Chapter 30: Pediatric Emergencies Thacher Wastrom Small Shredder

Anatomical Differences Airway differences Mouth smaller; tongue larger Trachea more flexible – can compress/collapse Breathing differences Newborns = through nose Small children = diaphragmatic breathing (less muscle dev.) Distress: increase rate/effort Retraction: muscles pull in between ribs and above sternum upon inhalation

Anatomical Differences Musculoskeletal differences Fontanels Absorb more force without breaking – greenstick fractures General size differences Head larger + heavier in relation to body Heat loss from head Trauma – head propelled forward first Brain smaller Greater body surface area, thinner skin, less muscle / fat (heat loss, toxin absorption, burns, multi-organ injuries)

Anatomical Differences Cardiovascular differences Constrict arteries more quickly Better initial compensation to shock – fail sooner Other Underdeveloped hypothalamus (temp. regulation) Higher rate of metabolism (need frequent meals; crash)

6 Stages of Child Development StageAgeNotes 1. Newborn1-28 daysCrying 2. Infant2-12 monthsFace recognition, motor skill development, standing 3. Toddler1-3 yearsWalking (8-14 m), high-risk, short sentences 4. Preschool3-5 years“Why/no”, greater motor skill dev., often begin skiing 5. School-Age5-13 yearsGreater understanding of risk, 6. Adolescent13-18 yearsDemand for independence (risk), blueberries

Pediatric Vitals Infants (Birth – 1 yr.)Children (1-8 yrs.) Pulse bpm bpm Respirations25-50 rpm15-30 rpm Blood PressureSystolic: mmHg Diastolic: mmHg Systolic: mmHg Diastolic: mmHg

Common Illnesses / Injuries Airway Problems Croup – inflammation of larynx from viral infection (barking cough in children < 3) Tonsilitis – bacterial infection; sore throat Bronchiolitis – inflammation of bronchioles from viral infection (fever, cough in children < 2) Pneumonia – viral or bacterial infection of the lung

Common Illnesses / Injuries Airway Problems Asthma – constriction of bronchioles + wheezing; caused by pollen, exercise, cold air, viruses Epiglottitis – severe inflammation of epiglottis, bacterial infection, inability to swallow, true medical emergency. Foreign body airway obstruction – food is most common

Common Illnesses / Injuries Respiratory Failure + Cardiac Arrest Abdominal Pain Nausea, Vomiting, Diarrhea (NVD) Seizures Meningitis

Common Illnesses / Injuries Poisoning SIDS Trauma Commotio cordis Growth plates Burns + Electrocutions Scalding water

Common Illnesses / Injuries Child Abuse + Neglect Abuse : act or failure to act on part of caregiver that results in serious physical/emotional harm to child Neglect : more common, failure to provide for shelter, safety, supervision, and nutritional needs of child Shaken Baby Syndrome : infant or toddler is picked up and violently shaken, causing traumatic brain injury Shock Most common?

Assessment Follow same steps as adult Modify assessment based on age and level of development Things to remember Heart + respiration rate can change rapidly Metabolic compensation can make a child seem stable when they aren’t If parent is present, ask for permission

Assessment - Tips Involve parents Eye level Explain step by step + be honest