TRANSITION SERIES Topics for the Advanced EMT CHAPTER Pediatrics 45

Objectives Discuss how to approach the pediatric patient. Review the Pediatric Assessment Triangle and how to implement it with pediatrics. Discuss common pediatric pathologies and their corresponding management.

Introduction Managing pediatrics requires: –Personal preparation –EMS system preparation –Hospital network system preparation

Approach: First Impression First impressions matter more to children. –They don't have the experiences to make correct judgments. –Get down to their level with the caregiver present. –Assessment starts as soon as you arrive.

Approach a young child on the child’s level, with the caregiver present.

Parents and Caretakers Parents and caretakers know you are there to help. –It doesn't mean they trust you. –Gaining parent's trust will help in gaining the child's trust.

Assessment Assessment of the pediatric patient differs from that of the adult patient. Rapid changes in anatomy, physiology, and cognitive ability. Vitals change during development.

Assessment (cont’d) Pediatric Assessment Triangle –Modifies traditional ABCs of airway- breathing-circulation to “appearance- breathing-circulation.” –Outside APGAR, PAT allows for objective and reproducible evaluation of sick pediatrics.

The Pediatric Assessment Triangle (PAT). (Used with permission of the American Academy of Pediatrics.) Source: General Approach to Pediatric Assessment

Assessment (cont’d) Appearance –Often the first clues to a problem are found in the appearance. –TICLS mnemonic can help.  Tone  Interactiveness  Consolability  Look/Gaze  Speech/Cry

Assessment (cont’d) Breathing –Ventilation needed for respiration. –Respiration needed for energy and cellular activity. –Pediatric respiratory system is ill- equipped to handle significant disturbances.

Assessment (cont’d) Circulation –Relationship of pump, pipes, and fluid. –When one fails, the other two have to cover. –Causes  Volume loss  Pump failure  Low vascular tone –IV versus IO access.

Case Study You are called to the home of a 5-year- old child who reportedly fell off a climbing gym in his back yard, and now has abdominal pain. The parents are gone and the child is in the care of the babysitter.

Case Study (cont’d) Scene Size-Up –Standard precautions taken. –Scene is safe, no entry or egress problems. –5-year-old male, about pounds.

Case Study (cont’d) Scene Size-Up –Patient found sitting under tree in back yard. –MOI is fall from a jungle gym (fall <5 feet). –Parents on way home, per babysitter.

Case Study (cont’d) Primary Assessment Findings –Patient is responsive. –Airway is clear. –Breathing adequate, patient crying, calms with babysitter.

Case Study (cont’d) Primary Assessment Findings –Carotid pulse 120/min, peripheral pulse present. –Peripheral skin warm and slightly diaphoretic. –Good muscle tone.

Case Study (cont’d) How would you characterize this patient according to PAT? What are the patient's life threats, if any? What care should be administered immediately?

Case Study (cont’d) Medical History –None per babysitter Medications –None per babysitter Allergies –None per babysitter

Case Study (cont’d) Pertinent Secondary Assessment Findings –Pupils reactive to light, membranes hydrated. –Airway patent, patient breathing at 24/min. –Central and peripheral pulses present, 90/minute. –Skin is still warm, not as diaphoretic.

Case Study (cont’d) Pertinent Secondary Assessment Findings (continued) –Pulse ox 100% with low-flow oxygen. –Patient markedly calmer, interacting appropriately. –Abdomen is tender to lower quadrants, no bruising, guarding, nor rigidity. –Parents arrive home and consent to transport.

Case Study (cont’d) Is the child improving or deteriorating? Is there any additional treatment or change in treatment required? What is the likely underlying cause for the emergency?

Case Study (cont’d) Care provided: –Patient immobilized supine, secured for transport. –Low-flow oxygen. –Transported with parent in front of ambulance. –Nonemergent transport to the hospital.

Summary Pediatric emergencies can be stressful for the provider, the parent, and the child. Approach to treatment of the pediatric patient should follow the PAT (Pediatric Assessment Triangle). Interventions should be provided based upon need, and in concert with the patient and/or parents if possible.