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Rapid Response Teams Recognition of Clinical Instability

Rapid Response Teams Recognition of Clinical Instability. AGE. Abnormal Heart Rate (Beats/Minute). Abnormal Resp Rate (Breaths/min). Abnormal Systolic BP (mm Hg). Neonate. <80 >200. <20 >75. <50. Infant (6 months). <80 >200. <20 >70. <60. Toddler (2 years. <65 >180. <16 >60.

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Rapid Response Teams Recognition of Clinical Instability

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  1. Rapid Response TeamsRecognition of Clinical Instability

  2. AGE Abnormal Heart Rate (Beats/Minute) Abnormal Resp Rate (Breaths/min) Abnormal Systolic BP (mm Hg) Neonate <80 >200 <20 >75 <50 Infant (6 months) <80 >200 <20 >70 <60 Toddler (2 years <65 >180 <16 >60 <65 Pre-school (5 yrs) <50 >160 >50 <70 School age (7 yrs) <50 >150 >45 <75 Adolescent <40 >140 >40 <85 Measures Of Clinical Instability

  3. Signs Of Respiratory Distress/Failure • Respiratory distress: Increased work of breathing • Increased respiratory rate • Nasal Flaring • Retractions • Grunting • Color Changes • Diaphoresis • Wheezing • Respiratory failure:Inadequate oxygenation/ventilation • Decreased Saturations • Decreased Level of Consciousness • Decreased Air Movement (hypoventilation or airway obstruction) • Compensatory Cardiovascular changes:(increased HR, decreased perfusion) • Increasing PaCO2 • Decreasing PaO2 • Apnea

  4. Signs of Shock • Early signs (compensated) • Increased heart rate from baseline • Poor systemic perfusion: capillary refill > 2 sec. • Possible increased BP • Late signs (decompensated) • Weak central pulses • Altered mental status • Hypotension • Note: Cascade of increasing symptoms occurs: (increasing heart rate, decreasing perfusion, normal to high BP ) with then decreasing cascade prior to arrest: ( decreasing BP, decreasing HR, respiratory failure, arrest )

  5. Signs Of Septic Shock • Cardiac output may be normal, increased, or decreased. • Hypotension and poor end-organ perfusion may be present despite “good” skin perfusion. Hypotension is still a sign of decompensation. • Early signs of sepsis/septic shock include ---Fever or hypothermia ---Tachycardia and tachypnea ---Increased or Decreased WBC, or increased bands

  6. Early Signs & Symptoms: Irritability High pitched cry Headache Vision changes: nystagmus, sunset eyes, disconjugate gaze Nausea & Vomiting Changes in speech Altered LOC Late Signs & Symptoms: Dilated, non reactive pupils (due to pressure on the oculomotor nerve Decreased pulse rate Increased systolic blood pressure Changes in respiratory rate and pattern Unresponsiveness to verbal or painful stimuli Abnormal posturing patterns (flexion, extension, flaccidity) Signs Of Increasing Intra-Cranial Pressure (IICP) IICP produces different signs and symptoms, depending on the stage of increased pressure. Age, developmental level, and functional baseline are essential to know when assessing a child suspected or at risk for IICP.

  7. Worrisome Patient Stable Patient Unstable Patient To Meet The Needs Of Worrisome Patients We Will Deploy Rapid Response Teams RAPID RESPONSETEAM

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