pediatrics pediatric patients & emergencies pediatrics family matters l when a child is ill or...

pediatricspediatrics

Pediatric PatientsPediatric Patients

& Emergencies& Emergencies


Family MattersFamily Matters

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

Children mimic caregiver behavior Children mimic caregiver behavior

Be calm, professional, and sensitive.Be calm, professional, and sensitive.


Anatomic DifferencesAnatomic Differences Less circulating bloodLess circulating blood Lose body heat more easilyLose body heat more easily Bones are more flexibleBones are more flexible Less fat surrounding organsLess fat surrounding organs Could be much internal damage Could be much internal damage

with little external visible traumawith little external visible trauma


Skeletal DifferencesSkeletal Differences

Bones are prone to fracture Bones are prone to fracture with stress.with stress.

Infants have two openings Infants have two openings in the skull called in the skull called fontanels.fontanels.– close by 18 months.close by 18 months.


Airway DifferencesAirway Differences– Larger tongue Larger tongue

relative to the mouthrelative to the mouth

– Less well-developed Less well-developed rings of cartilage in rings of cartilage in the tracheathe trachea

– Head tilt-chin lift Head tilt-chin lift may occlude the may occlude the airway.airway.


Breathing DifferencesBreathing Differences

Infants breathe faster than Infants breathe faster than children or adults.children or adults.

Infants use the diaphragm Infants use the diaphragm when they breathe.when they breathe.

Sustained, labored breathing Sustained, labored breathing may lead to respiratory may lead to respiratory failure.failure.


Circulation DifferencesCirculation Differences

The heart rate increases for The heart rate increases for illness and injuryillness and injury

Very effective vasoconstriction Very effective vasoconstriction keeps vital organs nourishedkeeps vital organs nourished

Pale, extremities, decreased Pale, extremities, decreased cap refill are early signs of cap refill are early signs of perfusion problemsperfusion problems


Approach to Approach to AssessmentAssessment

level of activity, work of breathing, and skin colorlevel of activity, work of breathing, and skin color cap refill cap refill ALS backup or immediate transport?ALS backup or immediate transport? Pediatric patients crash harder than Pediatric patients crash harder than

adultsadults Transport to peds facilities when Transport to peds facilities when

possiblepossible


Capillary RefillCapillary Refill


Treatment Treatment ConsiderationsConsiderations

OxygenOxygen - treat same as adult – Use - treat same as adult – Use “blow-by” administration if needed“blow-by” administration if needed

Patient position Patient position - same as adult - same as adult

*Remember* airway and breathing *Remember* airway and breathing are focusare focus


Growth and Growth and DevelopmentDevelopment

Usually grouped into stagesUsually grouped into stages– InfantInfant– ToddlerToddler– PreschoolPreschool– School-age School-age – AdolescentAdolescent


InfantInfant first year of lifefirst year of life

respond physical respond physical stimulistimuli

crying is main means crying is main means of expressionof expression

have caregiver hold pthave caregiver hold pt


ToddlerToddler 1 to 3 years of age1 to 3 years of age mobilemobile may resist may resist

separationseparation don’t like being don’t like being

restrainedrestrained can be distractedcan be distracted


PreschoolPreschool 3 to 6 years of age3 to 6 years of age can understand directionscan understand directions can identify painful areascan identify painful areas fearful of painfearful of pain allow them to handle allow them to handle

equipmentequipment explain what you are going to explain what you are going to

dodo


School-Age ChildSchool-Age Child 6 to 12 years of age6 to 12 years of age begin to think like adultsbegin to think like adults can be included when taking medical can be included when taking medical

historyhistory should be familiar with physical examshould be familiar with physical exam allow them to make choices when allow them to make choices when

possiblepossible


The AdolescentThe Adolescent 12 to 18 years of age12 to 18 years of age concerned about body imageconcerned about body image may have strong feelings about may have strong feelings about

being observedbeing observed respect their privacyrespect their privacy they understand painthey understand pain explain any procedureexplain any procedure


NotesNotes

never lie to a childnever lie to a child


Vital SignsVital Signs


RespirationsRespirations Abnormal respirations are a Abnormal respirations are a

common sign of illness or injurycommon sign of illness or injury Less than 3, count rise and fall of Less than 3, count rise and fall of

abdomenabdomen Note effort of breathing/noisesNote effort of breathing/noises Note if they are cryingNote if they are crying


Respiration NotesRespiration Notes

Less than 12 breaths/min Less than 12 breaths/min More than 60 breaths/min, More than 60 breaths/min, ALOC and/or an inadequate tidal ALOC and/or an inadequate tidal

volume volume

= ventilation with a BVM = ventilation with a BVM devicedevice


PulsePulse Infants -brachial Infants -brachial

or femoral or femoral Child- use Child- use

carotidcarotid Count at least 1 Count at least 1

minuteminute Note strengthNote strength


Blood PressureBlood Pressure

Use right size cuffUse right size cuff

Difficult scene? Don’t Difficult scene? Don’t waste timewaste time

Under 3? No BPUnder 3? No BP


Skin SignsSkin Signs important important

signsign feel for feel for

temperature temperature and moistureand moisture

always check always check capillary refillcapillary refill


Pediatric ProblemsPediatric Problems


FeverFever–Common CausesCommon Causes

InfectionsInfections Neoplasm (cancer)Neoplasm (cancer) Drug ingestionDrug ingestion Collagen vascular diseaseCollagen vascular disease High environmental temperaturesHigh environmental temperatures


Emergency Care for Emergency Care for FeverFever

Ensure BSIEnsure BSI Begin passive coolingBegin passive cooling

– Remove clothing/coveringsRemove clothing/coverings

– Damp towels Damp towels No iceNo ice No alcoholNo alcohol No cold water bathsNo cold water baths


Febrile SeizuresFebrile Seizures common in children 6 months common in children 6 months

to 6 yearsto 6 years most caused by high fevermost caused by high fever hx of infectionhx of infection generalized grand mal seizuregeneralized grand mal seizure less than 15 minutesless than 15 minutes


TreatmentTreatment

ABC’sABC’s protect patientprotect patient recovery positionrecovery position high flow oxygenhigh flow oxygen suction prnsuction prn passivepassive cooling measures cooling measures transporttransport


DehydrationDehydration

Dry lips and gumsDry lips and gums Fewer wet diapersFewer wet diapers Sunken eyes Sunken eyes Poor skin turgorPoor skin turgor Sleepy or irritableSleepy or irritable Sunken fontanelsSunken fontanels


Care for DehydrationCare for Dehydration Assess the ABCsAssess the ABCs

Obtain baseline vital signsObtain baseline vital signs

ALS backup may be needed ALS backup may be needed for IV administrationfor IV administration


Airway ObstructionAirway Obstruction

CroupCroup– An infection of the airway below An infection of the airway below

the level of the vocal cords, the level of the vocal cords, caused by a viruscaused by a virus

EpiglottitisEpiglottitis– Infection of the soft tissue in the Infection of the soft tissue in the

area above the vocal cordsarea above the vocal cords Foreign body AspirationForeign body Aspiration


CroupCroup

barking coughbarking cough stridorstridor wheezingwheezing ralesrales accessory muscle useaccessory muscle use nasal flaringnasal flaring grunting grunting


EpiglottitisEpiglottitis

severe dyspneasevere dyspnea stridorstridor inability to swallow - inability to swallow -

DROOLINGDROOLING feverfever tripod positiontripod position


Foreign body aspirationForeign body aspiration

Partial Partial BlockageBlockage– coughingcoughing– accessory accessory

muscle usemuscle use– nasal flaringnasal flaring– wheezingwheezing

Complete Complete BlockageBlockage- no soundno soundno cryno cry- stridorstridor- cyanosiscyanosis- loss of loss of

consciousnessconsciousness


treatmenttreatment

ABC’sABC’s high flow oxygen high flow oxygen position of comfortposition of comfort

do not do not attempt to visualize the throat!attempt to visualize the throat!

do not do not put anything into patient’s mouth.put anything into patient’s mouth.


AsthmaAsthma

dyspneadyspnea wheezingwheezing accessory muscle useaccessory muscle use nasal flaringnasal flaring respiratory rate - observerespiratory rate - observe


TreatmentTreatment

ABC’sABC’s high flow oxygenhigh flow oxygen position of comfortposition of comfort transporttransport


What is the most What is the most frequent cause of frequent cause of cardiac arrest in cardiac arrest in

pediatrics?pediatrics?


RespiratoryRespiratory arrestarrest!!


want to save a want to save a pediatric patient?pediatric patient?

aggressive ventilation & high aggressive ventilation & high flow oxygenflow oxygen


USC video!USC video!

Pediatric respiratory distress Pediatric respiratory distress


MeningitisMeningitis

Inflammation of meningesInflammation of meninges Bacterial or viralBacterial or viral Permanent brain Permanent brain

damage/deathdamage/death


Signs and Symptoms of Signs and Symptoms of Meningitis Meningitis

FeverFever ALOCALOC HeadachHeadach

ee SeizureSeizure Stiff neck Stiff neck

VomitingVomiting PhotophobiaPhotophobia IrritabilityIrritability Bulging Bulging

fontanelfontanel


Neisseria meningitidisNeisseria meningitidis

rapid onset rapid onset pinpoint cherry-red spots or pinpoint cherry-red spots or

larger purple/black rashlarger purple/black rash sepsis, shock, and deathsepsis, shock, and death all suspected cases considered all suspected cases considered

contagiouscontagious


TreatmentTreatment

BSIBSI ABC’sABC’s protect patientprotect patient high flow oxygenhigh flow oxygen passive cooling for feverpassive cooling for fever monitor for shockmonitor for shock TransportTransport Call ALS for backup if unstableCall ALS for backup if unstable


Submersion InjurySubmersion Injury

Drowning or near drowningDrowning or near drowning Second most common cause of Second most common cause of

unintentional deathunintentional death ABC’sABC’s May be in respiratory or cardiac May be in respiratory or cardiac

arrestarrest C-spine precautions?C-spine precautions? Be ready to suctionBe ready to suction Keep warmKeep warm


PoisoningPoisoning

Poisoning is common in childrenPoisoning is common in children Ask specific questions of Ask specific questions of

caregiverscaregivers Focus on the ABCsFocus on the ABCs Give oxygenGive oxygen Provide transportProvide transport Child’s condition could change at Child’s condition could change at

any timeany time


Pediatric Resuscitation Pediatric Resuscitation Tape Measure Tape Measure (Aka: (Aka:

Broslow tape)Broslow tape) Used to Used to

determine determine height, height, weight, weight, and proper and proper equipment.equipment.


Interossius IVInterossius IV

Used if traditional IV sites are Used if traditional IV sites are difficult to assessdifficult to assess

Medication delivered into bone Medication delivered into bone marrowmarrow

PainfulPainful


Interossius Interossius


Transporting Infants and Transporting Infants and ChildrenChildren

Children require padding under the torso Children require padding under the torso Newborns should be in special incubatorsNewborns should be in special incubators Do not hold child during the actual Do not hold child during the actual

transporttransport Drive with due careDrive with due care Do not allow your emotions to take controlDo not allow your emotions to take control


Sudden Infant Death Sudden Infant Death SyndromeSyndrome

SIDS - “crib death”SIDS - “crib death”


SIDSSIDS

Definition - unexplained death Definition - unexplained death of an apparently healthy of an apparently healthy infant.infant.

7500+ cases per year in U.S.7500+ cases per year in U.S. Leading cause of death in Leading cause of death in

infants <1 year oldinfants <1 year old more cases in winter monthsmore cases in winter months


Sudden Infant Death Sudden Infant Death Syndrome (SIDS)Syndrome (SIDS)

Several known risk factors:Several known risk factors:– Mother younger than 20 years oldMother younger than 20 years old– Mother smoked during pregnancyMother smoked during pregnancy– Low birth weightLow birth weight– Putting babies to sleep on stomachPutting babies to sleep on stomach– Siblings of SIDS babiesSiblings of SIDS babies


Tasks at SceneTasks at Scene

Assess and manage patientAssess and manage patient Communicate with and Communicate with and

support the familysupport the family Assess the sceneAssess the scene


Assessment and Assessment and ManagementManagement

Diagnosis of exclusionDiagnosis of exclusion Can be other causes of conditionCan be other causes of condition Regardless of cause, TX is sameRegardless of cause, TX is same Infant may have signs of Infant may have signs of

postmortem changespostmortem changes It is ok to work up an obviously It is ok to work up an obviously

dead babydead baby If no postmortem changes, begin If no postmortem changes, begin

CPR immediatelyCPR immediately


Communication and Communication and Support of FamilySupport of Family

The death of child is very stressful for the The death of child is very stressful for the familyfamily

Parents guilt is overwhelmingParents guilt is overwhelming Provide support in whatever ways you Provide support in whatever ways you

cancan IT IS NOT YOUR PLACE TO JUDGEIT IS NOT YOUR PLACE TO JUDGE Use the infant’s name Use the infant’s name Allow family time with the infantAllow family time with the infant


Scene AssessmentScene Assessment

Inspect the environment, noting:Inspect the environment, noting:– Signs of illness, including medicationsSigns of illness, including medications– General condition of the houseGeneral condition of the house– Family interactionFamily interaction– Site where infant was discoveredSite where infant was discovered


Support GroupsSupport Groups

Know your local phone Know your local phone numbers for referralsnumbers for referrals

Arrange for proper debriefingArrange for proper debriefing


Child AbuseChild Abuse

Any improper or excessive action Any improper or excessive action that injures or harms a child or infantthat injures or harms a child or infant

physical, sexual, emotional abuse physical, sexual, emotional abuse and neglectand neglect

More than 2 million cases reported More than 2 million cases reported annuallyannually

Be aware of signs of child abuse and Be aware of signs of child abuse and report it to authoritiesreport it to authorities


Questions Regarding Questions Regarding Signs of Abuse Signs of Abuse (1 of 4)(1 of 4)

Is the injury typical?Is the injury typical?

Is reported method of injury consistent with Is reported method of injury consistent with injuries?injuries?

Is the caregiver behaving appropriately?Is the caregiver behaving appropriately?

Is there evidence of drinking or drug Is there evidence of drinking or drug abuse?abuse?



Delay in seeking care?Delay in seeking care?

Good relationship between child Good relationship between child and caregiver?and caregiver?

Multiple injuries at various Multiple injuries at various stages of healing?stages of healing?

Any unusual marks or bruises?Any unusual marks or bruises?



Are there several types of Are there several types of injuries?injuries?

Any burns on the hands or feet Any burns on the hands or feet involving a glove distribution?involving a glove distribution?

Unexplained decreased level of Unexplained decreased level of consciousness?consciousness?



Is the child clean and an Is the child clean and an appropriate weight?appropriate weight?

Any rectal or vaginal bleeding?Any rectal or vaginal bleeding?

What does the home look like? What does the home look like?


Other IndicatorsOther Indicators

Withdrawn, fearful or hostile childWithdrawn, fearful or hostile child Refusal to discuss MOIRefusal to discuss MOI History of “accidents”History of “accidents” Conflicting storiesConflicting stories Caregiver lack of concernCaregiver lack of concern


Emergency Medical Emergency Medical CareCare

ABCsABCs

Transport if you Transport if you suspectsuspect child abusechild abuse

Do not make accusationsDo not make accusations

EMT-Bs must report all EMT-Bs must report all suspected cases of child suspected cases of child abuseabuse


Sexual AbuseSexual Abuse

Children of any age or either Children of any age or either gender can be victimsgender can be victims

Limit examinationLimit examination

Do not allow child to wash, Do not allow child to wash, urinate, or defecateurinate, or defecate

Document carefullyDocument carefully

TransportTransport


EMS Response to EMS Response to Pediatric EmergenciesPediatric Emergencies You may experience a wide You may experience a wide

range of emotions range of emotions You may feel anxiousYou may feel anxious Practice helpsPractice helps After difficult incidents, a After difficult incidents, a

debriefing may be helpfuldebriefing may be helpful


stopstop

questions?questions?

pediatrics pediatric patients & emergencies pediatrics family matters l when a child is ill or...

Documents

child slide

possible slide

pediatrics vital signs

pediatrics respirations

pediatrics infant

pediatrics toddler

pediatrics preschool

pediatrics notes