pediatrics… ... more than just little people

PEDIATRICS…

...more than just little people

Airway Differences Larger tongue relative to

the mouth Less well-developed

rings of cartilage in the trachea

Head tilt-chin lift may occlude the airway.

Breathing Differences Infants breathe faster than children

or adults. Infants use the diaphragm when

they breathe. Sustained, labored breathing may

lead to respiratory failure.

Circulation Differences The heart rate increases for

illness and injury. Vasoconstriction keeps vital

organs nourished. Constriction of the blood

vessels can affect blood flow to the extremities.

Skeletal Differences

Bones are weaker and more flexible. They are prone to fracture with

stress. Infants have two small openings

in the skull called fontanels. Fontanels close by 18 months.

Growth and Development Thoughts and behaviors of

children usually grouped into stages Infancy Toddler years Preschool age School age Adolescence

Infant First year of life They respond mainly to

physical stimuli. Crying is their main

avenue of expression. They may prefer to be with

caregiver. If possible, have caregiver

hold the infant as you start your examination.

Toddler 1 to 3 years of age They begin to walk and

explore the environment. They may resist separation

from caregivers. Make any observations you

can before touching a toddler. They are curious and

adventuresome.

Preschool 3 to 6 years of age They can use simple language effectively. They can understand directions. They can identify painful areas when

questioned. They can understand what you are going to

do using simple descriptions. They can be distracted by using toys.

School-Age Child 6 to 12 years of age They begin to think like adults. They can be included with the parent when

taking medical history. They may be familiar with physical exam. They may be able to make choices.

The Adolescent 12 to 18 years of age They are very concerned about body

image. They may have strong feelings about

being observed. Respect an adolescent’s privacy. They understand pain. Explain any procedure that you are doing.

Approach to Assessment Obtain a complete set of baseline vitals.

Assess the need for ALS backup or immediate transport.

A child’s condition may deteriorate rapidly during transport.

Have pediatric resuscitation equipment ready.

Vital Signs by Age

Appe

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Pediatric Triangle

The Pediatric Triangle

Circulation/Skin Color

AppearanceLook at the patient from across the

room……this is an important indicator of

oxygenation, brain perfusion,

and overall CNS function

AppearanceAlertness

Eye contactDistractibilityConsolabilitySpeech/Cry

Spontaneous motor activity

Sick or Not Sick!

BreathingAbnormal body position

Audible or abnormal airway sounds

RetractionsEffort/work of breathing

BreathingA child with abnormal breath

sounds needs high flow oxygen and immediate ALS

intervention!

Sick or Not Sick?

Circulation & Skin SignsColor

TemperatureCapillary refill time

Pulse quality

Skin Signs

Feel for temperature and moisture.

Estimate capillary refill.

Pulse In infants, feel over

the brachial or femoral area.

In older children use the carotid artery.

Count for at least 1 minute.

Note strength of the pulse.

Blood Pressure Use a cuff that covers two thirds

of the arm. If scene conditions make it

difficult to measure blood pressure accurately, do not waste time trying.

Circulation & Skin Signs

Poor color equals…poor circulation…

equals…SICK!

DECIDESICK NOT SICK

Appe

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Pediatric Triangle

Short Reportto ALS

Short Reportto ALS

100% O2NRM or BVM

Focused Hx/Physical Exam

AppropriatePosition

Rapid Trans-port/ALS

DetailedPhysical Exam

Ongoing Assess Keep

Warm

*Rapid medical assessment*Baseline vitals*SAMPLE history


AppropriateTreatment

AppropriateTransport


Low/ModerateFlow O2

*Focused medical assessment*Baseline vitals*SAMPLE history*OPQRST

Ongoing Assess Keep

Warm

Medical Patients

DECIDESICK NOT SICK

Appe

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Pediatric Triangle

Short Reportto ALS

Short Reportto ALS

Rapid Extrication


Spinal Immobilization



*Rapid trauma assessment*Baseline vitals*SAMPLE history




Extricate/Immobilize

Low/ModerateFlow O2

*Focused trauma assessment*Baseline vitals*SAMPLE history

100% O2NRM or BVM

SpinalStabilization

Ongoing Assess Keep

Warm

Ongoing Assess Keep

Warm

Trauma Patients

DECIDESICK NOT SICK

Appe

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ce Breathing


Pediatric Triangle

Short Reportto ALS

Short Reportto ALS

Rapid Extrication


Spinal Immobilization



*Rapid trauma assessment*Baseline vitals*SAMPLE history




Extricate/Immobilize

Low/ModerateFlow O2

*Focused trauma assessment*Baseline vitals*SAMPLE history

100% O2NRM or BVM

SpinalStabilization

Ongoing Assess Keep

Warm

Ongoing Assess Keep

Warm

Trauma PatientsTrauma Patients

Sick or Not Sick?

Make a decision within

60 seconds!

Children With Special Needs Children born prematurely who have associated

lung problems Small children or infants with congenital heart

disease Children with neurologic diseases Children with chronic diseases or with functions

that have been altered since birth

Tracheostomy Tube

Artificial Ventilators Provide respirations for children

unable to breathe on their own If ventilator malfunctions, remove

child from the ventilator and begin ventilations with a BVM device.

Ventilate during transport.

Central IV Lines

Gastrostomy Tubes

Shunts Tubes that drain excess fluid

from around brain If shunt becomes clogged,

changes in mental status may occur.

Patient may go into respiratory arrest.

Remember, family does matter…

When a child is ill or injured, you may have several patients, not just one.

Children often mimic the behavior of their caregivers.

Be calm, professional, and sensitive.

Thanks for all that you do!

pediatrics… ... more than just little people

Documents

years of agethey

blood flow

blood pressureuse

blood vessels

schoolage child6

immediate transport

older children

behaviors of children