Introduction to Emergency Medical Care 1

Introduction to Emergency Medical Care 1
Advance Preparation Invite programmed patients from each of the age groups to serve as discussion models. Contact a day care center and a nursing home to arrange class visits.

OBJECTIVES 7.1 Define key terms introduced in this chapter. Slides 9, 11, 14, 16, 20, 23, 27, 32, 35, Describe the physical and psychological characteristics, including normal vital signs, for individuals in each of the following age groups: Infant, Toddler, Preschool Age, School Age, Adolescent, Early Adult, Middle Adult, and Late Adult. Slides 9–13, 18, 22, 25, 29, 34, 37, 40 continued

OBJECTIVES 7.3 Describe the typical psychosocial characteristics and concerns of individuals at each stage during the life span. Slides 14, 19, 22, 25, 30, 34, 37, Use knowledge of physical, physiological, and psychosocial development to anticipate the needs and concerns of patients of all ages. Slides 9–14, 18–19, 22, 25, 29–31, 34, 37, 40

MULTIMEDIA Slide 15 Growth and Development: Major Life Transition—Infant Video Slide 26 School-aged Children Health Promotion Video Slide 41 Cognitive Function of Older Adults Video These videos appear later in the presentation; you may want to preview them prior to class to ensure they load and play properly. Click on the links above in slideshow view to go directly to the slides.

CORE CONCEPTS The physiological (physical) characteristics of different age groups from infancy through late adulthood The psychosocial (mental and social) characteristics of different age groups from infancy through late adulthood

Topics Infancy (Birth to 1 Year) Toddler Phase (12–36 Months)
Preschool Age (3–5 Years) School Age (6–12 Years) Adolescence (13–18 Years) Early Adulthood (19–40 Years) Middle Adulthood (41–60 Years) Late Adulthood (61 Years and Older) Planning Your Time: Plan 80 minutes for this chapter. Infancy (Birth to 1 Year) (10 minutes) Toddler Phase (12–36 Months) (10 minutes) Preschool Age (3–5 Years) (10 minutes) School Age (6–12 Years) (10 minutes) Adolescence (13–18 Years) (10 minutes) Early Adulthood (19–40 Years) (10 minutes) Middle Adulthood (41–60 Years) (10 minutes) Late Adulthood (61 Years and Older) (10 minutes) Note: The total teaching time recommended is only a guideline.

Infancy (Birth to 1 Year)
Teaching Time: 10 minutes Teaching Tips: There is no better way to teach this section than to present an actual infant. Use a real baby to demonstrate both anatomical and psychosocial points. Set anatomical and psychosocial differences within the context of EMS. Discuss challenges to assessment and treatment in a real-world framework. Teach that there are no absolutes concerning development. Wide ranges of capabilities appear in any age group.

Infancy (Birth to 1 Year)

Physiological Characteristics
3.0–3.5 kg (6.6–7.7 lb) at birth Weight doubles by 6 months; triples by 12 months Head 25% of body weight Airway narrow; easily obstructed Nose and diaphragm used for breathing Points to Emphasize: Infancy is a time of enormous growth and development. Significant changes occur in the first year of life. Compared to adults, infants rely more upon their noses and diaphragms when they breathe. Talking Points: While the fetus is in the mother’s uterus, the lungs do not function, and there is a different pattern of circulation before birth than after. The transition from fetal circulation to pulmonary circulation usually occurs within the first minutes or hours after birth. The infant’s airway is shorter, narrower, less stable, and more easily obstructed than at any other stage in life. Nasal congestion can cause breathing difficulty. Infants are also diaphragm breathers; you may see more movement in the abdomen than the chest. With breathing difficulty, infants fatigue easily because their accessory muscles are less mature and tire easily. They are more susceptible to trauma, since their chest wall is less rigid and lung tissue is more prone to trauma from pressure. continued

Antibodies passed from mother to child in pregnancy Antibodies also passed through breastfeeding Talking Points: The antibodies passed to the infant from the mother help protect the infant until she can produce her own antibodies, either from vaccination or exposure to diseases. Discussion Topic: List and describe three ways in which an infant is anatomically different from an adult. continued

Moro reflex (startle) Throws arms out, spreads fingers, grabs with fingers and arms Palmar reflex Grasps objects placed in palm Rooting reflex (hunger) Turns toward side of head touched Point to Emphasize: Infants have age-specific and unique neurological reflexes that can be tested. Talking Points: Moro reflex. These movements should be relatively equal on both sides. Palmar reflex. Within a couple of months, this merges with the ability to release an object from the hand. Sucking reflex. This reflex works in conjunction with the rooting reflex. continued

Sucking reflex Sucks when lips are stroked Sleep patterns Begin to regulate after 2–4 months Then sleeps through night Extremities grow from a combination of growth plates and epiphyseal plates Talking Points: Initially, infant will sleep 16–18 hours total throughout day and night. This soon changes to 4–6 hours during the day and 9–10 hours during the night. Though infants do sleep a lot, they are easy to awaken. Infant’s extremities grow from growth plates located at the ends of long bones (humerus, femur) and epiphyseal plates located near the ends of long bones. continued

Fontanelles not fused at birth—still soft until 9–18 months Sunken fontanelles: indicate dehydration Bulging fontanelles: indicate increased pressure inside skull Talking Points: The bones at the top of the skull are not fused at birth. The soft spot where these bones meet is called a fontanelle. The posterior fontanelle usually closes in 2–3 months; the anterior fontanelle between 9–18 months. Looking at the anterior fontanelle gives a good idea of the infant’s state of hydration. Normally the fontanelle is level with or slightly below the surface of the skull. A sunken fontanelle indicates dehydration. A bulging fontanelle indicates increased pressure inside the skull. Class Activity: If possible, bring an infant to class and allow students the opportunity to interact. Many students have little experience with children. Knowledge Application: Use programmed patients or anatomical models and have students perform assessments on infants. Discuss the impact of anatomical and psychosocial differences.

Psychosocial Characteristics
Bonding Trust vs. mistrust Scaffolding Temperament Point to Emphasize: An infant’s chief means of expression is crying. Later, other psychosocial traits develop including bonding, trust, scaffolding, and temperament. Talking Points: Within the first 6 months, infants start displaying the following characteristics: Bonding. This is their sense that their needs will be met. When they are hungry, they are fed. When they need to be held, they are held. Trust vs. mistrust. Infants like orderly, predictable environment. When the environment is disorderly and irregular, infants develop anxiety and insecurity. Scaffolding. Infants learn by building on what they already know. Temperament. This is an infants’ reaction to the environment. Discussion Topics: Discuss the psychosocial development traits of an infant. Explain how the anatomical and developmental differences of an infant might impact your assessment. Knowledge Application: Have students work in small groups to trace the psychosocial development of infants through the first year of life. How does development change over that period? Critical Thinking: How might you assess mental status in an infant?

Growth and Development: Major Life Transition—Infant Video
Video Clip Growth and Development: Major Life Transition—Infant What accomplishments do infants achieve during their first year? What are the goals of health supervisor visits? Discuss health promotion and intervention activities that might occur during a health supervision visit. Click here to view a video on the subject of an infant’s growth and development. Back to Directory

Toddler Phase (12–36 Months)
Teaching Time: 10 minutes Teaching Tips: Inviting a toddler to class is a wonderful way to demonstrate this developmental stage. Relate developmental issues to assessment, for toddlers are notoriously difficult to assess. Compare the anatomical and psychosocial development of a toddler to that of an infant and to that of an adult. Demonstrate the progression.

Toddler Phase (12–36 Months)

Pulmonary system Nervous system Musculoskeletal system Immune system Teeth Point to Emphasize: Rapid physiological development continues through the toddler phase. Mobility and fine motor dexterity swiftly increase. Talking Points: Body systems continue to grow and refine themselves. Pulmonary system. Terminal airways branch and grow. Alveoli increase in number. Nervous system. Brain is now 90 percent of adult brain weight. Fine motor skills develop. Musculoskeletal system. Muscle mass and bone density increase. Immune system. More susceptible to illness. Develops immunity to pathogens as exposure occurs and through vaccination. Teeth. By 36 months, toddler has all primary teeth. Discussion Topic: Describe the anatomical development from infant to toddler. How are their bodies different? Knowledge Application: Divide the class into two groups. Have one group develop an assessment strategy for infants and the other group develop an assessment strategy for toddlers. Discuss. How do the strategies vary?

Begins to understand cause and effect Highly curious and investigating Separation anxiety Begins to develop “magic thinking,” imagination, and ability to role play Point to Emphasize: Psychosocial development includes curiosity, cause-and-effect thinking, and separation anxiety. Talking Points: The toddler’s mental and social development continues, and the child develops more individuality. This age group’s curiosity has led to such terms as “curtain climbers” or “rug rats.” Their developing personality is sometimes referred to as the “terrible twos.” These years can be very rewarding for both toddler and caregivers. By 12 months, toddlers begin to understand that words “mean” something. They are likely to be toilet trained by 28 months. By ages 3–4, they have mastered the basics of language. Discussion Topics: Describe how the curiosity and mobility of a toddler can increase the risk of injury. Explain why the psychosocial development of a toddler makes assessment very difficult. Class Activity: If a toddler is available to come to class (and if his caregiver is willing), have students attempt to persuade him to lie on a backboard and be immobilized. (Do not use forcible restraint.) Award a prize for the strategy that allows for completion of this task. Critical Thinking: Both separation anxiety and fear might make spinal immobilization of a toddler extremely difficult. Discuss what you would do if immobilization attempts resulted in the toddler’s screaming and crying.

Preschool Age (3–5 Years)
Teaching Time: 10 minutes Teaching Tips: If possible, bring a preschooler to class. Demonstrate anatomical and psychosocial differences first hand. Arrange a field trip to a local day care center. Observe social interactions and practice assessment.

Preschool Age (3–5 Years)

Physiological and Psychosocial Characteristics
Body systems continue to develop Psychosocial Developing interactive and social skills Points to Emphasize: During the preschool years, this age group is typically introduced to social interaction in day care or preschool. Anatomical development continues. Mobility and dexterity increase. Discussion Topic: What anatomical and psychosocial differences should you expect when assessing a preschooler compared to assessing an infant? Knowledge Application: Explain how you might use a parent or caregiver to overcome separation anxiety and improve your assessment of a preschooler. Critical Thinking: How might the assessment of mental status be different for a preschooler from what it would be for an infant? How might it be similar?

School Age (6–12 Years) Teaching Time: 10 minutes
Teaching Tips: Emphasize the psychosocial differences that emerge in school-age children. EMTs can take a significantly different approach when dealing with this older age group. Point out that under stress, development can regress to an earlier stage. The independence of a school-age child can crumble rapidly when faced with a painful injury.

School Age (6–12 Years)

Loss of baby teeth Psychosocial Less general supervision Developing decision-making skills More awareness of self-esteem Values opinions of peers (positive or negative) Points to Emphasize: Anatomical development continues, but school-age children develop most rapidly from a psychosocial standpoint. Socialization and independence from parents create a developmental growth spurt in this time frame. School-age children develop the capabilities of reasoning. EMTs can utilize this capability to assist with assessment and treatment. Discussion Topics: What role do independence, decision making, and self-esteem play in assessing a school-age child? Describe the anatomical differences of a school-age child compared to an infant and to an adult. Class Activity: This chapter discusses “Jamie.” Make a growth and development chart for the classroom, detailing the anatomical and psychosocial changes that Jamie will experience over her life span. Knowledge Application: Using a programmed patient, practice assessment strategies for infants, toddlers, preschoolers, and school-age children. Critical Thinking: How might peer pressure impact the assessment of a school-age child?

School-Aged Children Health Promotion Video
Video Clip School-Aged Children Health Promotion What is the typical age range for school-aged children? Discuss possible reasons why children in this age group may not see physicians frequently. Why is it important to promote a healthy lifestyle to this age group? Click here to view a video on the subject of promoting a healthy lifestyle in school-age children. Back to Directory

Adolescence (13–18 Years) Teaching Time: 10 minutes
Teaching Tips: Use media clips to demonstrate judgment issues common in adolescence. Consider motor vehicle crashes and drug use as examples. Adolescents often are as difficult to assess as toddlers. Compare psychosocial difficulties within each group.

Adolescence (13–18 Years)

Growth spurt Sexual maturity Points to Emphasize: Adolescence is anatomically the transition to adulthood. In this stage, bodies become more adult than childlike. Sexual maturity is typically reached during adolescence. Talking Points: Adolescents experience a rapid 2- to 3-year growth spurt, beginning with enlargement of feet and hands followed by enlargement of arms and legs. Chest and trunk enlarge in the final stage of growth. Girls are usually finished growing by age 16; boys by 18. In late adolescence, the average male is taller and stronger than the average female. Both males and females reach reproductive maturity. Secondary sexual development occurs, with noticeable development of external sexual organs. In females, menstruation begins and breasts develop. Discussion Topic: Describe anatomical developments that make adolescents more like adults than like children. Knowledge Application: Have students research the significance of reaching sexual maturity. For what new disorders are adolescents at risk? Consider pregnancy, ectopic pregnancy, and sexually transmitted diseases. Critical Thinking: What is the most common cause of death in this age group? How are anatomical and psychosocial factors related to this cause of death?

Strives for independence Concern about body image and peer pressure May be prone to self-destructive behaviors Developing personal code of ethics Point to Emphasize: Although adolescents possess the capability for logical, abstract, and analytical thinking, developmentally they often are distracted by peer pressure and body image concerns. Talking Points: Adolescence can be a time of serious family conflicts as the adolescent strives for independence and parents strive for continued control. This is a time when eating disorders are common. It also is a time when self-destructive behaviors begin, such as use of tobacco, alcohol, illicit drugs, and unsafe driving. Depression and suicide are alarmingly common in this age group. As adolescents develop their capacity for logical, analytical, and abstract thinking, they begin to develop a personal code of ethics. Discussion Topic: Describe psychosocial concerns that are unique to adolescents. How might those concerns impact your assessment and treatment? Knowledge Application: Use programmed patients to create adolescent assessment scenarios. Address self-image and peer-pressure concerns.

Think About It Adolescents are often injured because of risk taking
May be resistant to disclose what happened Must be encouraged to explain circumstances surrounding an incident Talking Points: Sometimes you must explain the risks of withholding information to them, such as delays in treatment. It’s pretty easy to figure the mechanism of injury if they recorded it for YouTube!

Early Adulthood (19–40 Years)
Teaching Time: 10 minutes Teaching Tips: Shift now to the use of adult anatomical models and illustrations. Discuss how this anatomy differs from that of previous age groups. Teach that there is no guarantee that all early adults are in peak physical condition. Many factors can add variation to this expectation.

Early Adulthood (19–40 Years)

Lifelong habits formed Reaches peak physical condition Psychosocial Job and family stress Marriage, childbirth, child rearing Accidents leading cause of death Points to Emphasize: Early adulthood sees anatomical development reach full maturity. In many cases, development often reaches peak physical condition. Psychosocial development now introduces new responsibilities and stresses. These stressors play a role in physiological disease and can make assessment and treatment more difficult. Discussion Topic: Compare and contrast the anatomical features of an adult with those of an infant. Discuss the stages of physiological development in between. Knowledge Application: Divide students into groups and ask each group to develop assessment strategies that are “early adult specific.” Have each group present and compare notes. Critical Thinking: Can early adults make decisions that are more like those of an adolescent than an adult? Use specific examples. Does poor decision making put early adults at risk for injury and illness?

Middle Adulthood (41–60 Years)
Teaching Time: 10 minutes Teaching Tips: Compare the anatomy and physiology of middle adulthood to that of early adulthood. These groups are similar. As in early adulthood, physical conditioning can vary greatly. In middle adulthood, age-associated diseases can increase the variation.

Middle Adulthood (41–60 Years)

May need vision correction Cancer, heart disease often develop Weight control more difficult Psychosocial Empty-nest syndrome Caring for elderly parents Talking Points: There are no significant changes in vital signs from early adulthood. Adults start to have vision problems and often wear glasses. Cholesterol may be high, and adults are concerned about health problems. For women, menopause commences. Heart disease is the major killer after 40 in all age, sex, and racial groups. Adults become more task oriented as they see the time for accomplishing lifetime goals diminish. They tend to approach problems more as challenges than as threats. With their children starting lives of their own, they are experiencing “empty-nest syndrome.” This may also be a time of increased freedom and opportunity for self-fulfillment. They are also concerned about their aging parents. Discussion Topic: Discuss diseases that are more prominent in middle to late adulthood. What role does age play in disease prevalence? Critical Thinking: How might an EMT address the psychosocial concerns of a middle adult? What issues might the EMT address to make a bad situation easier for the middle adult to deal with? Class Activity: Discuss the role of menopause with regard to women’s health. What new health concerns emerge following menopause?

Late Adulthood (61 Years and Older)
Teaching Time: 10 minutes Teaching Tip: Invite a late adult to class. Have him discuss both the physical challenges and the psychosocial challenges facing late adulthood. Visit a nursing home. Interview residents, practice assessments, and learn vital signs.

Late Adulthood (61 Years and Older)

Body systems less efficient Psychosocial Living environment Self-worth Financial burdens Death and dying Talking Points: Vital signs will depend on physical and health condition. The cardiovascular system becomes less efficient, and the volume of blood decreases. Adults are less tolerant of tachycardia (fast heart rate). The respiratory system deteriorates, making development of respiratory disorders more likely. Changes in the endocrine system result in decreased metabolism. The sleep-wake cycle is disrupted, causing sleep problems. All other body systems are deteriorating. How long can the adult live at home becomes an important question. Is assisted living, or perhaps a nursing home, needed? Though having slowed down, the adult is concerned with producing quality work. With limited income and increasing expenses, financial concerns weigh heavily. The adult sees friends and relatives become ill and die. Concerns about the adult’s own health condition and mortality often come to mind. Discussion Topics: Describe how the body might change physiologically during late adulthood. Describe the anatomical differences between early adulthood and late adulthood. Discuss examples of the psychosocial stressors of late adulthood. Class Activity: Help students experience the changes of late adulthood. Work in small groups to simulate the decline of the body systems. Use restrictive clothing, blacked-out glasses, and so on to give real-life insight into the challenges of age.

Cognitive Function of Older Adults Video
Video Clip Cognitive Function of Older Adults Discuss the cognitive functioning of an individual over a lifetime. What normal changes in cognition are experienced by older adults? What types of disorders may affect a patient’s cognitive state? Explain how dementia and depression might affect an older patient. Click here to view a video on the subject of cognitive function of older adults. Back to Directory

Chapter Review

Chapter Review Understanding basic physiological and psychosocial development for each age group will assist you in communicating with and assessing patients of various ages. continued

Chapter Review Physiological differences between ages will affect your care (for example: differences in respiratory systems; effects of pre-existing conditions). Infants and young children have less-developed, smaller respiratory structures which can worsen respiratory conditions. continued

Chapter Review Communicating with patients will depend on their stage of development: could be fear of strangers, separation anxiety, embarrassment, denial, depression.

Remember Infants present massive bursts of anatomical and psychosocial development in the first year of life. Although preschoolers begin to develop independence and reason, in many ways they still resemble the psychosocial development of toddlers. continued

Remember School-age children often are independent and logical, but that may crumble with illness or injury. Adolescents are reaching physiological maturity, but they often face difficult psychosocial challenges. continued

Remember Early, middle, and late adults vary greatly in terms of physiological development and conditioning; they also face psychosocial challenges unique to adulthood.

Questions to Consider How do I approach a patient most effectively based on developmental characteristics? Does the age of my patient pose any assessment or care challenges based on physiologic development? Talking Points: You must approach patients of different ages differently. Consider what you have learned about the characteristics of the different stages in life to help you approach each patient’s problem. As patients age, an overall decrease in body functions can lead to many medical problems as well as be a factor in trauma.

Critical Thinking You are called for abdominal pain in a 16-year-old girl. She is with friends at the park. She seems hesitant to answer any of your questions. What characteristic of adolescent development is most likely the cause of this? How could you overcome it? Talking Points: Her need for privacy and independence may keep her from openly answering questions around others. The easiest way to resolve this is to ask “private” questions inside a closed ambulance without her friends present.

Please visit Resource Central on www. bradybooks
Please visit Resource Central on to view additional resources for this text. Please visit our web site at and click on the mykit links to access content for this text. Under Instructor Resources, you will find curriculum information, lesson plans, PowerPoint slides, TestGen, and an electronic version of this instructor’s edition. Under Student Resources, you will find quizzes, critical thinking scenarios, weblinks, animations, and videos related to this chapter—and much more.

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