An initial triage of the patient based on the ABCDs of resuscitation will determine the urgency of subsequent interventions. It will also serve as the baseline assessment for later comparison during the actual emergency treatment.
D = Da Brain
| Responsiveness |
|
Awake |
|
Responds to voice |
|
Responds to pain |
|
Unresponsive |
| Recognition of parents |
| Muscle tone |
| Pupillary reflexes |
| Posturing |
C = Circulation
| Heart rate/blood pressure |
| Quality/strength of pulses |
| Skin perfusion |
|
Color |
|
Capillary refill time |
|
Temperature |
|
Mottling |
| Urine output > 1cc/kg/hr |
B = Breathing
| Respiratory mechanics |
|
Respiratory rate |
|
Retractions/Use of accessory muscles |
|
Flaring/grunting |
| Air entry/exchange |
|
Chest expansion |
|
Paradoxical breathing |
|
Stridor/wheezing |
| Color |
A = Airway
| Patent |
| Maintainable with adjuncts |
|
Head tilt/chin lift |
|
Jaw thrust |
|
Oral/nasal airway |
| Unmaintainable |
|
Removal of foreign body obstruction |
|
Endotracheal intubation |
The clinical conditions listed below are the most common emergencies presenting to the pediatric office. Of these, asthma is the most common, cardiac arrest the least. They are also suggested by the AAP as suitable scenarios for use during an office mock code. A protocol for handling each should be part of the office emergency plan. Sample protocols for each are included here.