Download presentation
Presentation is loading. Please wait.
1
BLS Management of the Peds Patient
By Daniel B. Green II, NREMT-P, CCP
2
Objectives Review developmental milestones of children
Use the pediatric assessment triangle to assess pediatric patients Discuss modifications to patient assessment based on age Review common pediatric illnessess and treatments
3
Pediatric Development
4
Pediatric Development
5
Age and Weight Important to be able to estimate ages and weights for pediatric patients Affects treatment decisions, particularly for AED and CPR
6
Age and Weight
7
Age and Weight
8
Developmental Characteristics
Children have different behaviors at different ages Tailor your assessment
9
Newborns and Infants Birth to 1 Year
Do not like cold Do not like separation from primary caregivers Let parent or caregiver hold child during assessment Ask caregiver to expose areas for examination Warm stethoscope bell before placing on child
10
Newborns and Infants Birth to 1 Year
Ask caregiver to comfort crying child Try distraction: pen or toy Check fontanels Bulging indicates possible increased intracranial pressure Sunken may indicate dehydration
11
Toddlers 1–3 Years Sense of independence but unable to communicate complex ideas Do not like strangers or separation from parents Require assurance May consider illness or separation from family as punishment
12
Toddlers 1–3 Years Place bell of stethoscope under shirt, rather than taking off clothing Consider demonstrating procedure such as chest auscultation on stuffed toy before using on child May not tolerate oxygen mask Use blow-by oxygen
13
Preschoolers 3–6 Years More developed concrete thinking skills
Ask for their version of events and feelings Frightened of potential pain, blood, injury Reassure, provide simple explanations Allow parent or caregiver to remain Protect modesty
14
School Aged Children 6–12 Years
Have basic idea of body and its functions Very literal Aware of and afraid of dying, pain, deformity, permanent injury Use reassurance and include them in discussions of care
15
Adolescents 12–18 Years More thorough understanding of A&P
Able to process and express complex ideas Good risk takers, poor judges of consequence Sense of immortality Speak respectfully Protect privacy
16
The Pediatric Airway Head Tongue Trachea
Proportionally larger and heavier than body Tongue Larger in proportion to lower jaw Falls back, occluding airway Trachea Thinner, more elastic May close off with hyperextension
17
Breathing Infants breath primarily through nose
Nose may be blocked with secretions Infant and child have higher respiratory rate Abdominal breathers Tire quickly when stressed
18
Pediatric Assessment Triangle
19
Pediatric Assessment Elements of the pediatric assessment triangle
Appearance and environment Work of breathing Circulation
20
Appearance and Environment
Key questions Is scene safe? Is there an obvious mechanism of injury? Is environment safe for a child? Is child active and attentive? Can child make eye contact, respond to parent’s voice?
21
Work of Breathing Look for symmetrical chest movement
Note respiratory rate Primary causes of cardiac arrest in children are respiratory disorders
22
Abnormal Findings Stridor Retraction of chest wall muscles
Harsh, high pitched sound during inhalation or exhalation Indicates partial upper airway obstruction Retraction of chest wall muscles Muscles pulling in between ribs, above sternum with inspiration Nasal flaring Extended opening or flaring of nostrils Wheezing High pitched sounds created by air moving through narrowed air passages in lungs
23
Assessing Circulation
Central perfusion Supply of oxygen to and removal of wastes from central circulation Asses with brachial and femoral pulse checks Check capillary refill Assess skin temperature, color, and moisture
24
Assessing Circulation
BP difficult to obtain below 3 years of age Rely on mental status, quality of pulses, and capillary refill Children 3 Ensure right size BP cuff Be aware of variation of vital signs with age
25
Compensating/Decompensating
Children will compensate for poor respirations and circulation However, decompensation may develop quickly
26
Respiratory Emergencies in Infants and Children
Respiratory distress Respiratory failure Respiratory arrest Airway management Airway adjuncts Oxygen therapy Assisted artificial ventilations Shock
27
Respiratory Distress Most common cause in pediatric patients is asthma
Also includes Chronic lung disease Airway obstruction Congenital heart disease Foreign body aspiration Chest wall trauma
28
Definitions Respiratory distress Respiratory failure
Abnormal physiologic process that prevents adequate gas exchange Respiratory failure Inability of respirations to maintain adequate oxygenation and ventilation Respiratory arrest Absence of breathing
29
Upper Airway Obstruction
Partial obstruction Stridor on inspiration Complete obstruction No crying, no speaking, no coughing Cyanosis
30
Lower Airway Obstruction
Wheezing Prolonged, labored exhalations Rapid respiratory rate No stridor
31
Signs of Respiratory Distress in Children
Altered mental status Flared nostrils Pale or cyanotic lips or mouth Noisy respirations (stridor, grunting, gasping, wheezing) Respiratory rate greater than 60 Retractions Use of abdominal muscles for breathing (see-saw breathing) Poor peripheral perfusion Decreased heart rate
32
Signs of Respiratory Failure
Decreased mental status Poor eye contact No response to verbal stimuli Pale, cyanotic skin Delayed capillary refill, weak pulses Fatigue, floppy, head bobbing
33
Continuing Respiratory Failure
Without immediate intervention, child will continue to deteriorate Respiratory rate 10/min Unresponsive, limp Decreasing heart rate Eventual respiratory and cardiac arrest
34
Airway Management Airway is primary concern for children
Modify head tilt/chin lift to maintain neutral position Avoid hyperextension or flexion Consider placing towel under body to maintain neutral airway position
35
Suctioning Secretions and Vomit
Use bulb-type suction device for suctioning nose and mouth of infant For larger children, use thin flexible plastic catheter Use rigid catheter for removing thick secretions and vomit
36
Principles of Suctioning
Administer oxygen prior to suctioning Suction for maximum of 5 seconds at a time Do not touch the back of the throat May slow heart rate and cause soft-tissue damage
37
Partial Airway Obstruction
Alert Noisy respirations Increased work of breathing Retractions around ribs and sternum Pink mucous membranes Good peripheral pulses
38
Managing Partial Airway Obstruction
Place child in position of comfort Likely sitting up Calm child Allow child to sit with parent or caregiver Provide oxygen by mask or blow-by technique Let child or caregiver hold oxygen device
39
Management of Airway Obstruction
Intervene if following signs are noted Absence of speaking or crying Ineffective cough Altered mental status Respiratory arrest
40
Children Under 1 Year of Age
If ventilation is ineffective or impossible, clear airway 5 back blows 5 chest thrusts If object is visible, remove Continue until effective
41
Children Over 1 Year of Age
If ventilation is ineffective or impossible, clear airway Perform chest compressions Do not perform blind finger sweeps
42
Shock Causes in children Less common Vomiting Diarrhea Infection
Trauma Blood loss Less common Allergic reactions Poisoning
43
Cardiac Causes of Shock
Very rare in children Occasionally may have child with congenital or chronic heart disease
44
Signs and Symptoms of Shock
Rapid heart rate Rapid respiratory rate Cool extremities Pale skin, dry mucous membranes Delayed capillary fill time Weak central pulse Weak or absent distal pulse Decreased response to environment “Floppy” muscle tone
45
Questions to Ask Caregiver
Has child been vomiting or had diarrhea? How many wet diapers in the past 24 hours?
46
Management of Shock in Children
Child showing signs of shock is very sick Children tend to compensate well, then decompensate quickly
47
Emergency Care for Shock
BSI and scene safety Ensure adequate ABCs Control obvious bleeding Administer high flow oxygen Keep patient warm Elevate legs, if possible Expedite transport/call for ALS backup
48
Trauma in Children Leading cause of death in infants and children
Head injuries Chest injuries Abdominal injuries Injuries to the extremities Burn injuries
49
Common Mechanisms of Injury
Motor vehicle crash Motor vehicle versus bicycle Pedestrian versus motor vehicle Fall from height Diving into shallow water Others Burns, sports injuries, child abuse
50
Motor Vehicle Crashes Most common cause of blunt trauma
Unrestrained child Injuries to head and neck Restrained child Abdominal and lower spine injuries
51
Motor Vehicle versus Bicycle
Injuries to Head Spine Abdominal injuries
52
Pedestrian versus Motor Vehicle
Bumper hits abdomen or upper legs Child thrown and lands on head With toddlers, bump will impact head and neck Often associated with abdominal, head, upper leg, pelvic injuries
53
Head Injuries Use modified jaw-thrust
Tongue obstruction in supine patient most common cause of hypoxia Developing respiratory failure and arrest Watch for Nausea, vomiting Secondary injuries
54
Chest Injuries Children's ribs are more pliable
Will bend further before breaking May be significant internal bleeding without obvious external signs of injury
55
Abdominal Injuries More common in children than adults
Abdominal muscles are weaker than in adults Internal organs are less securely anchored Suspect abdominal injury in child who is deteriorating without outward signs of injury Be aware of gastric distension when providing assisted ventilations
56
Injuries to the Extremities
Isolated limb injuries more frequent in pediatric population Rarely life-threatening Use of PASG prohibited in children Ensure you know local protocols
57
Burn Injuries Impaired skin integrity and exposure increase risk of hypothermia Know Rule of 9s for infants and children Heads are larger relative to body Cover with sterile nonstick gauze Transport to burn center
58
Emergency Medical Care
BSI, scene survey Maintain cervical stabilization Use modified jaw-thrust Suction if necessary Provide oxygen Assist respirations as required Secure to backboard Transport to appropriate facility
59
Seizures Causes Infection Poisoning Hypoglycemia Hypoxia Head trauma
60
Febrile Seizures Most common cause of seizures in infants and children
Usually associated with viral illness
61
Assessment of Seizure Patient
Ask caregiver How many seizures child has had How long seizures lasted What part of the body was convulsing Recent history of fever or chronic seizure disorder What medications child takes
62
Emergency Care for Seizures
Protect cervical spine as necessary Ensure patent airway Provide oxygen Suction, assist respirations, if required Transport to appropriate facility
63
Poisoning Common cause is accidental ingestion
Look for substance and container at scene
64
Emergency Care for Poisoning
If responsive Contact medical direction Administer oxygen and transport If unresponsive Maintain patent airway Suction and assist ventilations as necessary
65
Fever Seldom life-threatening on its own Causes usually infectious
e.g., meningitis Transport and be alert for seizures
66
The Last Word Keys are airway, breathing, and oxygenation
Cardiac events in children are almost always preceded by an obstructed airway or inadequate respirations EMS providers often intimidated by pediatric calls Practice your skills when working with children Remain calm and supportive
Similar presentations
