1. Care of the Family and Child MIKE PYORALA RCP, P.A.L.S, A.C.L.S., B.L.S., 12-LEAD ECG A.H.A. INSTRUCTOR

2. Care of the Family and Child  Psychological aspects  Developmental issues  Approach  Assessment Objectives

3. Care of the Family and Child Why are psychological and emotional needs difficult to manage?

4. Care of the Family and Child  Child’s viewpoint  Parent’s viewpoint  Health Care Provider’s viewpoint Psychological Aspects

5. Care of the Family and Child  CHALLENGES  Individual  Unit Crisis

6. Care of the Family and Child  Pain  Fear  Guilt Child’s Viewpoint

7. Care of the Family and Child  Frightened  Guilty  Exhausted Parent’s Viewpoint

8. Care of the Family and Child  Scared  Inexperienced  Empathetic Health Care Provider’s Viewpoint

9. Care of the Family and Child Child’s Responses

10. Care of the Family and Child

12. Care of the Family and Child Care of the Family and Child

13. Care of the Family and Child  Be honest  Give real choices  Support family relationship  Maintain self-control  Respect right to privacy Key Points

14. Care of the Family and Child  Assume the child can hear you.  Do not introduce fear/anxiety.  Praise children. Key Points

15. Care of the Family and Child  Decreased ability to:  accept and understand incoming information  think clearly and to solve problems  Helplessness  Anxiety  Hysteria  Anger  Guilt Parental Responses

16. Care of the Family and Child  Perception of the event  Previous experience  Family relationships  Culture/religion  Support systems Assessment

17. Care of the Family and Child  Include the parents and child  Ask for the parent’s assistance  Acknowledge feelings  Be honest  Stay calm  Familiarize family with the environment  Give control  Prepare the family Strategies

18. Care of the Family and Child The child’s chronological age may not always match the developmental age. Developmental Issues

19. Care of the Family and Child

25. Care of the Family and Child Care of the Family and Child

26. Care of the Family and Child  Does the child look sick?  Does the child sound sick? Physical Examination

27. Care of the Family and Child  Appearance  Airway and C-spine  Breathing Primary Survey

28. Care of the Family and Child Many problems, especially respiratory distress, are made worse by agitation. Remember:

29. Care of the Family and Child Varies with age Approach

30. Care of the Family and Child  Respond to  Soothing voice  Gentle hands  Pacifier  Keep warm  Exam chest and abdomen first Less than 1 month of age

31. Care of the Family and Child  Unafraid of strangers  Responds to cooing and tickling  Keep warm  Exam chest and abdomen first Infant (1-6 Months)

32. Care of the Family and Child  Afraid of strangers  Separation anxiety  Examine in parent’s lap  Examine trunk then proceed to head Infant (6-12 Months)

33. Care of the Family and Child  Independent  Strong distrust of strangers  Patient but firm approach  Keep parents nearby  Limit exam to bare essentials Toddler (1-3 Years)

34. Care of the Family and Child  Frightened of bodily injury  Need explanations and reassurance  May be more cooperative  Modest  Examine in presence of parents  Examine chest and abdomen first Preschooler (3-5 Years )

35. Care of the Family and Child  Cooperative  More aware of death  Need reassurance  Modest  Examine with parents present  Examine in an adult fashion School-Age Child (6-12 Years)

36. Care of the Family and Child  Expect to be treated as an adult  Many of the same fears as younger children  Body image  Excessively modest  Examine as an adult Adolescent (12-18 Years)

37. The approach to the unconscious child of any age is the same as for the unconscious adult, with rapid performance of the primary survey and institution of priority treatments. Care of the Family and Child

38.  Talk to all patients of all ages  Give explanations in simple language  Be honest  Be sympathetic  Offer reassurance  Carefully document Tips on Treatment

39. Care of the Family and Child Vary with age Vital Signs

40. Care of the Family and Child Broselow® Resuscitation Tape

41. Care of the Family and Child  Critical measurement  (Age in years x 2) + 8 = weight in kilograms Weight

42. Care of the Family and Child  Count respirations before touching the child.  Count for 1 full minute to assess:  quantity  quality  effort Respirations

43. Care of the Family and Child  Newborn  Infant/young child  Older child Umbilical Cord Brachial artery Carotid artery Heart Rate

44. Care of the Family and Child Heart rate rises long before blood pressure falls!!!!!! In Shock, Remember :

45. Bradycardia in an ill child indicates extreme distress, requiring URGENT intervention. Care of the Family and Child Remember :

46. Care of the Family and Child  Wide range of normals  May see up to 25% decrease in blood volume before BP decreases.  Over one year may estimate minimum systolic: (Age in years x 2 ) + 70 = minimum systolic blood pressure Blood Pressure

47. Care of the Family and Child Never wait until the child is hypotensive to initiate volume resuscitation!!!!!! Remember:

48. Care of the Family and Child  Children cool quickly  Exposure and low cardiac output lower core temperature Temperature

49. Care of the Family and Child  Anterior Fontanel  Bulging or tense  Sunken Neurological

50. Care of the Family and Child  Alertness  Eye contact  Recognition of parents  Playing  Withdrawal to pain LOC

51. Care of the Family and Child  Talk  Reassure  Be Honest  Carefully document

52. Care of the Family and Child  Discuss and review difficult pediatric cases  Critical Stress Debriefings Care for Yourself