Pediatric emergencies

Introduction Pediatric patients are not just little adults Many providers have a level of discomfort responding to and caring for pediatrics Pediatric patients respond differently to stressful events and that response will differ based on developmental levels Common problems in adults do not occur in children Communication with child and caregiver is paramount Remain calm , professional and sensitive A calm parent contributes to a calm child

Growth and development Infancy – First year of life Toddler – 1-3 years Preschool Age – 3-6 years School age – 6-12 years Adolescence – 12-18 years

Anatomical differences Airway is smaller in diameter and shorter Lungs are smaller The occiput is larger and rounder Tongue is proportionally larger Cartilage rings on trachea less developed Children have an oxygen demand double that of an adult Gastric distension can interfere with air movement If SOB muscles fatigue easily resulting in respiratory failure Respiratory issues are leading cause of cardiac arrest in pediatric patients

Circulatory system Pulse rates differ from adults Children have ability to constrict blood vessels and increase heart rate to compensate for poor perfusion A small amount of blood loss can lead to shock. May be in shock despite normal BP

Nervous system Pediatric nervous system is immature, underdeveloped and not well protected Head to body ratio larger Brain tissue and vasculature are fragile and prone to bleeding form shear forces Pediatrics brains require higher blood flow, oxygen and glucose Secondary brain damage from hypotension and hypoxia more likely Spinal injuries are less common in pediatric patients

Gastrointestinal Liver spleen and kidneys are larger in proportion and situated more anteriorly and organs are closer to each other Multiple organ injury is a higher risk Liver and splenic injuries are more common in pediatric patients Large amounts of bleeding can occur without signs of shock Be alert for signs of shock AMS Tachypnea Tachycardia bradycardia

Musculoskeletal injuries Growth plates on bones allow for growth Make bones flexible More prone to stress factures Injuries to growth plates can alter bone growth Immobilize all strains sprains or injury complaints

Skin Skin is thinner Higher ratio of body surface to body mass Skin burns more easily and deeper Higher ratio of body surface to body mass Results in larger fluid and heat losses More prone to hypothermia Keep them warm

Primary assessment Form a general impression. Use pediatric assessment triangle (PAT). 15- to 30- second structured assessment tool

PAT Does not require equipment Does not require you to touch the patient Three steps: Appearance Work of breathing Circulation

Appearance Note LOC, muscle tone, interactiveness. TICLS mnemonic helps determine if patient is sick or not sick. Tone Interactiveness Consolability Look or gaze Speech or cry

Work of breathing Increases body temperature May manifest as tachypnea, abnormal airway noise, retractions of intercostal muscles or sternum

Circulation to the skin Pallor of skin and mucous membranes may be seen in compensated shock. Mottling is sign of poor perfusion. Cyanosis reflects decreased level of oxygen.

Stay or go From PAT findings, you will decide if the patient is stable or requires urgent care. If unstable, assess ABC’s, treat life threats, and transport immediately. If stable, continue with the remainder of the assessment process.

History Investigate chief complaint How long have they been sick Any fever Eating drinking and urine output Activity Vomiting diarrhea Rashes

Secondary assessment Infants, toddlers, and preschool-aged children should be assessed started at the feet and ending at the head. School-aged children and adolescents should be assessed using the head-to-toe approach.

Transport safety Use a restraint system appropriate for pt age, unless treatment of patient precludes that