Chapter 17: Pediatric Emergencies

National EMS Education Standard Competencies (1 of 8) Special Patient Populations Recognizes and manages life threats based on simple assessment findings for a patient with special needs while awaiting additional emergency response. Special Patient Populations Recognizes and manages life threats based on simple assessment findings for a patient with special needs while awaiting additional emergency response.

National EMS Education Standard Competencies (2 of 8) Pediatrics Age-related assessment findings and age-related assessment and treatment modifications for pediatric-specific major diseases and/or emergencies Upper airway obstruction Lower airway reactive disease Respiratory distress/failure/arrest Pediatrics Age-related assessment findings and age-related assessment and treatment modifications for pediatric-specific major diseases and/or emergencies • Upper airway obstruction (pp 369-371) • Lower airway reactive disease (p 373) • Respiratory distress/failure/arrest (pp 371-372)

National EMS Education Standard Competencies (3 of 8) Pediatrics (cont’d) Shock Seizures Sudden infant death syndrome (SIDS) Patients With Special Challenges Recognize and report abuse and neglect • Shock (p 379) • Seizures (p 375) • Sudden infant death syndrome (SIDS) (p 378) Patients With Special Challenges • Recognizing and reporting abuse and neglect (pp 380-381)

National EMS Education Standard Competencies (4 of 8) Medicine Recognizes and manages life threats based on assessment findings of a patient with a medical emergency while awaiting additional emergency response. Medicine Recognizes and manages life threats based on assessment findings of a patient with a medical emergency while awaiting additional emergency response.

National EMS Education Standard Competencies (5 of 8) Respiratory Anatomy, signs, symptoms, and management of respiratory emergencies including those that affect the Upper airway Lower airway Respiratory Anatomy, signs, symptoms, and management of respiratory emergencies including those that affect the • Upper airway (pp 366-372; pp 373-374) • Lower airway (p 373)

National EMS Education Standard Competencies (6 of 8) Trauma Uses simple knowledge to recognize and manage life threats based on assessment findings for an acutely injured patient while awaiting additional emergency medical response. Trauma Uses simple knowledge to recognize and manage life threats based on assessment findings for an acutely injured patient while awaiting additional emergency medical response.

National EMS Education Standard Competencies (7 of 8) Special Considerations in Trauma Recognition and management of trauma in Pregnant patient Pediatric patient Geriatric patient Special Considerations in Trauma Recognition and management of trauma in • Pregnant patient (Chapter 16, Childbirth) • Pediatric patient (pp 378-379) • Geriatric patient (Chapter 18, Geriatric Emergencies)

National EMS Education Standard Competencies (8 of 8) Anatomy and Physiology Uses simple knowledge of the anatomy and function of the upper airway, heart, vessels, blood, lungs, skin, muscles, and bones as the foundation of emergency care. Anatomy and Physiology Uses simple knowledge of the anatomy and function of the upper airway, heart, vessels, blood, lungs, skin, muscles, and bones as the foundation of emergency care.

Introduction Sudden illness and medical emergencies are common in children and infants. Anatomical differences exist between adults and children. Respiratory care for children is extremely important. I. Introduction A. Sudden illnesses and medical emergencies are common in children and infants. B. Anatomical differences exist between adults and children. 1. Special knowledge and skills are needed to assess and treat children and infants. C. Respiratory care for children is extremely important. D. Emergency medical responders (EMRs) should learn some basic information and treatment for common pediatric emergencies.

General Considerations (1 of 3) Managing a pediatric emergency can be one of the most stressful situations you face as an emergency medical responder (EMR). You must remain calm and professional. Unless you are prepared, your anxiety and fear may interfere with your ability to deliver proper care. II. General Considerations A. Managing a pediatric emergency can be one of the most stressful situations you face as an EMR. 1. In an atmosphere where everyone involved is tense, you must remain calm and behave in a controlled and professional manner. B. Emergency medical services (EMS) personnel often have mixed feelings when treating a child. 1. Unless you are prepared, your anxiety and fear may interfere with your ability to deliver proper care.

General Considerations (2 of 3) The parents can be either allies or a potential problem. Talk to both the parents and the child as much as possible. Try to develop a rapport with the child. Squat, kneel, or sit down and establish eye contact. Ask simple questions about the pain. C. The parents 1. The child’s parents or caregivers can be either allies or a potential problem. a. Talk to both the parents and the child as much as possible. b. Helpful parents can tell you how the child’s behavior is different from his or her usual behavior. 2. Children get many of their behavioral cues from their parents. a. Calm the parents and ask for their assistance in calming the child. b. If possible, let a parent hold the child. 3. Try to develop a rapport with the child. a. Tell the child your first name, find out what the child’s name is, and use the child’s name as you explain what you are doing. b. Squat, kneel, or sit down and establish eye contact. c. Ask simple questions about the pain.

General Considerations (3 of 3) The parents (cont’d) Be honest with the child. Some agencies provide the child with a trauma teddy bear to hold while being examined. 4. Be honest with the child. a. Tell the child what you are going to do and explain that it may hurt. b. In talking to the child, you can also request his or her help. 5. Some agencies provide the child with a trauma teddy bear to hold while being examined. Figure: The trauma teddy bear helps keep a child calm while being examined. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Pediatric Anatomy and Function (1 of 3) Differences between children and adults A child’s airway is smaller in relation to the rest of the body compared to an adult’s airway. A child’s tongue is proportionally larger than an adult’s. III. Pediatric Anatomy and Function A. Children and adults have the same body systems that perform the same functions, but certain differences exist. 1. A child’s airway is smaller in relation to the rest of the body compared to an adult’s airway. a. It is more easily blocked by secretions or swelling. 2. A child’s tongue is proportionally larger than an adult’s. It can more easily block the airway if the child becomes unresponsive. Figure: The anatomy of a child’s airway differs from that of an adult. The tongue is proportionally larger and can more easily block the airway. Also, the back of a child’s head is larger, so head positioning requires more care. © Jones & Bartlett Learning.

Pediatric Anatomy and Function (2 of 3) Differences between children and adults (cont’d) A child’s upper airway is more flexible than that of an adult. For at least the first 6 months of their lives, infants can breathe only through their noses. When the demands on a child’s respiratory system change, the child is able to quickly compensate by increasing breathing efforts. 3. A child’s upper airway is more flexible than that of an adult. a. Avoid hyperextending the neck when attempting to open the airway. b. Position the head in a neutral or slight sniffing position. 4. For at least the first 6 months of their lives, infants can breathe only through their noses. a. Clear the nose of mucous secretions. 5. When the demands on a child’s respiratory system change, the child is able to quickly compensate by increasing his or her breathing rate and efforts. a. However, these compensatory mechanisms will function only for a short period of time. b. The child may show signs of severe respiratory distress and rapidly progress to respiratory failure. c. Perform a thorough patient assessment and recheck vital signs at least every 5 minutes.

Pediatric Anatomy and Function (3 of 3) Differences between children and adults (cont’d) Infants and children have limited abilities to compensate for changes in temperature as compared to adults. 6. Infants and children have limited abilities to compensate for changes in temperature as compared to adults. a. Children lose relatively more heat than adults do. b. Keep pediatric patients warm if they become chilled.

Examining a Child Use the same following five steps as in the adult patient assessment sequence: Perform a scene size-up. Complete a primary assessment. Complete a secondary assessment by examining the child from head to toe. Obtain a medical history. Perform reassessments as needed. IV. Examining a Child A. The examination of a child should consist of the same five steps used in the patient assessment sequence for adults. 1. Perform a scene size-up to ensure that the scene is safe for you and for the patient. 2. Complete a primary assessment. a. Form a general impression of the patient. b. Determine the patient’s level of responsiveness. c. Assess the status of the airway, breathing, and circulation. 3. Complete a secondary assessment by examining the child from head to toe. 4. Obtain a medical history. 5. Perform reassessments as needed.

The Pediatric Assessment Triangle (1 of 5) The pediatric assessment triangle (PAT) helps you quickly form a general impression of the child using only your senses of sight and hearing. Can be used to assess a child from a distance Source: Used with permission of the American Academy of Pediatrics, Pediatric Education for Prehospital Professionals, ©American Academy of Pediatrics, 2000. B. The pediatric assessment triangle (PAT) 1. The PAT was developed to help you quickly form a general impression of the child using only your senses of sight and hearing. a. It provides you with an accurate initial picture of the functioning of the child’s airway, breathing, circulation, and level of responsiveness. 2. The PAT can be used to assess a child from a distance and to determine which steps need to be taken first. Figure: The three components of the PAT include appearance, work of breathing, and circulation to the skin.

The Pediatric Assessment Triangle (2 of 5) Appearance Indicator of how well the heart, lungs, and central nervous system are working Compare the child’s appearance with what you would expect from a healthy child. Assess eye contact, muscle tone, and skin color. Reassess regularly because the appearance can change quickly. 3. Appearance a. The general appearance is an indicator of how well the heart and lungs are working. b. Appearance is also a good indication of how well the central nervous system is working. c. Compare the child’s appearance and actions with what you would expect from a healthy child of the same age. d. Assess the child’s eye contact, muscle tone, and skin color. i. A child who is not crying may have a decreased level of consciousness, an upper airway infection, or swelling in the airway. ii. A child who is unresponsive, is lackluster, and appears ill should be evaluated carefully. e. Reassess the child’s appearance regularly because it can change quickly.

The Pediatric Assessment Triangle (3 of 5) Table: Characteristics of Appearance © Jones & Bartlett Learning.

The Pediatric Assessment Triangle (4 of 5) Work of breathing More accurate indicator of a child’s condition than merely determining the respiratory rate Determined by measuring four factors 4. Work of breathing a. Assessing the work of breathing is a more accurate indicator of a child’s condition than merely determining the rate of respirations. b. The work of breathing is determined by measuring the following four factors: i. Abnormal breath sounds ii. Abnormal positioning iii. Retractions of the neck or chest iv. Flaring of the nostrils c. Assessment can be made without touching the child and can be done from across the room. Table: Characteristics of Work of Breathing © Jones & Bartlett Learning.

The Pediatric Assessment Triangle (5 of 5) Circulation to the skin Three characteristics are used to assess the circulation. 5. Circulation to the skin a. There are three characteristics for determining circulation. i. Paleness—White or pale skin indicates inadequate blood flow to the skin. ii. Mottling—Patchy skin discoloration is caused by too much or too little circulation to the skin. iii. Cyanosis—Bluish discoloration is caused by low levels of oxygen in the blood. 6. The PAT should be used with other parts of the patient assessment sequence. Table: Characteristics of Circulation to the Skin © Jones & Bartlett Learning.

Respirations (1 of 2) Count respirations for 30 seconds and multiply by 2. Look for signs of respiratory distress. Assess how much work the child is doing to breathe. Look for abnormal breath sounds such as noisy breathing, snoring, crowing, grunting, and wheezing. C. Respirations 1. To calculate the respiratory rate of a child, you should count respirations for 30 seconds and multiply by 2. 2. Look for signs of respiratory distress. a. Assess how much work the child is doing to breathe. b. Look for abnormal breath sounds: i. Noisy breathing ii. Snoring iii. Crowing iv. Grunting v. Wheezing

Respirations (2 of 2) Look for signs of respiratory distress. (cont’d) Determine whether the child is holding himself or herself in an abnormal position. Check for retractions of the neck and chest. Look for flaring of the nostrils. c. Determine whether the child is holding himself or herself in an abnormal position. d. Check for retractions of the neck and chest. e. Look for flaring of the nostrils.

Pulse Rate (1 of 2) The normal pulse rate of a child is faster than an adult’s normal rate. For a child younger than 1 year, palpate a brachial pulse. © Jones & Bartlett Learning. D. Pulse rate 1. The normal pulse rate of a child is faster than an adult’s normal rate. 2. For a child younger than 1 year, palpate a brachial pulse. Figure: The best place to take the pulse in an infant is over the brachial artery or directly over the heart.

Pulse Rate (2 of 2) Figure: Normal Vital Signs in Children at Rest Data from: American Heart Association. 2015 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Chameides L, Samson RA, Schexnayder SM, Hazinski MF, eds. Pediatric Advanced Life Support Provider Manual. Dallas, TX: American Heart Association; 2011.

High Body Temperature High temperatures are accompanied by Flushed, red skin Sweating Restlessness To feel a high temperature, touch the child’s chest and head. A child’s heart rate increases with each degree of temperature rise. E. High body temperature 1. High temperatures in children are often accompanied by flushed, red skin; sweating; and restlessness. 2. To feel a high temperature, touch the child’s chest and head. 3. A child’s heart rate increases with each degree of temperature rise.

Respiratory Care (1 of 2) It is important to open and maintain the airway and to ventilate adequately any child with respiratory problems. V. Respiratory Care A. It is important to open and maintain the child’s airway and to ventilate adequately any child with respiratory problems. 1. Problems can lead to respiratory arrest, followed by cardiac arrest.

Respiratory Care (2 of 2) Causes of cardiopulmonary arrest in children Suffocation caused by aspiration of a foreign body Infections of the airway such as croup and epiglottitis SIDS Accidental poisonings Injuries around the head and neck 2. Specific causes of cardiopulmonary arrest in children include a. Suffocation caused by aspiration of a foreign body b. Infections of the airway such as croup and epiglottitis c. SIDS d. Accidental poisonings e. Injuries around the head and neck

Treating Respiratory Emergencies (1 of 7) Opening the airway Use the head tilt–chin lift maneuver on children who have not sustained any injury to the neck or head. Do not hyperextend the child’s neck when you tilt the head back. © Jones & Bartlett Learning. Courtesy of MIEMSS. B. Treating respiratory emergencies in infants and children 1. Opening the airway a. The general techniques are the same for children and adults. b. The head tilt–chin lift maneuver can be used for children who have not sustained an injury to the neck or head. i. Do not hyperextend the child’s neck when you tilt the head back. ii. Use a neutral or slight sniffing position. iii. Place a folded towel under the child’s shoulders to help maintain the position. Figure: Open the child’s airway using the head tilt‒chin lift maneuver.

Treating Respiratory Emergencies (2 of 7) Opening the airway (cont’d) If there is a possibility of injury to the head or neck, try the jaw-thrust maneuver. Basic life support Cardiopulmonary resuscitation (CPR) for children is different from adult CPR. If you are alone and emergency medical services (EMS) has not been called, perform five cycles (2 minute) of CPR before activating the EMS system. c. If the possibility of injury to the head or neck exists, try the jaw-thrust maneuver. 2. Basic life support a. You must use specific techniques when you perform cardiopulmonary resuscitation (CPR) on children. b. CPR for children (1 year of age to the onset of puberty) is different from adult CPR in three ways: i. If you are alone and EMS has not been called, you should perform five cycles (2 minutes) of CPR before activating the EMS system.

Treating Respiratory Emergencies (3 of 7) Basic life support (cont’d) Use the heel of one hand or two hands to perform chest compressions. Compress the sternum at least one third the depth of the chest © Jones & Bartlett Learning. Courtesy of MIEMSS. ii. Use the heel of one hand or two hands to perform chest compressions, depending on the size of the child. iii. Compress the sternum at least one third the depth of the chest. Figure: Place one or two hands in the middle of the chest, between the nipples.

Treating Respiratory Emergencies (4 of 7) Basic life support (cont’d) CPR for infants is different from adult CPR. Check for responsiveness by tapping the infant’s foot or gently shaking the shoulder. Check the brachial pulse. Use your middle and ring fingers to compress the sternum just below the nipple line. Compress the sternum at least one third the depth of the chest. Give gentle rescue breaths. c. CPR for infants (younger than 1 year) has five differences from adult CPR: i. Check for responsiveness by tapping the infant’s foot or gently shaking the shoulder. ii. Check the brachial pulse. iii. Use your middle and ring fingers to compress the sternum just below the nipple line. iv. Compress the sternum at least one third the depth of the chest. v. Give gentle rescue breaths, using mouth-to-mouth-and-nose ventilations.

Treating Respiratory Emergencies (5 of 7) Suctioning Clear the airway initially by turning the patient on his or her side and use your gloved finger to scoop out the substance. Use suctioning to remove the rest of the foreign substance. Suctioning can be a lifesaving procedure. 3. Suctioning a. When a patient’s airway is blocked by secretions, vomitus, or blood, you should clear it initially by turning the patient on his or her side and use your gloved fingers to scoop out as much of the substance as possible. b. You can use suctioning to remove the foreign substances that cannot be removed with a gloved finger. c. Suctioning can be a lifesaving procedure.

Treating Respiratory Emergencies (6 of 7) Suctioning (cont’d) The procedure for suctioning is the same as for adults, with the following exceptions: Use a tonsil tip or rigid tip to suction the mouth. Use a flexible catheter to suction the nose of a child. Use a bulb syringe to suction the nose of an infant. Never suction for more than 5 seconds. Try to ventilate and reoxygenate the patient before repeating the suctioning. d. The procedure used for suctioning infants and children is generally the same as for adults, with some exceptions: i. Use a tonsil tip or rigid tip to suction the mouth; do not insert the tip any farther than you can see. ii. Use a flexible catheter to suction the nose of a child; set the suction on low or medium power. iii. Use a bulb syringe to suction the nose of an infant. iv. Never suction for more than 5 seconds at one time. v. Try to ventilate and reoxygenate the patient before repeating the suctioning.

Treating Respiratory Emergencies (7 of 7) Airway adjuncts Oral airways can maintain an open airway after you have opened the patient’s airway manually. Use the steps in Skill Drill 17-1 to insert an oral airway in a child or an infant. EMRs rarely use nasal airways for children. 4. Airway adjuncts a. Oral airways can maintain an open airway after you have opened the patient’s airway by manual means. b. Use the steps in Skill Drill 17-1 to insert an oral airway in a child or an infant. c. EMRs rarely use nasal airways for children.

Mild (Partial) Airway Obstruction (1 of 2) Place the child on his or her back, tilt the head, and lift the chin in the usual manner. Remove the object if it is clearly visible in the mouth and can be removed easily. If not, do not attempt to remove the object as long as the child can still breathe. Children should be transported to the emergency department. C. Mild (partial) airway obstruction 1. You can usually relieve a mild airway obstruction by placing the child on his or her back, tilting the head, and lifting the chin in the usual manner. 2. An airway that is blocked by an aspirated foreign object is a common problem in young children. 3. Remove the object if it is clearly visible in the mouth and can be removed easily. a. If not, do not attempt to remove the object as long as the child can still breathe air around the object. b. Trying to remove an object that is partially blocking a child’s airway can push the object down and result in a severe airway blockage. 4. Children should be transported to the emergency department. a. Talk constantly to the child about what you are doing to provide comfort and reduce his or her terror. b. Most of the time, parents are able to realize the seriousness of the situation, redirect their emotions, and work with you to reassure and calm the child.

Mild (Partial) Airway Obstruction (2 of 2) Administer oxygen if it is available and you are trained to use it. Place the oxygen mask over the child’s mouth and nose. Do not try to get an airtight seal. Hold the mask 1" to 2" away from the child’s face. 5. Administer oxygen if it is available and you are trained to use it. a. Place the oxygen mask over the child’s mouth and nose. b. Do not try to get an airtight seal; hold it 1" or 2" away from the child’s face.

Severe (Complete) Airway Obstruction in Children (1 of 3) Severe airway obstruction is a serious emergency. Signs and symptoms Poor air exchange Increased breathing difficulty Silent cough Inability to speak No movement D. Severe (complete) airway obstruction in children 1. A severe airway obstruction is a serious emergency. 2. A severe airway obstruction exists when the child has a. Poor air exchange b. Increased breathing difficulty c. Silent cough d. Inability to speak e. No air movement

Severe (Complete) Airway Obstruction in Children (2 of 3) Use the Heimlich maneuver. It provides enough energy to expel most foreign objects. 3. Use the Heimlich maneuver because it provides enough energy to expel most foreign objects that could completely block a child’s airway. Figure: Performing abdominal thrusts on a child. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Severe (Complete) Airway Obstruction in Children (3 of 3) Relieving an airway obstruction in a child is the same as for an adult, with a few exceptions. When opening a child’s airway, tilt the head back just past the neutral position. If you are by yourself, perform CPR for five cycles before activating the EMS system. 4. The steps for relieving an airway obstruction in a conscious child are the same as for an adult patient, with a few slight adjustments: a. When opening the airway of a child or infant, tilt the head back just past the neutral position. b. If you are by yourself and a child with an airway obstruction becomes unresponsive, perform CPR for five cycles (about 2 minutes) before activating the EMS system.

Complete or Severe Airway Obstruction in Infants (1 of 4) An infant is very fragile. If you suspect an airway obstruction, assess the infant to determine whether any air exchange is occurring. If the infant is crying, the airway is not completely obstructed. If no air is moving in or out of the infant’s mouth and nose, suspect an obstructed airway. E. Complete or severe airway obstruction in infants 1. An infant (younger than 1 year) is very fragile. 2. If you suspect an airway obstruction, first assess the infant to determine whether any air exchange is occurring. a. If the infant is crying, the airway is not completely obstructed. b. If no air is moving in or out of the infant’s mouth and nose, suspect an obstructed airway.

Complete or Severe Airway Obstruction in Infants (2 of 4) Use a combination of back slaps and the chest-thrust maneuver. Assess the infant’s airway and breathing. Place the infant in a face-down position over your one arm and deliver five back slaps between the shoulder blades. 3. To relieve an airway obstruction in a conscious infant, use a combination of back slaps and the chest-thrust maneuver. a. Assess the infant’s airway and breathing status. b. Place the infant in a face-down position over your one arm and deliver five back slaps forcefully between the infant’s shoulder blades with the heel of your hand. Figure: Administering back slaps and chest thrusts in an infant. (First) Hold the infant facedown with the body resting on your forearm. Support the jaw and face with your hand without blocking the airway and keep the head lower than the rest of the body. Give the infant five back slaps between the shoulder blades, using the heel of your hand. © Jones & Bartlett Learning.

Complete or Severe Airway Obstruction in Infants (3 of 4) Use a combination of back slaps and the chest-thrust maneuver. (cont’d) Turn the infant face-up. Deliver five chest thrusts in the middle of the sternum with your two fingers. Repeat these steps until the object is expelled or until the infant becomes unresponsive. © Jones & Bartlett Learning. c. Turn the infant face-up by sandwiching the infant between your hands and arms. d. Deliver five chest thrusts in the middle of the sternum with your two fingers. e. Repeat the series of back slaps and chest thrusts until the foreign object is expelled or until the infant becomes unresponsive. Figure: Administering back slaps and chest thrusts in an infant. (Next) Sandwich the infant between your hands, turn the infant over, and give the infant five quick chest thrusts, using two fingers placed on the lower half of the sternum (finger position should be the same as CPR for infants).

Complete or Severe Airway Obstruction in Infants (4 of 4) If the infant becomes unresponsive, continue with the following steps: Ensure that EMS has been activated. Begin CPR, starting with chest compressions. Continue CPR until personnel with more advanced EMS skills arrive. f. If the infant becomes unresponsive, continue with the following steps: i. Ensure that EMS has been activated. ii. Begin CPR. iii. Continue CPR until personnel with more advanced EMS skills arrive.

Swallowed Objects If small, round objects do not become airway obstructions, they usually pass uneventfully through the child. Sharp or straight objects are dangerous if swallowed. Arrange for prompt transport. F. Swallowed objects 1. If small, round objects do not become airway obstructions, they usually pass uneventfully through the child and are eliminated in a bowel movement. 2. Sharp or straight objects are dangerous if swallowed. a. Arrange for prompt transport.

Respiratory Distress (1 of 3) Signs of respiratory distress A breathing rate of more than 60 breaths per minute in infants A breathing rate of more than 30 to 40 breaths per minute in children Nasal flaring on each breath Retraction of the skin between the ribs and around the neck muscles Stridor G. Respiratory distress 1. Respiratory distress indicates that a child has a serious problem that requires immediate medical attention. 2. Signs of respiratory distress include a. A breathing rate of more than 60 breaths per minute in infants b. A breathing rate of more than 30 to 40 breaths per minute in children c. Nasal flaring on each breath d. Retraction of the skin between the ribs and around the neck muscles e. Stridor

Respiratory Distress (2 of 3) Signs of respiratory distress (cont’d) Cyanosis of the skin Altered mental status Combativeness or restlessness Treatment of respiratory distress Try to determine the cause. Support the child’s respirations by placing the child in a comfortable position, usually sitting. f. Cyanosis of the skin g. Altered mental status h. Combativeness or restlessness 3. Treatment of respiratory distress a. Try to determine the cause. b. Support the child’s respirations by placing the child in a comfortable position, usually sitting.

Respiratory Distress (3 of 3) Treatment of respiratory distress (cont’d) Keep the child as calm as possible by letting a parent hold the child if practical. Prepare to administer oxygen if it is available and you are trained to use it. Monitor the child’s vital signs. Arrange for prompt transport. c. Keep the child as calm as possible by letting a parent hold the child if practical. d. Prepare to administer oxygen if it is available and you are trained in its use. e. Monitor the child’s vital signs. f. Arrange for prompt transport.

Respiratory Failure/Arrest (1 of 5) Often results as respiratory distress proceeds Signs and symptoms A breathing rate of fewer than 20 breaths per minute in an infant A breathing rate of fewer than 10 breaths per minute in a child Limp muscle tone H. Respiratory failure/arrest 1. Respiratory failure often results as respiratory distress proceeds. 2. Signs of respiratory failure include a. A breathing rate of fewer than 20 breaths per minute in an infant b. A breathing rate of fewer than 10 breaths per minute in a child c. Limp muscle tone

Respiratory Failure/Arrest (2 of 5) Signs and symptoms (cont’d) Unresponsiveness Decreased or absent heart rate Weak or absent distal pulses A child in respiratory failure is on the verge of experiencing respiratory and cardiac arrest. d. Unresponsiveness e. Decreased or absent heart rate f. Weak or absent distal pulses 3. A child in respiratory failure is on the verge of experiencing respiratory and cardiac arrest.

Respiratory Failure/Arrest (3 of 5) Treatment Support respirations by performing mouth-to-mask ventilations. Administer oxygen if it is available. Begin chest compressions if the heart rate is absent or less than 60 beats per minute. Arrange for prompt transport. a. Support respirations by performing mouth-to-mask ventilations. b. Administer oxygen if it is available. c. Begin chest compressions if the heart rate is absent or less than 60 beats per minute. d. Arrange for prompt transport.

Respiratory Failure/Arrest (4 of 5) Circulatory failure The most common cause of circulatory failure in children is respiratory failure. Can lead to cardiac arrest Indicated by an increased heart rate, pale or bluish skin, and changes in mental status 4. Circulatory failure a. The most common cause of circulatory failure in children is respiratory failure. b. Uncorrected circulatory failure can lead to cardiac arrest. c. An increased heart rate, pale or bluish skin, and changes in mental status indicate circulatory failure.

Respiratory Failure/Arrest (5 of 5) Circulatory failure (cont’d) If the heart rate is more than 60 beats per minute: Complete the patient assessment sequence. Support ventilations. Administer oxygen. Observe vital signs. If the heart rate is less than 60 beats per minute, begin chest compressions and rescue breathing. d. If the heart rate is more than 60 beats per minute i. Complete the patient assessment sequence. ii. Support ventilations. iii. Administer oxygen. iv. Observe vital signs. e. If the heart rate is less than 60 beats per minute and there are signs of poor circulation, begin chest compressions and rescue breathing.

Altered Mental Status (1 of 2) Causes of altered mental status in children Low blood glucose level Poisoning Postseizure state Infection Head trauma Decreased oxygen levels VI. Sudden Illness and Medical Emergencies A. Not many illnesses occur suddenly in young children, so it is important to recognize and treat key pediatric illnesses. B. Altered mental status 1. Causes of altered mental status in children include a. Low blood glucose level b. Poisoning c. Postseizure state d. Infection e. Head trauma f. Decreased oxygen levels

Altered Mental Status (2 of 2) Complete the patient assessment. Pay particular attention to the patient’s initial vital signs. Calm the patient and the patient’s family. Be prepared to support the patient’s ABCs. Place unconscious patients in the recovery position. 2. Complete the patient assessment, paying particular attention to any clues at the scene. 3. Pay particular attention to the patient’s initial vital signs. a. Recheck vital signs regularly to monitor any changes. 4. Calm the patient and the patient’s family. 5. Be prepared to support the patient’s airway, breathing, and circulation if needed. 6. Place unconscious patients in the recovery position.

Respiratory Illnesses (1 of 7) Because infants breathe primarily through their noses, even a minor cold can cause breathing difficulties. Asthma Caused by a spasm or constriction and inflammation of smaller airways in the lungs Usually produces a wheezing sound Calm and reassure the parents and the child. C. Respiratory illnesses 1. A respiratory problem can range from a minor cold to complete blockage of the airway. 2. Because infants breathe primarily through their noses, even a minor cold can cause breathing difficulties. 3. EMRs should be able to recognize three serious conditions: asthma, croup, and epiglottitis. 4. Asthma a. A child who has asthma is usually already being treated for the condition by a physician and is taking a prescribed medication. b. Asthma is caused by a spasm or constriction and inflammation of the smaller airways in the lungs and usually produces a characteristic wheezing sound. c. A child who is experiencing an asthma attack is in obvious respiratory distress. d. The primary treatment consists of calming and reassuring both the parents and the child.

Respiratory Illnesses (2 of 7) Asthma (cont’d) Place the child in a sitting position. Pursed-lip breathing relieves some of the internal lung pressures. Help administer the child’s medication. Arrange for prompt transport. e. Place the child in a sitting position to make breathing more comfortable. f. Pursed-lip breathing relieves some of the internal lung pressures that cause an asthma attack. g. If a child has asthma medication but it has not been administered, help the parent administer the medication. h. If the child’s physician is not available, arrange for prompt transport. Figure: Pursed-lip breathing may help relieve an asthma attack. © American Academy of Orthopaedic Surgeons.

Respiratory Illnesses (3 of 7) Croup Infection of the upper airway that occurs mainly in children between 6 months and 6 years of age Results in a hoarse, whooping noise during inhalation and a seal-like, barking cough Often occurs in colder climates 5. Croup a. Croup is an infection of the upper airway that occurs mainly in children who are between 6 months and 6 years of age. b. The lower throat swells and compresses the airway, resulting in a hoarse, whooping noise during inhalation and a seal-like, barking cough. c. Croup occurs often in colder climates and is frequently accompanied by a cold.

Respiratory Illnesses (4 of 7) Croup (cont’d) A lack of fright and the willingness to lie down are important signs that distinguish croup from epiglottitis. If the EMS unit is delayed, turn on the hot water in the shower and close the bathroom door. The moist, warm air relaxes the vocal cords. d. A lack of fright and the willingness to lie down are important signs that distinguish croup from epiglottitis. e. If the EMS unit is delayed, ask the parents to turn on the hot water in the shower and close the bathroom door. i. The moist, warm air relaxes the vocal cords and lessens the croupy noise.

Respiratory Illnesses (5 of 7) Epiglottitis Severe inflammation of the epiglottis The flap is so inflamed and swollen that air movement into the trachea is completely blocked. Usually occurs in children between ages 3 and 6 years 6. Epiglottitis a. Epiglottitis is a severe inflammation of the epiglottis, the small flap that covers the trachea during swallowing. b. The flap becomes so inflamed and swollen that air movement into the trachea is completely blocked. c. Epiglottitis usually occurs in children between ages 3 and 6 years.

Respiratory Illnesses (6 of 7) Epiglottitis (cont’d) Signs and symptoms The child is usually sitting upright. The child cannot swallow. The child is not coughing. The child is drooling. The child is anxious and frightened. The child’s chin is thrust forward. d. Signs and symptoms of epiglottitis i. The child is usually sitting upright. ii. The child cannot swallow. iii. The child is not coughing iv. The child is drooling. v. The child is anxious and frightened. vi. The child’s chin is thrust forward.

Respiratory Illnesses (7 of 7) Epiglottitis (cont’d) Make the child comfortable with as little handling as possible. Keep everyone calm. Administer oxygen. Arrange for prompt transport. e. Treatment i. Make the child comfortable with as little handling as possible. ii. Keep everyone calm. iii. Administer oxygen. iv. Arrange for prompt transport.

Drowning (1 of 3) Caused by submersion in water and initially causes respiratory arrest Second most common cause of accidental death among children 5 years of age or younger in the United States Do not put yourself in danger as you attempt a rescue. D. Drowning 1. Drowning is caused by submersion in water and initially causes respiratory arrest. 2. It is the second most common cause of accidental death among children 5 years of age or younger in the United States. 3. Ordinary water sources around the home increase the risk of drowning for young children. 4. If you respond to a drowning situation, do not put yourself in danger as you attempt a rescue.

Drowning (2 of 3) Signs and symptoms include lack of breathing and no pulse. Treatment Assess the ABCs. Turn the child onto one side and allow the water to drain out of the child’s mouth. Use suction if it is available. Start rescue breathing if necessary. 5. Signs and symptoms of drowning include lack of breathing and no pulse. 6. Treatment a. Assess the airway, breathing, and circulation. b. Turn the child onto one side and allow the water to drain out of the child’s mouth. c. Use suction if it is available. d. Start rescue breathing if necessary.

Drowning (3 of 3) Treatment (cont’d) Administer supplemental oxygen. If no pulse is present, start chest compressions. Stabilize the neck. To reduce the risk of hypothermia, dry the child and cover him or her with dry blankets. Arrange for prompt transport. e. Administer supplemental oxygen if it is available and you are trained to use it. f. If no pulse is present, start chest compressions. g. Because there is a chance that the patient has a cervical spine injury, stabilize the neck. h. To reduce the risk of hypothermia, dry the child with towels and cover the child with dry blankets or jackets. i. Arrange for prompt transport.

Heat-Related Illnesses Heatstroke is a serious and potentially fatal condition that requires rapid treatment. Remove the child’s clothing, sponge water over the child, and fan him or her. You may wrap the child in wet sheets to speed up the evaporation and cooling process. Arrange for rapid transport. E. Heat-related illnesses 1. Heat-related illnesses may range from relatively minor muscle cramps to vomiting, heat exhaustion, and heatstroke 2. Heatstroke is a serious and potentially fatal condition that requires rapid treatment. a. Remove the child’s clothing, sponge water over the child, and fan him or her. b. You may wrap the child in wet sheets to speed up the evaporation and cooling process, but do not let the child become chilled. c. Arrange for rapid transport.

High Fever (1 of 2) Fevers are common in children. Because the temperature-regulating mechanism in young children has not fully developed, a very high temperature can occur quickly. Most children can tolerate temperatures as high as 104F (40C). F. High fever 1. Fevers are common in children and can be caused by many different infections, especially ear and gastrointestinal infections. 2. Because the temperature-regulating mechanism in young children has not fully developed, a very high temperature can occur quickly. 3. Most children can tolerate temperatures as high as 104F (40C).

High Fever (2 of 2) Treatment Uncover the child so that body heat can escape. Attempt to reduce the high temperature by undressing the child. Fan the child to cool him or her down. Protect the child during any seizure, and make certain that normal breathing resumes after each seizure. 4. Treatment a. Uncover the child so that body heat can escape. b. Attempt to reduce the high temperature by undressing the child. c. Fan the child to cool him or her down. d. Protect the child during any seizure, and make certain that normal breathing resumes after each seizure.

Seizures (1 of 3) Can result from a high fever or from disorders such as epilepsy Vary in intensity During a seizure The child loses consciousness. The eyes roll back. The teeth become clenched. The body shakes with jerking movements. G. Seizures 1. Seizures can result from a high fever or from disorders such as epilepsy. 2. Seizures can vary in intensity from simple, momentary staring spells to generalized seizures that involve full-body tremors. 3. Seizures are not usually dangerous. 4. During a seizure a. The child loses consciousness. b. The eyes roll back. c. The teeth become clenched. d. The body shakes with severe jerking movements.

Seizures (2 of 3) During a seizure (cont’d) Treatment The child’s skin becomes pale or turns blue. Sometimes the child loses bladder and bowel control. Treatment Place the patient on the floor or a bed to prevent injury. Maintain an adequate airway after the seizure ends. e. The child’s skin becomes pale or turns blue. f. Sometimes the child loses bladder and bowel control. 5. Treatment a. Place the patient on the floor or a bed to prevent injury. b. Maintain an adequate airway after the seizure is ends.

Seizures (3 of 3) Treatment (cont’d) Provide supplemental oxygen. Arrange for prompt transport. Monitor the patient’s vital signs and support the ABCs. After the seizure is over, cool the patient if he or she has a high fever. c. Provide supplemental oxygen. d. Arrange for prompt transport. e. Monitor the patient’s vital signs and support the ABCs. f. After the seizure is over, cool the patient if he or she has a high fever.

Vomiting and Diarrhea Usually caused by gastrointestinal infections May produce severe dehydration The dehydrated child is lethargic and has very dry skin. Hospitalization may be required to replace fluids. If you suspect dehydration, arrange for transport. H. Vomiting and diarrhea 1. Vomiting and diarrhea are usually caused by gastrointestinal infections. 2. Prolonged vomiting and diarrhea may produce severe dehydration. 3. The dehydrated child is lethargic and has very dry skin. 4. Hospitalization may be required to replace fluids through the veins. 5. If you suspect that a child may be dehydrated, arrange for transport.

Abdominal Pain One of the most serious causes of abdominal pain in children is appendicitis. Seen in people between 10 and 25 years Usually the child is nauseated, has no appetite, and occasionally will vomit. Treat every child with a sore or tender abdomen as an emergency. Arrange for prompt transport. I. Abdominal pain 1. One of the most serious causes of abdominal pain in children is appendicitis. a. Appendicitis is often seen in people who are between 10 and 25 years of age. b. A cramping pain in the belly button area moves to the right lower quadrant of the abdomen, becoming steady and more severe. c. Usually the child is nauseated, has no appetite, and occasionally will vomit. 2. Treat every child with a sore or tender abdomen as an emergency. 3. Arrange for prompt transport.

Poisoning (1 of 6) Ingestion An ingested poison is taken by mouth. Signs and symptoms Chemical burns, odors, or stains around the mouth Nausea Vomiting Abdominal pain Diarrhea J. Poisoning 1. Young children are curious and often like to sample the contents of brightly colored bottles or cans. 2. The two most common types of poisonings in children are those caused by ingestion and absorption. 3. Ingestion a. An ingested poison is taken by mouth. b. A child who has ingested a poison may have the following signs and symptoms: i. Chemical burns, odors, or stains around the mouth ii. Nausea iii. Vomiting iv. Abdominal pain v. Diarrhea

Poisoning (2 of 6) Ingestion (cont’d) Later symptoms Abnormal or decreased respirations Unconsciousness Seizures Try to identify the poison, and send the container to the emergency department. Gather any spilled tablets and replace them in the bottle so they can be counted. c. Later symptoms may include [the following]: i. Abnormal or decreased respirations ii. Unconsciousness iii. Seizures d. If you believe a child has ingested a poisonous substance, take the following steps: i. Try to identify the poison, and send the bottle or container along with the child to the emergency department. ii. Gather any spilled tablets and replace them in the bottle so they can be counted.

Poisoning (3 of 6) Ingestion (cont’d) Contact the local poison control center if transportation is delayed. You may need to give the child large amounts of water or administer activated charcoal. Monitor the child’s breathing and pulse. Arrange for prompt transport. iii. Contact the local poison control center if transportation is delayed. iv. You may need to give the child large amounts or water or administer activated charcoal. v. Monitor the child’s breathing and pulse closely. vi. Arrange for prompt transport.

Poisoning (4 of 6) Absorption Occurs when a poisonous substance enters the body through the skin Localized symptoms include skin irritation or burning. Systemic signs and symptoms include nausea, vomiting, dizziness, and shock. 4. Absorption a. Poisoning by absorption occurs when a poisonous substance enters the body through the skin. b. A child who has absorbed a poison may have localized symptoms (skin irritation or burning) or systemic signs and symptoms (nausea, vomiting, dizziness, and shock).

Poisoning (5 of 6) Absorption (cont’d) Ensure that the child is no longer in contact with the poisonous substance. Protect yourself from exposure. Remove the child’s clothing if it is contaminated. Brush off any dry chemical and then wash the child with water for at least 20 minutes. Try to identify the poison. c. If you believe a child has absorbed a poisonous substance, you should do the following: i. Ensure that the child is no longer in contact with the poisonous substance. ii. Protect yourself from exposure and call for specially trained personnel if indicated. iii. Remove the child’s clothing if you think it is contaminated. iv. Brush off any dry chemical and then wash the child with water for at least 20 minutes. v. Wash off any liquid poisons by flushing with water for at least 20 minutes. vi. Try to identify the poison.

Poisoning (6 of 6) Absorption (cont’d) Monitor the child for any changes in respiration and pulse. If the child has vomited, save a sample and send it to the hospital. Arrange transport. vii. Monitor the child for any changes in respiration and pulse. viii. If the child has vomited, save a sample and send it with the patient to the hospital. ix. Arrange transport.

Sudden Infant Death Syndrome (1 of 2) Also called crib death Sudden and unexpected death of an apparently healthy infant Usually occurs in infants between the ages of 3 weeks and 7 months No adequate scientific explanation exists for SIDS. Be compassionate with the parents. K. SIDS 1. A condition frequently mistaken for child abuse is SIDS, also called crib death. 2. SIDS is the sudden and unexpected death of an apparently healthy infant. 3. SIDS usually occurs in infants between the ages of 3 weeks and 7 months. 4. No adequate scientific explanation exists for SIDS. 5. If the infant is still warm, begin CPR and continue until help arrives.

Sudden Infant Death Syndrome (2 of 2) If the infant is still warm, begin CPR and continue until help arrives. If the infant is dead, do not mistake the large, bruise-like blotches on the body for signs of child abuse. The blotches are caused by the pooling of the infant’s blood after death. Follow the local protocol for the management of deceased patients. 6. In many cases, the infant has been dead several hours and the body is cold and lifeless. a. Do not mistake the large, bruise-like blotches on the infant’s body for signs of child abuse. b. The blotches are caused by the pooling of the infant’s blood after death. c. Follow the protocol in your community for the management of deceased patients. 7. Be compassionate and supportive with the parents.

Pediatric Trauma (1 of 2) Trauma is the number one killer of children. Treat an injured child as you would treat an injured adult, but remember the following differences: A child cannot communicate symptoms as well as an adult. A child may be shy and overwhelmed by adult rescuers. VII. Pediatric Trauma A. Trauma is the number one killer of children. B. Treat an injured child as you would treat an injured adult, but remember the following differences: 1. A child cannot communicate symptoms as well as an adult can. 2. A child may be shy and overwhelmed by adult rescuers, so it is important to develop a good relationship quickly to reduce the child’s fear and anxiety.

Pediatric Trauma (2 of 2) Treat an injured child as you would treat an injured adult, but remember these differences: (cont’d) You may need to adapt materials and equipment to the child’s size. A child does not show signs of shock as early as an adult but can progress into severe shock quickly. 3. You may need to adapt materials and equipment to the child’s size. 4. A child does not show signs of shock as early as an adult but can progress into severe shock quickly.

Patterns of Injury (1 of 4) The patterns of injury sustained by children will be related to three factors: Type of trauma they experience Type of activity causing the injury Child’s anatomy Motor vehicle crashes Unrestrained patients have more head and neck injuries. C. Patterns of injury 1. The patterns of injuries sustained by children will reflect three factors: a. The type of trauma they experience b. The type of activity causing the injury c. The child’s anatomy 2. Motor vehicle crashes a. Unrestrained patients tend to have more head and neck injuries.

Patterns of Injury (2 of 4) Motor vehicle crashes (cont’d) Restrained patients often suffer head, spinal, and abdominal injuries. Bicycle accidents Children often suffer head, spinal, abdominal, and extremity injuries. The use of bicycle helmets can greatly reduce the number and severity of head injuries. b. Restrained patients often suffer head, spinal, and abdominal injuries. 3. Bicycle accidents a. Children often suffer head, spinal, abdominal, and extremity injuries in bicycle accidents. b. The use of bicycle helmets can greatly reduce the number and severity of head injuries.

Patterns of Injury (3 of 4) Children hit by cars often sustain chest, abdominal, thigh, and extremity injuries. Falls from a height or diving accidents cause head, spinal, and extremity injuries. Burns are a major cause of injuries to children. © Jones & Bartlett Learning. 4. Children hit by cars a. Pedestrians often sustain chest, abdominal, thigh, and head injuries. 5. Falls from a height or diving accidents tend to cause head and spinal injuries and extremity injuries. 6. Burns are a major cause of injuries to children. Figure: Look for these typical injuries when a child has been hit by a motor vehicle.

Patterns of Injury (4 of 4) Sports injuries cause a wide variety of injuries depending on the type of sport activity. Treatment regardless of the cause of injury Check the patient’s ABCs. Stop severe bleeding. Treat the patient for shock. Conduct a full-body assessment. Stabilize all injuries you find. If the patient has head lacerations, treat the wounds with direct pressure and bandaging. 7. Sports activities cause a wide variety of injuries depending on the type of sports activity. 8. Treatment regardless of the cause of injury: a. Check the patient’s ABCs. b. Stop severe bleeding. c. Treat the patient for shock. d. Conduct a full-body assessment. e. Stabilize all injuries you find. 9. If the patient has head lacerations, treat the wounds with direct pressure and appropriate bandaging techniques.

Traumatic Shock in Children (1 of 2) Children show shock symptoms much more slowly than adults do, but they progress through the stages of shock quickly. If signs of shock are present, the child is already in severe shock: Cool, clammy skin Rapid, weak pulse Rapid or shallow respirations D. Traumatic shock in children 1. Children show shock symptoms much more slowly than adults do, but they progress through the stages of shock quickly. 2. If signs of shock are present, the child is already in severe shock. 3. Signs of shock include a. Cool, clammy skin b. Rapid, weak pulse c. Rapid or shallow respirations

Traumatic Shock in Children (2 of 2) Seizures are relatively common in children who have sustained a serious head injury. The greatest dangers are airway obstruction and hemorrhage. Treatment Open and maintain the airway. Control bleeding. Arrange for prompt transport. 4. Seizures are relatively common in children who have sustained a serious head injury. 5. The greatest dangers to any patient who has sustained trauma are airway obstruction and hemorrhage. 6. When caring for an injured child a. Open and maintain the airway. b. Control bleeding. c. Arrange for prompt transport.

Car Seats and Children If you find a child properly restrained in a car seat after a motor vehicle crash, leave the child in the car seat until the ambulance arrives. In many cases, a child can be transported to the hospital secured in the car seat. E. Car seats and children 1. If you find a child properly restrained in a car seat after a motor vehicle crash, leave the child in the car seat until the ambulance arrives. 2. In many cases, a child can be transported to the hospital secured in the car seat. Figure: Leave the child in the car seat if possible. © Jones & Bartlett Learning. Courtesy of MIEMSS.

Child Abuse (1 of 4) Be concerned if the child is withdrawn, fearful, or hostile and is unwilling to discuss how the injuries occurred. Treat the child’s injuries and, if you suspect abuse, ensure the child’s safety. F. Child abuse 1. Child abuse is not limited to any ethnic, social, or economic group or to families with any particular level of education. 2. Suspect abuse if the child’s injuries do not match the story you are told about how the injuries occurred. 3. The abused child may have many visible injuries at different stages of healing. 4. Be concerned if the child is withdrawn, fearful, or hostile and is unwilling to discuss how the injuries occurred. 5. Treat the child’s injuries and, if you are suspicious that the incident may involve child abuse, ensure the safety of the child.

Child Abuse (2 of 4) Signs and symptoms Multiple fractures Bruises in various stages of healing Human bites Burns Reports of bizarre accidents 6. Signs and symptoms of child abuse include a. Multiple fractures b. Bruises in various stages of healing c. Human bites d. Burns e. Reports of bizarre accidents that do not seem to have a logical explanation

Child Abuse (3 of 4) © American Academy of Orthopaedic Surgeons. Figure: (Left) Bruises of different ages suggest physical maltreatment. New bruises are red or pink; over time, bruises turn blue, green, yellow-brown, and faded. (Center) A human bite wound has a characteristic appearance. (Right) Stocking/glove burns of the hands and feet in the infant or toddler are often inflicted injuries. Courtesy of Ronald Dieckmann, MD. © American Academy of Orthopaedic Surgeons.

Child Abuse (4 of 4) Transport the child. If the parents object, summon law enforcement personnel. Signs and symptoms of neglect Lack of adult supervision Malnourished-appearing child Unsafe living environment Untreated chronic illness 7. Transport the child to an appropriate medical facility. a. If the parents object to having the child examined by a physician, summon law enforcement personnel and explain your concerns to them. 8. Neglect is another form of child abuse. a. Children who are neglected are often dirty or too thin or appear developmentally delayed because of a lack of stimulation. 9. Signs and symptoms of neglect a. Lack of adult supervision b. Malnourished-appearing child c. Unsafe living environment d. Untreated chronic illness 10. Handle each situation in a nonjudgmental manner and know whom you need to contact to report suspected cases.

Sexual Assault of Children In addition to experiencing sexual assault, the child may have been beaten and may have other serious injuries. Obtain as much information from the child and any witnesses. Provide a caring approach. All victims of sexual assault should receive transport to an appropriate medical facility. G. Sexual assault of children 1. In addition to experiencing sexual assault, the child may have been beaten and may have other serious injuries. 2. If you suspect sexual assault has occurred, obtain as much information as possible from the child and any witnesses. 3. Providing a caring approach is extremely important, and you should take appropriate action to shield the child from onlookers. 4. All victims of sexual assault should receive transport to an appropriate medical facility.

Emergency Medical Responder Debriefing Calls involving children tend to produce strong emotional reactions. You may need to talk about feelings of anger or frustration with a counselor. By attending debriefing sessions, you can Express your feelings Learn some coping strategies Maintain a healthy approach to future calls VIII. EMR Debriefing A. You will respond to many calls that involve children. 1. These calls tend to produce strong emotional reactions. 2. You may feel especially angry or helpless when you suspect the neglect or abuse of a child. B. You may need to talk about your frustrations with a counselor or with another member of your department following serious pediatric calls. C. It may be helpful to set up a critical incident stress debriefing session. 1. By attending a debriefing session, you ca[n] a. Express your feelings b. Learn some coping strategies Maintain a healthy approach to future calls D. A child’s airway is smaller in relation to the rest of the body compared to an adult’s airway, so secretions and swelling from illnesses or trauma can more easily block the child’s airway. Because the tongue is relatively larger than the tongue of an adult, a child’s tongue can more easily block the airway. Hyperextension of a child’s neck can occlude the airway.

Summary (1 of 7) Because the anatomy of children and infants differs from that of adults, special knowledge and skills are needed to assess and treat pediatric patients. Because both the child and the parents may be frightened and anxious, you must behave in a calm, controlled, and professional manner. IX. Summary A. Sudden illnesses and medical emergencies are common in children and infants. Because the anatomy of children and infants differs from that of adults, special knowledge and skills are needed to assess and treat pediatric patients. Managing a pediatric emergency can be a stressful situation for EMRs. Because both the child and the parents may be frightened and anxious, you must behave in a calm, controlled, and professional manner. A child’s airway is smaller in relation to the rest of the body compared to an adult’s airway, so secretions and swelling from illnesses or trauma can more easily block the child’s airway. Because the tongue is relatively larger than the tongue of an adult, a child’s tongue can more easily block the airway. Hyperextension of a child’s neck can occlude the airway.

Summary (2 of 7) The child who is unresponsive, is lackluster, and appears ill should be evaluated carefully because the lack of activity and interest signal serious illness or injury. The three components of the pediatric assessment triangle are overall appearance, work of breathing, and circulation to the skin. D. The child who is unresponsive, is lackluster, and appears ill should be evaluated carefully because the lack of activity and interest signal serious illness or injury. After conducting the primary assessment, carry out the routine patient examination, paying special attention to mental awareness, activity level, respirations, pulse rate, body temperature, and color of the skin. E. The PAT is designed to give you a quick general impression of the child using only your senses of sight and hearing. The three components of the PAT are overall appearance, work of breathing, and circulation to the skin.

Summary (3 of 7) It is important to open and maintain the patient’s airway and to ventilate adequately any child with respiratory problems. Young children often obstruct their upper and lower airway with foreign objects, such as small toys or candy. F. It is important to open and maintain the patient’s airway and to ventilate adequately any child with respiratory problems. Otherwise, the child may experience respiratory arrest, followed by cardiac arrest. G. Cardiopulmonary resuscitation for children and infants differs from adult cardiopulmonary resuscitation in several important ways. You should be certain that you understand these differences and are able to perform the appropriate steps confidently in the field. H. Suctioning removes foreign substances that you cannot remove with your gloved fingers from the airway of a child. Oral airways can be used to maintain an open airway after you have opened the child’s airway by manual means. I. Young children often obstruct their upper and lower airway with foreign objects, such as small toys or candy. If the object is only partially blocking the airway, the child should be able to pass some air around it. You should attempt to remove the object only if it is clearly visible and you can remove it easily.

Summary (4 of 7) In complete or severe airway obstruction in a conscious child, you should perform the Heimlich maneuver. If the child becomes unresponsive, begin cardiopulmonary resuscitation. To relieve an airway obstruction in an infant, use a combination of back slaps and chest thrusts. J. In complete or severe airway obstruction in a conscious child, you should perform the Heimlich maneuver (abdominal thrusts). If the child becomes unresponsive, begin cardiopulmonary resuscitation. K. To relieve an airway obstruction in an infant, use a combination of back slaps and chest thrusts.

Summary (5 of 7) Three serious respiratory problems in pediatric patients are asthma, croup, and epiglottitis. Other pediatric medical emergencies include drowning, heat-related illnesses such as heatstroke, high fevers, seizures, vomiting and diarrhea, and abdominal pain. L. Children in respiratory distress require immediate medical attention. Signs of respiratory distress include a rapid or slow breathing rate, nasal flaring, retraction of the skin between the ribs and around the neck muscles, stridor, cyanosis, altered mental status, and combativeness. Respiratory distress can lead to respiratory failure, which in turn can lead to circulatory failure. M. Three serious respiratory problems in pediatric patients are asthma, croup, and epiglottitis. A child who has asthma is usually already being treated for the condition by a physician; your primary treatment consists of calming and reassuring the parents and the child. Croup is an upper airway infection that results in a barking cough. Although epiglottitis resembles croup, it is a serious respiratory emergency; you must arrange for prompt transport in such cases. N. Other pediatric medical emergencies include drowning, heat-related illnesses such as heatstroke, high fevers, seizures, vomiting and diarrhea, and abdominal pain.

Summary (6 of 7) The two most common types of poisonings in children are caused by ingestion (taken by mouth) and absorption (entering through the skin). SIDS, also called crib death, is the unexpected death of an apparently healthy infant. O. Children’s natural curiosity may lead them to sample medications or household items that contain poisonous substances. The two most common types of poisonings in children are caused by ingestion (taken by mouth) and absorption (entering through the skin). P. Sudden infant death syndrome, also called crib death, is the unexpected death of an apparently healthy infant. You should know your local guidelines for the management of sudden infant death syndrome. Remember that the parents could do nothing to prevent the death.

Summary (7 of 7) Major trauma in children usually results in multiple system injuries. If you suspect child abuse or sexual assault, you must transport the child to an appropriate medical facility. Q. When caring for pediatric trauma patients, remember that you may have to adapt materials and equipment to the child’s size. Also remember that children do not show signs of shock as early as adults do, although they can progress into severe shock quickly. R. Major trauma in children usually results in multiple system injuries. Your first priority is always to check the ABCs and then stop severe bleeding, treat for shock, and proceed with the physical examination. S. If you suspect child abuse or sexual assault, you must transport the child to an appropriate medical facility.

Review The purpose of the pediatric assessment triangle (PAT) is to guide the hands-on physical assessment. help you determine if the child’s vital signs are appropriate. allow you to quickly form a general impression of the child. help you remember the systematic assessment process. 105

Review Answer: C. allow you to quickly form a general impression of the child.

Review Which of the following statements about SIDS is FALSE? It usually occurs in children between the ages of 3 and 7 years. No adequate scientific explanation exists. It occurs in apparently healthy children. You should start CPR if the child is still warm when you arrive.

Review Answer: A. It usually occurs in children between the ages of 3 and 7 years.

Review Which of the following is NOT a common respiratory condition in children? Asthma Epiglottitis Pneumonia Croup 109

Review Answer: C. Pneumonia