 10% of your entire pedi population) then the rest is cake!

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