How does a parent (or a doctor or nurse) decide when an infant or child is or may be critically ill and require emergency evaluation and treatment.
The pediatric assessment triangle and the primary assessment (procedures of the Pediatric Advanced Life Support course discussed in earlier blog posts) tend to be abnormal late in a child’s illness.
Now hospitals have developed Rapid Response Teams (RRTs) that are called to the patient’s bedside whenever there is concern that an infant or child is at risk. Another name for these teams is Medical Emergency Teams (METs). The purpose of these teams is to detect and treat potentially life-threatening problems early to prevent worsening.
The team is called to the bedside by anyone (parent, doctor, nurse, or others) who notices that the patient appears to be in trouble. Below is criteria that can be used to suggest the team needs to be called. But “The most important activation criterion is the bedside staff’s and/or family member’s concern that something is wrong, even if the other indicators are within acceptable limits. This clinical intuition is often quite sensitive and warrants additional assessment.” (from Pediatric Fundamental Critical Care Support, 2008, Society of Critical Care Medicine).
The following is from Appendix 1 of Pediatric Fundamental Critical Care Support. They are clues that the Rapid Response Team should be called.
Clues That An Infant May Be Seriously Ill
A change in the heart rate to less than 80 or greater than 180
A change in the systolic blood pressure to less than 60 or greater than 130 mmHg
A change in the urine output over 4 consecutive hours to less than 1 cc per kg per hour
A change in the respiratory rate to less than 14 or greater than 40 breaths per minute
A change in the pulse oximetry (oxygen saturation) despite oxygen therapy of less than 90%
A change in level of consciousness such as unusual irritability, lethargy, or decreased response to the parent or to painful stimuli.
Clues That A Child May Be Seriously Ill
A change in the heart rate to less than 60 or greater than 180
A change in the systolic blood pressure to less than [70 + (2 x Age in years)] or greater than 130 mmHg
A change in urine output over 4 consecutive hours to less than 1 cc per kg per hour
A change in the respiratory rate to less than 10 or greater than 30 breaths per minute
A change in pulse oximetry (oxygen saturation) despite oxygen therapy of less than 90%
A change in the level of consciousness such as unusual irritability, lethargy, or decreased response to parents and/or painful stimuli.
Even if all of the above clues are normal but the observer (parent, doctor, or nurse) feels that something serious is wrong with the infant or child, she should obtain emergency evaluation.