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pediatrics Pediatric Patients & Emergencies
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pediatrics Family Matters l When a child is ill or injured, you may have several patients, not just one. l Children mimic caregiver behavior l Be calm, professional, and sensitive.
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pediatrics Anatomic Differences l Less circulating blood l Lose body heat more easily l Bones are more flexible l Less fat surrounding organs l Could be much internal damage with little external visible trauma
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pediatrics Skeletal Differences l Bones are prone to fracture with stress. l Infants have two openings in the skull called fontanels. –close by 18 months.
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pediatrics Airway Differences –Larger tongue relative to the mouth –Less well-developed rings of cartilage in the trachea –Head tilt-chin lift may occlude the airway.
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pediatrics Breathing Differences l Infants breathe faster than children or adults. l Infants use the diaphragm when they breathe. l Sustained, labored breathing may lead to respiratory failure.
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pediatrics Circulation Differences l The heart rate increases for illness and injury l Very effective vasoconstriction keeps vital organs nourished l Pale, extremities, decreased cap refill are early signs of perfusion problems
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pediatrics Approach to Assessment level of activity, work of breathing, and skin color level of activity, work of breathing, and skin color l cap refill l ALS backup or immediate transport? l Pediatric patients crash harder than adults l Transport to peds facilities when possible
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pediatrics Capillary Refill
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pediatrics Treatment Considerations l Oxygen - treat same as adult – Use “blow-by” administration if needed l Patient position - same as adult l *Remember* airway and breathing are focus
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pediatrics Growth and Development l Usually grouped into stages – Infant – Toddler – Preschool – School-age – Adolescent
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pediatrics Infant l first year of life l respond physical stimuli l crying is main means of expression l have caregiver hold pt
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pediatrics Toddler l 1 to 3 years of age l mobile l may resist separation l don’t like being restrained l can be distracted
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pediatrics Preschool l 3 to 6 years of age l can understand directions l can identify painful areas l fearful of pain l allow them to handle equipment l explain what you are going to do
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pediatrics School-Age Child l 6 to 12 years of age l begin to think like adults l can be included when taking medical history l should be familiar with physical exam l allow them to make choices when possible
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pediatrics The Adolescent l 12 to 18 years of age l concerned about body image l may have strong feelings about being observed l respect their privacy l they understand pain l explain any procedure
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pediatrics Notes l never lie to a child
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pediatrics Vital Signs
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pediatrics Respirations l Abnormal respirations are a common sign of illness or injury l Less than 3, count rise and fall of abdomen l Note effort of breathing/noises l Note if they are crying
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pediatrics Respiration Notes l Less than 12 breaths/min l More than 60 breaths/min, l ALOC and/or an inadequate tidal volume = ventilation with a BVM device
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pediatrics Pulse l Infants -brachial or femoral l Child- use carotid l Count at least 1 minute l Note strength
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pediatrics Blood Pressure l Use right size cuff l Difficult scene? Don’t waste time l Under 3? No BP
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pediatrics Skin Signs l important sign l feel for temperature and moisture l always check capillary refill
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pediatrics Pediatric Problems
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pediatrics Fever –Common Causes l Infections l Neoplasm (cancer) l Drug ingestion l Collagen vascular disease l High environmental temperatures
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pediatrics Emergency Care for Fever l Ensure BSI l Begin passive cooling –Remove clothing/coverings –Damp towels l No ice l No alcohol l No cold water baths
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pediatrics Febrile Seizures l common in children 6 months to 6 years l most caused by high fever l hx of infection l generalized grand mal seizure l less than 15 minutes
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pediatrics Treatment l ABC’s l protect patient l recovery position l high flow oxygen l suction prn l passive cooling measures l transport
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pediatrics Dehydration l Dry lips and gums l Fewer wet diapers l Sunken eyes l Poor skin turgor l Sleepy or irritable l Sunken fontanels
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pediatrics Care for Dehydration l Assess the ABCs l Obtain baseline vital signs l ALS backup may be needed for IV administration
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pediatrics Airway Obstruction l Croup –An infection of the airway below the level of the vocal cords, caused by a virus l Epiglottitis –Infection of the soft tissue in the area above the vocal cords l Foreign body Aspiration
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pediatrics Croup l barking cough l stridor l wheezing l rales l accessory muscle use l nasal flaring l grunting
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pediatrics Epiglottitis l severe dyspnea l stridor l inability to swallow - DROOLING l fever l tripod position
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pediatrics Foreign body aspiration l Partial Blockage –coughing –accessory muscle use –nasal flaring –wheezing l Complete Blockage - no sound - no cry - stridor - cyanosis - loss of consciousness
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pediatrics treatment l ABC’s l high flow oxygen l position of comfort do not attempt to visualize the throat! do not put anything into patient’s mouth.
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pediatrics Asthma l dyspnea l wheezing l accessory muscle use l nasal flaring l respiratory rate - observe
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pediatrics Treatment l ABC’s l high flow oxygen l position of comfort l transport
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pediatrics What is the most frequent cause of cardiac arrest in pediatrics?
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pediatrics Respiratory arrest !
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pediatrics want to save a pediatric patient? aggressive ventilation & high flow oxygen
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pediatrics USC video! Pediatric respiratory distress
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pediatrics Meningitis l Inflammation of meninges l Bacterial or viral l Permanent brain damage/death
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pediatrics Signs and Symptoms of Meningitis l Fever l ALOC l Headache l Seizure l Stiff neck l Vomiting l Photophobia l Irritability l Bulging fontanel
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pediatrics Neisseria meningitidis l rapid onset l pinpoint cherry-red spots or larger purple/black rash l sepsis, shock, and death l all suspected cases considered contagious
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pediatrics Treatment l BSI l ABC’s l protect patient l high flow oxygen l passive cooling for fever l monitor for shock l Transport l Call ALS for backup if unstable
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pediatrics Submersion Injury l Drowning or near drowning l Second most common cause of unintentional death l ABC’s l May be in respiratory or cardiac arrest l C-spine precautions? l Be ready to suction l Keep warm
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pediatrics Poisoning l Poisoning is common in children l Ask specific questions of caregivers l Focus on the ABCs l Give oxygen l Provide transport l Child’s condition could change at any time
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pediatrics Pediatric Resuscitation Tape Measure (Aka: Broslow tape) l Used to determine height, weight, and proper equipment.
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pediatrics Interossius IV l Used if traditional IV sites are difficult to assess l Medication delivered into bone marrow l Painful
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pediatrics Interossius
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pediatrics Transporting Infants and Children l Children require padding under the torso l Newborns should be in special incubators l Do not hold child during the actual transport l Drive with due care l Do not allow your emotions to take control
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pediatrics Sudden Infant Death Syndrome SIDS - “crib death”
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pediatrics SIDS l Definition - unexplained death of an apparently healthy infant. l 7500+ cases per year in U.S. l Leading cause of death in infants <1 year old l more cases in winter months
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pediatrics Sudden Infant Death Syndrome (SIDS) l Several known risk factors: –Mother younger than 20 years old –Mother smoked during pregnancy –Low birth weight –Putting babies to sleep on stomach –Siblings of SIDS babies
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pediatrics Tasks at Scene l Assess and manage patient l Communicate with and support the family l Assess the scene
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pediatrics Assessment and Management l Diagnosis of exclusion l Can be other causes of condition l Regardless of cause, TX is same l Infant may have signs of postmortem changes l It is ok to work up an obviously dead baby l If no postmortem changes, begin CPR immediately
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pediatrics Communication and Support of Family l The death of child is very stressful for the family l Parents guilt is overwhelming l Provide support in whatever ways you can l IT IS NOT YOUR PLACE TO JUDGE l Use the infant’s name l Allow family time with the infant
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pediatrics Scene Assessment l Inspect the environment, noting: –Signs of illness, including medications –General condition of the house –Family interaction –Site where infant was discovered
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pediatrics Support Groups l Know your local phone numbers for referrals l Arrange for proper debriefing
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pediatrics Child Abuse l Any improper or excessive action that injures or harms a child or infant l physical, sexual, emotional abuse and neglect l More than 2 million cases reported annually l Be aware of signs of child abuse and report it to authorities
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pediatrics Questions Regarding Signs of Abuse (1 of 4) l Is the injury typical? l Is reported method of injury consistent with injuries? l Is the caregiver behaving appropriately? l Is there evidence of drinking or drug abuse?
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pediatrics Questions Regarding Signs of Abuse (2 of 4) l Delay in seeking care? l Good relationship between child and caregiver? l Multiple injuries at various stages of healing? l Any unusual marks or bruises?
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pediatrics Questions Regarding Signs of Abuse (3 of 4) l Are there several types of injuries? l Any burns on the hands or feet involving a glove distribution? l Unexplained decreased level of consciousness?
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pediatrics Questions Regarding Signs of Abuse (4 of 4) l Is the child clean and an appropriate weight? l Any rectal or vaginal bleeding? l What does the home look like?
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pediatrics Other Indicators l Withdrawn, fearful or hostile child l Refusal to discuss MOI l History of “accidents” l Conflicting stories l Caregiver lack of concern
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pediatrics Emergency Medical Care l ABCs l Transport if you suspect child abuse l Do not make accusations l EMT-Bs must report all suspected cases of child abuse
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pediatrics Sexual Abuse l Children of any age or either gender can be victims l Limit examination l Do not allow child to wash, urinate, or defecate l Document carefully l Transport
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pediatrics EMS Response to Pediatric Emergencies l You may experience a wide range of emotions l You may feel anxious l Practice helps l After difficult incidents, a debriefing may be helpful
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pediatrics stop questions?
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