0071643192.pdf

Pediatrics

Volume assessment in children is made difficult by the normal variation of

vital signs seen with increasing age. Thus, some knowledge of normal vital

signs is important (see Table 1.13).

After the neonatal stage, cardiac reserve becomes substantially better. As a result,

even significant volume loss may be well compensated for by increasing HRs.

However, after a point, this compensation will fail, and blood pressure and

HR will both fall precipitously.

SYMPTOMS/EXAM

■ Mild volume loss (1–5%)

■ Increased thirst

■ Normal examination

■ Moderate volume loss (5–10%)

■ Tachycardia

■ Irritability

■ Delayed capillary refill

■ Sunken eyes and fontanelle

■ Dry mucous membranes and decreased tears

■ Severe volume loss (>15%)

■ Marked tachycardia, weak pulse, hypotension

■ Lethargy and somnolence

■ Very delayed capillary refill, cold and mottled.

■ Parched mucous membranes and no tears

■ Very sunken eyes and fontanelle

ADULT

Adults have more or less the same cardiac reserve as older children. However,

adults have less vascular tone. As a result, BP changes with far less volume loss are

seen in this group of patients. Volume loss can be estimated more precisely in

adults than in children since physical findings are more predictable with increas-

ing amounts of loss. The American College of Surgeons Advanced Trauma Life

Support course suggests a means of correlating blood loss in trauma with patient

appearance and vital signs (see Table 1.14). It is likely that signs and symptoms are

similar regardless of the actual mechanism of volume loss.

SYMPTOMS/EXAM

■ Tachycardia

■ Tachypnea

RESUSCITATION

TABLE 1.13. Normal Vital Signs for Pediatric Patients

HR RR SYSTOLIC

AGE (BPM)(BREATHS/MIN)BP (MMHG)

Neonates, 0–28 days 120–160 30–50 > 60

Infants, 1–12 months 100–120 20–30 70–95

Children, 1–8 years 80–100 20–30 80–110

Pediatric hypotension =

systolic blood pressure < 70

mmHg+(2×age in years).