First off, welcome back! I think we’ve finally worked the kinks out of this blog thing and I’m all ready to go! One thing I’d like to start doing each week is summarizing some key points we learned from our lecture series each week. To start out, I want to review the AMAZING pediatrics lecture given by Patrick Maloney, MD one of the pediatric emergency medicine fellows. I learned so much from this lecture! The topic was “the critically ill neonate in your community ED.” Here’s some key take-home points:
Perhaps the most important thing I learned was a general approach to a sick peds patient. He talked about the concept of a Pediatric Assessment Triangle. I had learned this the last time I took PALS, and have heard it mentioned in some pediatric updates but here’s what I found most interesting.
Lets say you knock out one side of the triangle. Perhaps the kid has increased work of breathing. As long as the child looks well (general appearance side of triangle intact,) you would call this respiratory distress. Now if you knock out two sides of the triangle, say work of breathing with general appearance. That equals respiratory failure.
Lets do this with the circulation side of the triangle now. If you knock out only this side, you have a child in compensated shock. If, on top of this, the general appearance is poor, you have decompensated shock.
Lets say you only knock out the general appearance side (the child just doesn’t look well,) but the work of breathing and circulation is normal. In this case you are likely dealing with a primary brain dysfunction.
If all three sides are knocked out, you have cardiopulmonary failure.
There are two reasons I found this so interesting. First, it provides a standardized approach to a sick child. Its like the ABC’s. Perhaps more importantly, it breaks down pediatric gestalt that EM physicians who treat sick kids develop over time, but sometimes have difficulty explaining to young physicians or medical students. This gives us a wonderful way to explain “sick vs not sick” for pediatrics. Here’s what I couldn’t help thinking as I listened to him explain this. Why can’t we use this triangle when we try and explain “sick vs not sick” for our adult patients?
I know this was a long update for just a small portion of his talk, but I really was intrigued with the potential application in the educational setting for adult patients. I will post some other take home points from his talk in my next update, but for now, remember the triangle and use it!