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Oklahoma Prehospital Pediatric Supplement

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Presentation on theme: "Oklahoma Prehospital Pediatric Supplement"— Presentation transcript:

1 Oklahoma Prehospital Pediatric Supplement
Developed by the Oklahoma EMSC Resource Center for the: “Infants and Children Module of the 1994 EMT-Basic Curriculum” PART 1: INTRODUCTORY 2003 Oklahoma EMSC Resource Center

2 Oklahoma EMSC Resource Center
Introduction OSDH-EMS approved PAC’s course to include in EMT-B 1998’s NSC in 1993 USDOT-NHTSA: EMT-B 1994’s NSC in 1995 EMSC Pediatric Supplement (Revision of PAC’s) to include in EMT-B 1994’s NSC in 1996 Mandatory inclusion into EMT-B courses 2003 Oklahoma EMSC Resource Center

3 PART 1: Introductory - Injury Prevention Methodology
This section covers the following informational areas. - Emergency Medical Services for Children - Injury Prevention Methodology - Anatomy and Physiology - Approaching Children - Vital Signs Assessment - Assessment Tools 2003 Oklahoma EMSC Resource Center

4 Oklahoma EMSC Resource Center
Objectives Define Emergency Medical Services for Children (EMSC). Objective: 6-1.0 Discuss how an integrated EMSC system can affect patient outcome. Objective: A Identify methods/mechanisms of injury prevention for Infants and Children. Objective: B 2003 Oklahoma EMSC Resource Center

5 Objectives (Continued)
Identify two (2) anatomic and physiologic differences between children and adults regarding skin and body surface. Objective: A Identify four (4) areas to consider when taking the child’s history. Objective: A 2003 Oklahoma EMSC Resource Center

6 Objectives (Continued)
Describe important factors in taking and interpreting vital signs. Objective: B Pulse Respirations Blood Pressure Temperature Identify a minimum of four (4) significant differences between the adult and pediatric airway which affect ventilation. Objective: C 2003 Oklahoma EMSC Resource Center

7 Emergency Medical Services for Children (EMSC)
OBJECTIVE: 6-1.0 Definition A program designed to reduce child and youth mortality and morbidity due to severe illness or trauma. History 1984 Legislation National Management MCHB NHTSA Oklahoma Management OUHSC 2003 Oklahoma EMSC Resource Center

8 Oklahoma EMSC Resource Center
EMSC (Continued) National Resource Centers National EMSC-NRC National EMSC Resource Alliance (NERA) Oklahoma Resource Center Oklahoma EMSC Resource Center Oklahoma Education and Training Pediatric Specialty Courses PALS PEPP PPC ENPC 2003 Oklahoma EMSC Resource Center

9 Oklahoma EMSC Resource Center
EMSC (Continued) Prehospital Curricula Pediatric ’94 NSC Supplement Injury Prevention Bystander Care Emergency 1st Care for Childcare Providers Childcare Health and Safety Courses Other Areas Pediatric Resource Library Education Assessment and Management Tools Information Center Instructional Outcome Statistics and Improvement 2003 Oklahoma EMSC Resource Center

10 Oklahoma EMSC Resource Center
EMSC (Continued) OBJECTIVE A Integrated EMSC Systems Prevention Prehospital E D’s I C U’s Rehab Community Psychological Trauma Systems State Agencies 2003 Oklahoma EMSC Resource Center

11 Oklahoma EMSC Resource Center
EMSC (Continued) Patient Outcome Affect Prevention Reduction Emergencies Disability Death Negative Impact Family Community 2003 Oklahoma EMSC Resource Center

12 Oklahoma EMSC Resource Center
Injury Prevention OBJECTIVE B Methodology and Mechanisms C P R and 1st Aid Training Certification Requirement Bicycle Safety Community Injury Prevention Programs Data Analysis Common Injury Specific Education 2003 Oklahoma EMSC Resource Center

13 Anatomy and Physiology (A&P)
OBJECTIVE A Skin and Body Surface Area (BSA) Infants and Young Children Head = 20% BSA BSA Larger in Proportion to Body Mass Changes by Body Part through Childhood Assumes Adult as Adolescent Thin Skin and Less Subcutaneous Fat Prone to Hypothermia and Deeper Burns than Adult Resuscitation and Drug Therapy Reduced in Hyperthermia Newborn Temperature Regulation Not Well Developed 2003 Oklahoma EMSC Resource Center

14 Oklahoma EMSC Resource Center
A & P (Continued) 2003 Oklahoma EMSC Resource Center

15 Oklahoma EMSC Resource Center
Pediatric Approach OBJECTIVE A Obtaining a History Primary Caregiver Information Reassures and Calms Elements Similar to Adult Additional Elements Birth Weight Problems with Pregnancy Current Estimated Weight 2003 Oklahoma EMSC Resource Center

16 Pediatric Approach (Continued)
Cooperation Enhancement Permit “Transition Phase” Level of Child Calm and Friendly Mannerism Cooperation of Child Uncooperative Child A-B-C’s Appropriate? Condition Known? Don’t Waste Time! 2003 Oklahoma EMSC Resource Center

17 Pediatric Approach (Continued)
General Examination Guidelines Remain and Display Calmness Assessment Life-Threatening = Head to Toe Non-Life-Threatening = Toe to Head Non-Traumatic = In Caregivers Lap/Arms Use Assessment Tools Take Opportune Advantages Color and Moistness of Mucous Membranes Presence of Tears Inspiratory Breath Sounds 2003 Oklahoma EMSC Resource Center

18 Pediatric Assessment Triangle (PAT)
APPEARANCE WORK OF BREATHING CIRCULATION TO SKIN PAT does not exclude an initial or focused assessment, but by precluding it complements them giving opportunity for immediate interventions to be established. 2003 Oklahoma EMSC Resource Center

19 Pediatric Trauma Score (PTS)
COMPONENTS +2 +1 -1 WEIGHT >20 kg (>44 lbs) 10-20 kg (22-44 lbs) <10 kg (<22 lbs) AIRWAY PATENT MAINTAINABLE NON – MAINTAINABLE SYSTOLIC BP (AUSCULTATED) >90 mmHg 50-90 mmHg <50 mmHg (PALPATED PULSE) RADIAL CAROTID NONE MENTAL STATUS Awake VERBAL OR PAIN UNRESPONSIVE FRACTURES CLOSED OR SUSPECTED MULTIPLE OPEN OR CLOSED WOUNDS MINOR MAJOR BURNS OR PENETRATING 2003 Oklahoma EMSC Resource Center

20 Other Assessment Tools
GLASGOW COMA SCALE (GCS) EYES MOTOR VERBAL 4 SPONTANEOUS 3 SPEECH 2 PAIN 1 NONE 6 OBEYS COMMANDS 5 LOCALIZED PAIN 4 WITHDRAWS TO PAIN 3 DECORTICATE/FLEXION 2 DECEREBRATE/EXTENSION 1 NONE 5 ORIENTED/BABBLES 4 CONFUSED/CRYING 3 CRY TO PAIN 2 INCOMPREHENSIBLE 1 NONE 2003 Oklahoma EMSC Resource Center

21 Oklahoma EMSC Resource Center
AGE kg H-R R-R SYS-BP DIAS-BP TIDAL VOLUME N-B mL 1 m mL 2 m mL 3 m mL 6 m mL 8 m mL 10 m mL 1 y mL 1 y mL 2 y mL 2 y mL 3 y mL 3 y mL 4 y mL 4 y mL 5 y mL 5 y mL 6 y mL 7 y mL 7 y mL 8 y mL 9 y mL 2003 Oklahoma EMSC Resource Center

22 Oklahoma EMSC Resource Center
Vital Signs OBJECTIVE B PULSE CENTRAL Carotid Femoral PERIPHERAL Radial Brachial Popliteal Pedal 2003 Oklahoma EMSC Resource Center

23 Vital Signs (Continued)
Monitor Pulse 30 seconds minimum Rate and Quality Central and Peripheral Tachycardia (Fast) and Triggers Compensatory Mechanism Shock Anxiety Fever Pain Medical Illness Traumatic Injury Environmental Insult 2003 Oklahoma EMSC Resource Center

24 Vital Signs (Continued)
Bradycardia (Slow) and Triggers End Stages Shock Hypothermia Hypoxia/Hypoxemia Cardiac Pathology Congenital Anomalies Certain Medications Rates Decrease through Childhood to Adolescence 2003 Oklahoma EMSC Resource Center

25 Vital Signs (Continued)
RESPIRATION OBSERVATION Begins with P-A-T Prior to and During Exam For Following Tachypnea (Fast) or Bradypnea (Slow) Hyperpnea (Deep) or Hypopnea (Shallow) Apnea (Absent) Use of Accessory Muscles Intercostal, Subcostal, Subclavicular, or Diaphragmatic Noises Wheezing (Inspiratory and/or Expiratory), Grunting (Expiratory), Rhonchi (Upper Airway Rattling), Rales (Lower Airway Crackles) Nasal Flaring 2003 Oklahoma EMSC Resource Center

26 Vital Signs (Continued)
Tachypnea (Fast) and Triggers Compensatory Mechanism Shock Anxiety Fever Pain Medical Illness Traumatic Injury Environmental Insult Monitor 30 seconds minimum Rate, Depth, and Quality 2003 Oklahoma EMSC Resource Center

27 Vital Signs (Continued)
BLOOD PRESSURE Compensatory Mechanism Sustains Normotension (Normal BP) Longer in Pediatrics Hypotension (Low BP) Confirms Decompensated Shock Peripheral Pulse Presence Infants (Birth to 12 months) = Minimum Systolic Pressure of 60 mmHg Children (1 year to 8 years) = Minimum Systolic Pressure of 70 + (2 x Age in Years) Normal Diastolic = 2/3 Systolic Appropriate Size BP Cuff Mandatory 2003 Oklahoma EMSC Resource Center

28 Vital Signs (Continued)
TEMPERATURE Protective Mechanism Environmental (Heat and Cold) Regulator Microbial Protection Assessment Rectally (Most Accurate): Normal = 36º C (96.8 º F) Axillary or Tympanic: Normal = 36.5º C (97.6 º F) Orally: Normal = 37º C (98.6 º F) Fever: Most common cause of seizure in infants 2003 Oklahoma EMSC Resource Center

29 Vital Signs (Continued)
PULSE OXIMETRY Placement Proximal to Central Circulation Earlobe = Recommended Site Administer O2 if SAO2 < 95% CO binds with Hemoglobin 200 times faster than O2 Pulse Ox of NO VALUE in such case 2003 Oklahoma EMSC Resource Center

30 Airway: Pediatric vs Adult
OBJECTIVE C Airway Differences Pediatric Head Prominent Occiput Tongue Larger More Anterior Epiglottis “U” Shaped Floppier Protrudes more in Laryngopharynx 2003 Oklahoma EMSC Resource Center

31 Oklahoma EMSC Resource Center
Airway (Continued) Pediatric (Continued) Trachea Shorter Infant: 4-5 cm Child: 8 cm More Flexible Rings Less Well Developed Smallest Airway Diameter = Cricoid Ring Larynx More Anterior More Cephalad Cords Shorter and Concave Lungs: (Tidal Volume Dependent on Diaphragmatic Movement) Adult Opposite that Mentioned 2003 Oklahoma EMSC Resource Center

32 Oklahoma EMSC Resource Center
Summary: Section 1 EMSC: Defined and Integrated Pediatric Injury Prevention Methodology Pediatric A&P vs Adult Approach to Obtaining Medical History Assessing and Interpreting Vital Signs Pediatric vs Adult Airway 2003 Oklahoma EMSC Resource Center

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