pediatric medical emergenciesmcrh.msu.edu/education/pediatric medical emergencies2.pdf · michigan...
TRANSCRIPT
Pediatric Medical EmergenciesAndrea Abbas MS NRP FTO
Scenario
It’s 3 am, your unit responds lights and sirens to a residence for a 4 y.o. male
patient complaining of difficulty in breathing. You arrive to find the patient
on scene with his parents by his side. He is sitting in a tri-pod position and
lung sounds of stridor are noted with assessment. A barking cough is noted.
Nasal flaring and intercostal contractions are noted. His respiratory rate is
elevated and he is showing signs of respiratory distress. Enroute to the
emergency department his condition worsens and you note cyanosis and
irritability.
You begin to panic. The last time you cared for an unstable pediatric patient
was over a year ago. You’ve attended one pediatric webinar but chose to eat
a turkey sandwich and have a text conversation during the presentation.
You’ve had no required agency pediatric training and/or education. You
realize you’re underprepared for this medical emergency.
When Was Your Last Pediatric Focused Training Opportunity?
Internal vs. external
opportunities
What are some of the
challenges you face when it
comes to internal training?
How can you improve education
and training programs within
your
agency/department/division?
Kids Are Just Different
Anatomical differences:
Larger head
Less blood volume
Larger tongues and smaller airways
Smaller oxygen reserves
A child may be in shock and have a normal blood pressure
Bradycardia is often a response to hypoxia
The abdominal organs are closer together and less protected
Epiphyseal plates: bone growth
Kids Are Just Different
The Pediatric Assessment Triangle
Medical Emergency #1
You respond to a 5 y.o. male patient c/o difficulty breathing that began 30
minutes ago. His mother is on scene and explains that her son does not have
any significant medical history. Patient assessment reveals: a respiratory rate
of 36 breaths per minute, heart rate of 125 beats per minute, and an SPO2
showing 90% on room air. Nasal flaring is noted. Lung sounds show audible
expiratory wheezes. No fever. His skin is pale,warm, and dry.
What do you suspect?
What is the pathophysiology behind this respiratory disorder?
Pathophysiology
Treating Asthma With COVID in Mind
Weblink State of Michigan EMS Protocol:
Clinical Treatment for Patient with Suspected COVID-19 Crisis Standards of
Care [2]
Has treatment of the asthma patient changed since the COVID pandemic? How
so?
The Pediatric Assessment Triangle, ABC’s
Rapid transport decision
OPQRST
Advanced treatments to consider: Albuterol, Atrovent, Epinephrine,
Magnesium Sulfate
MI Medic Dosing Cards.pdf [3]
Medical Emergency #2
You respond to a 3 y.o. male having a witnessed seizure. His mother is on
scene and describes tonic clonic like movements lasting approximately one
minute. The child is awake and alert. He smiles. His skin is red, warm, and
dry. Patient assessment reveals: HR 140 bpm, RR 30 bpm, SpO2 95% on room
air. Axillary temperature shows 104 F. Lung sounds are clear.
What do you suspect?
What is the pathophysiology behind this neurological episode?
Pathophysiology
Treating Seizures
The Pediatric Assessment Triangle, ABC’s
Rapid transport decision, actively seizing?
OPQRST
Advanced treatments to consider: Midazolam (Versed), Lorazepam (Ativan),
blood glucose
MI Medic Dosing Cards.pdf [3]
NAEMSP Study: Benzo Before Blood
Sugar [4]
The study investigated: Is routine blood glucose testing of all children in the
prehospital setting indicated?
The results:
67% of patients had a glucose recorded on chart review
14% were actively seizing on EMS arrival
0.5% of all patients were found to be hypoglycemic in the field.
The most common diagnosis was simple and complex seizures.
To view the full article click here
Publication: Mom Holding Onto Baby
Isn’t An Acceptable Transport Option [5]
This topic is becoming more widely discussed.
“Old School” mom holds the baby during transport. This is unsafe.
What about a newborn? How can you secure both mom and baby safely?
There are NHTSA guidelines outlining recommended practices (linked in the
publication below).
Many child restraints have been developed by vendors to secure young
children to the cot, to secure a child over a restrained parent, and even in
conjunction with the captain chair of the ambulance.
If children are not properly restrained in the back of the ambulance they
become projectiles.
View the full publication here. [5]
Agency Training
Does your education program
cover child restraint use?
Do new employees receive
training about these systems
during orientation?
Some child restraint systems
are complex and warrant hands
on training before use.
Bibliography
1. Sanders Paramedic Textbook 5th Edition. M. Sanders & K. McKenna 2019
2. Michigan Department of Health and Human Services EMS COVID-19
Resources.
3. Michigan MI-Medic Pediatric Dosing Cards, Michigan Department of Health
and Human Services
4. Article Bites: Benzo Before Blood Sugar: A proposed algorithm for
prehospital management of pediatric seizures. NAEMSP 2/20/2020.
5. Mom Holding Onto Baby is Unacceptable Transport Option. EMS1. T.
Nowak.3/2/2020.
CE Quiz and Evaluation
It is a requirement to complete the quiz/evaluation within two weeks of the
EMS webinar to receive your CE.
You must score at least 80% on the quiz to receive a CE award. If you score
below 80% you will be contacted.
The link to the CE quiz & evaluation can be found below and also in the email
communication containing all other course materials.
The slides have been sent to your email and are also posted on our EMS page
CE Quiz/Evaluation web-link:
https://msu.co1.qualtrics.com/jfe/form/SV_8c9ZL0KZYayO0JL
Special Guest Dr. Samantha Mishra
Contact information:
Dr. Samantha Mishra DO, MPH
EMS for Children Coordinator
Division of EMS and Trauma
Bureau of EMS, Trauma, and Preparedness
Michigan Department of Health and Human Services