identify the signs, symptoms
TRANSCRIPT
Identify the signs, symptoms and treatments of common pediatric emergencies.
The Pediatric PatientCommon Medical Conditions Traumatic InjuriesChild Abuse and Neglect
Transporting Infants and Children
EMS Response to Pediatric Emergencies
Pediatrics - medical care devoted to the young
Children to the age of 18
Infants◦ birth to 1 yearfirst 30 days referred to as neonate
Toddlers◦ ages 1-3 years
Preschool◦ ages 3-6 years
School-age◦ ages 6-12 years
Adolescents◦ ages 12-18 years
Major cause of death◦ Infants
related to birth◦ Developmental stages
Trauma (MVA)
Infants◦ Keep with parents◦ Keep warm◦ Assess general appearance and
breathing before touching◦ Make sure stethoscope and hands are
are warm before touching infant◦ Heart and lungs first, head last
Children Might◦ Be frightened◦ Dislike being touched by strangers◦ Be afraid of needles◦ Resist O2
Children (cont.)◦ Do not separate from parents◦ Reassure them they are not in trouble◦ Respect their modesty◦ Treat adolescents as if they were adults
Airway Obstruction◦ Partial Airway ObstructionStill able to breathePlace in position of comfortAdminister high-flow O2Remove foreign body (if visible in mouth,
NO blind finger sweeps)Limit assessment to ABCDDo not agitatePrompt transport
Complete Airway Obstruction◦ Chest does not rise and fall◦ Decreased LOC◦ Cyanosis◦ Inability to cry or speak◦ Perform thrust maneuvers to attempt to remove
object (Abdominal, Chest/Back – Age dependent, follow AHA Guidelines)◦ Attempt ventilation's with BVM (per AHA
Guidelines) ◦ Transport
Signs of Respiratory Problems◦ Early Distress◦ Severe Distress◦ Respiratory Arrest
Early Distress◦ Audible wheezing◦ Grunting◦ Stridor◦ Nasal Flaring◦ Use of accessory muscles
Severe distress ◦ Respiration's more than 60 breaths/min◦ Cyanosis◦ Drooling◦ Decreased muscle tone◦ Altered level of consciousness◦ Delayed capillary refill (>2 sec.)◦ Use of accessory muscles
Respiratory Arrest◦ Less than 10 breaths per minute◦ Agonal or no respirations◦ unconscious and unresponsive◦ Limp muscle tone◦ Heart rate less than 60 beats/min◦ Distal pulses weak or absent◦ Full ventilatory support with BVM & chest
compressions
Common among children Usually not life threatening Causes great anxiety Most episodes last 15 seconds or less May lose bladder control Common with high fever (febrile
seizure)
Other causes◦ Brain or CNS infections◦ Poisoning◦ Trauma◦ Inadequate O2◦ Hypoglycemia◦ Unknown reasons
Determine cause Mechanism of Injury / Illness Assist ventilation's as needed Transport Obtain history of episode
Hypoglycemia Poisoning Infection Treatment? Insufficient O2 Head injury Seizure episode
Gather information about poison • From the container• (Poison Control 1-800-222-1222)
Bring poison to hospital (if can safely be done)
No activated charcoal in pre-hospitalsetting
Prompt transport Monitor LOC Prepare to provide BLSinterventions as necessary
Croup - A viral illness that causes acute swelling of the lining of the larynx below its opening.
Epiglottitis - Bacterial infection that produces severe swelling of the epiglottis, the flap of tissue that protects the opening of the larynx.
Signs & Symptoms◦ Fever◦ Progressive respiratory difficulty◦ Barking, brassy cough and hoarseness◦ Progressive and excessive musculareffort with breathing
Never use tongue blade, finger, or Oropharyngeal airway
Avoid back-blows & abdominal-thrust maneuver
Sniffing position
O2◦ moist - epiglottis◦ cool mist for croup
Suction secretions and transport
◦ Meningitis◦ Heat-Related Emergencies◦ Febrile Convulsions
Extremely serious Hot and obviously sick Headache and stiff neck Sore throat and upper respiratory
infection prior Rapid transport Alert for seizures!
Heat related emergenciesMost dangerous is feversSame care for child as adultReduce body temperatureTransportMonitor carefully
Febrile Convulsions◦ Usually last less than 15 seconds◦ Rarely result in permanent injury◦ No special treatment other than airway
management and cooling
Appendicitis◦ Most serious cause of abdominal pain in
childhood◦ Most frequent ages of 10-25 years◦ Crampy pain◦ Pain starts over the umbilicus and rapidly
moves to the RLQ
◦ Pain becomes steady and severe◦ Nauseated, may vomit, irritable or fussy with no
appetite◦ Low grade fever is common◦ Transport all children with abdominal pain◦ Should not try to determine the cause
Dehydration ◦ Associated with abdominal pain◦ Common with infants and children◦ May cause shock
◦ Measles ◦ German Measles◦ Chicken pox◦ Mumps
Treatment?
Rarely result of Heart Condition Meningitis Blood Infection Dehydration* Abdominal injury Blood Loss*
Signs & Symptoms◦ Rapid heartbeat◦ Delayed capillary refill◦ Pale, cool, clammy skin◦ Weak or absent peripheral pulses◦ Altered level of consciousness
Late indicator - low systolic blood pressure◦ A pediatric 12 years old and under is considered
hypotensive when the systolic blood pressure is 70 + (age x 2)◦ Remember normal BP for a pediatric 12 years old
and under is 90+ (age x 2)◦ Once the pediatric reach age 13 years old the
normal BP and hypotension is equivalent to that of an adult
MOA C-spine Dress obvious
wounds Splint fractures
Elevate feet Keep warm Handle gently NPO
Ventilation is top priority Other considerations◦ Spinal injuries◦ Hypothermia◦ Alcohol or drug use in adolescents
Prompt transport
Cause unknown Occurs during sleep Primarily between the ages of 2-6
months Anguished, severely disturbed parents
BLS before and during transport Continue until baby is pronounced dead by a
physician Notify MCC Remain alert for signs of child abuse
The Basic Principles of Trauma Management◦ MOA◦ C-spine◦ Control bleeding◦ Splint musculoskeletal injuries
Usually caused by motor vehicle accidents, falls, or diving mishaps
Treatment◦ Do not bend neck or back◦ MOA◦ Assist ventilation's◦ Avoid urge to pick-up and cradle◦ Transfer child with head slightly elevated
Treatment (cont.)◦ Monitor level of consciousnessAVPURecord observations every 5 minutes
Penetrating abdominal or chest injuries are uncommon
Blunt injuries are far more common◦ Falls◦ Motor vehicle accidents
Blunt abdominal trauma may rupture:◦ Spleen◦ Liver◦ Kidney
Suspect shock if:◦ Sustained blunt abdominal injury◦ Complains of abdominal pain
Transport promptly Monitor vital signs Anticipate shock Be alert for vomiting
Extremity Injuries◦ Treatment? .. .. .. Control bleeding, bandage, splint
Severe Bleeding and use of a PASG◦ Do we use them? .. .. .. No
Burns◦ Treatment same as adults
Child Abuse - Deliberate, intentional injury of a child physically and emotionally.
Recognizing Child Abuse◦ History does not match injury◦ Multiple injuries at different stages of healing◦ HX of several accidents in the past
◦ Child may appearWithdrawnFearfulHostileUndernourished
Handling◦ Do not diagnose/accuse◦ Professional approach◦ Carefully record history◦ Can’t transport without parents permission◦ Consult law enforcement◦ Follow local protocol
Reporting◦ Report to Physician◦ What you saw, not what you think!
Most rape victims are over 10 years of age Should not examine genitalia unless:◦ Obvious bleeding◦ Injuries that must be treated
When abuse suspected:
◦ Ensure law enforcement is notified◦ Patient should not wash, urinate, or defecate◦ Same sex EMT if at all possible◦ Concerned caring approach is important◦ Allow law enforcement to collect evidence (If you
must collect evidence place in a paper sack)◦ Transport to a facility with a S.A.N.E. Nurse
Obtain history from child and witnesses◦ May be hysterical◦ May be unwilling, especially if abuser is:SiblingRelativeFamily friend
EMT is in best position to get information◦ Record information carefully and completely◦ Written in clear and accurate detail◦ Use ambulance report form
Transport
Neglect - Occurs when a parent or caregiver does not provide basic care to a child.◦ Provide food◦ Clothing◦ Shelter
Abandoning Follow local protocol
Susceptible of temperature changes◦ Lose body heat more rapidly◦ Wrap in blankets and keep warm◦ O2 should be warmed
Susceptible to infection◦ Avoid breathing or coughing on child◦ Universal precautions◦ Transport newborns in special incubators when it is
possible
Child should have a familiar person close◦ Parent◦ Relative◦ Close friends
Familiar objects may help◦ Dolls / Toys◦ Stuffed animal◦ Favorite blanket
The ECA/EMR, EMT, Paramedic should:◦ Maintain a caring professional approach◦ Stay at eye level when possible◦ Be honest◦ Verbally repeat procedures◦ Respect child’s modesty◦ Friendly tone of voice◦ Maintain eye contact
May experience wide range of emotions Prepare for pediatric cases◦ Practice with equipment◦ Review local protocol◦ Mentally prepare yourself
Debriefing is helpful Know when to seek help
Pediatric Patient Common Medical Conditions Traumatic Injuries Child Abuse and Neglect Transporting EMS Response