Pediatric Informatics: Computer Applications in Child Health (Health ...

70 M.A. Del Beccaro et al.
and maintenance of local emergency readiness protocols, 1,2 rapid response and
triage systems, 3 public information centers, 4 and research networks. 5
Recovery and maintenance of viability: The variability of the needs of children
has given rise to training programs 6 (education/certification), protocols 7,8
and standards for resuscitation, stabilization, and transport of children of differing
ages and medical needs in the field. The “platinum half-hour” 9 refers to the
need for speed of delivery of resuscitative care to a child or infant quickly after
a physiologic insult.
Real-time monitoring: The need for second-to-second updating of vital signs
and other indicators of physiologic functioning implies a core data set for children
and infants for collection, communication, and trending. This also implies
the need for a knowledgebase of what is normal in each population and the
differences in response and tolerances to stressors such as trauma, blood loss,
temperature, and exposure, as well as preparedness to respond to those differences
in a child-appropriate fashion.
7.2.2 Core Knowledge
Normal values: Norms for vital signs (blood pressure, pulse, respirations)
and responses (Glascow Coma Score) vary across the age spectrum. In addition,
there are special indicators (Apgar Scores) which may apply in different
situations (birth). Laboratory values (hemoglobin, blood glucose) and changes
over time may have different meanings at different ages and states of health,
and these must be interpreted correctly in the context of the patient and the situation
(birth, trauma, illness).
Vulnerabilities: Smaller children have differences in the distribution of body
surface area, which makes them vulnerable to heat loss. Smaller absolute losses
of blood may well be fatal if not appreciated in the field. A major difference in
pediatric and adult arrests is that most pediatric arrests are due to respiratory
failure as opposed to cardiac failure, which may shift the order of resuscitation
protocols in the two populations. In addition to vulnerabilities in the field,
children have vulnerabilities within care environments, to preventable errors
and adverse events, as a consequence of the complexity of pediatric critical and
emergency care.
Tolerances: Children have differential tolerances to stressors in comparison to
adults. Adults may present with progressive signs of deterioration, where in children,
sympathetic responses may sustain blood pressure and pulse (and appear
to be stable) to the point of exhaustion and present as a sudden arrest that may
be preventable.
Pediatric standards: Pediatric-specific resuscitation standards and equipment
may not be available, in which case, knowledge of appropriate protocols to follow
is necessary. Pediatric equipment adjustments (such as smaller paddles and
voltages for defibrillation 10 ) may or may not be required to prevent additional