Pediatric Patients

& Emergencies

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Family Matters

When a child is ill or injured, you may have several patients, not just one. Children mimic caregiver behavior Be calm, professional, and sensitive.

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Anatomic Differences
Less circulating blood Lose body heat more easily Bones are more flexible Less fat surrounding organs Could be much internal damage with little external visible trauma

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Skeletal Differences

Bones are prone to fracture with stress. Infants have two openings in the skull called fontanels.
close by 18 months.

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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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Breathing Differences
Infants breathe faster than children or adults. Infants use the diaphragm when they breathe. Sustained, labored breathing may lead to respiratory failure.

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Circulation Differences
The heart rate increases for illness and injury Very effective vasoconstriction keeps vital organs nourished Pale, extremities, decreased cap refill are early signs of perfusion problems

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Approach to Assessment

level of activity, work of breathing, and skin color cap refill ALS backup or immediate transport? Pediatric patients crash harder than adults

Transport to peds facilities when possible

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Capillary Refill

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Treatment Considerations

Oxygen - treat same as adult Use blow-by administration if needed Patient position - same as adult *Remember* airway and breathing are focus

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Growth and Development

Usually grouped into stages

Infant Toddler Preschool School-age Adolescent

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Infant

first year of life

respond physical stimuli crying is main means of expression have caregiver hold pt

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Toddler
1 to 3 years of age mobile may resist separation dont like being restrained can be distracted

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Preschool
3 to 6 years of age can understand directions can identify painful areas fearful of pain allow them to handle equipment explain what you are going to do

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School-Age Child

6 to 12 years of age begin to think like adults can be included when taking medical history should be familiar with physical exam allow them to make choices when possible

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The Adolescent

12 to 18 years of age concerned about body image may have strong feelings about being observed respect their privacy they understand pain explain any procedure

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Notes

never

lie to a child

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Vital Signs

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Respirations
Abnormal respirations are a common sign of illness or injury Less than 3, count rise and fall of abdomen Note effort of breathing/noises Note if they are crying

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Respiration Notes
Less than 12 breaths/min More than 60 breaths/min, ALOC and/or an inadequate tidal volume

= ventilation with a BVM device

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Pulse
Infants -brachial or femoral Child- use carotid Count at least 1 minute Note strength

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Blood Pressure

Use right size cuff Difficult scene? Dont waste time Under 3? No BP

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Skin Signs
important sign feel for temperature and moisture always check capillary refill

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Pediatric Problems

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Fever
Common Causes

Infections Neoplasm (cancer) Drug ingestion Collagen vascular disease High environmental temperatures

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Emergency Care for Fever

Ensure BSI Begin passive cooling

Remove clothing/coverings Damp towels

No ice No alcohol No cold water baths

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Febrile Seizures
common in children 6 months to 6 years most caused by high fever hx of infection generalized grand mal seizure less than 15 minutes

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Treatment
ABCs protect patient recovery position high flow oxygen suction prn passive cooling measures transport

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Dehydration
Dry lips and gums Fewer wet diapers Sunken eyes Poor skin turgor Sleepy or irritable Sunken fontanels

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Care for Dehydration

Assess the ABCs Obtain baseline vital signs ALS backup may be needed for IV administration

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Airway Obstruction

Croup
An infection of the airway below the level of the vocal cords, caused by a virus

Epiglottitis
Infection of the soft tissue in the area above the vocal cords

Foreign body Aspiration

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Croup
barking cough stridor wheezing rales accessory muscle use nasal flaring grunting

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Epiglottitis
severe stridor inability fever tripod

dyspnea to swallow - DROOLING

position

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Foreign body aspiration

Partial

Blockage
coughing accessory muscle use nasal flaring wheezing

Complete

Blockage
-

no sound no cry stridor cyanosis loss of consciousness

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treatment
ABCs high

flow oxygen position of comfort

do not attempt to visualize the throat!

do not put anything into patients mouth.

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Asthma
dyspnea wheezing accessory

muscle use nasal flaring respiratory rate - observe

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Treatment
ABCs high

flow oxygen position of comfort transport

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What is the most frequent cause of cardiac arrest in pediatrics?

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Respiratory arrest!

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want to save a pediatric patient?

aggressive ventilation & high flow oxygen

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USC video!
Pediatric respiratory distress

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Meningitis
Inflammation of meninges Bacterial or viral Permanent brain damage/death

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Signs and Symptoms of Meningitis

Fever ALOC Headache Seizure Stiff neck

Vomiting Photophobia Irritability Bulging fontanel

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Neisseria meningitidis
rapid onset pinpoint cherry-red spots or larger purple/black rash sepsis, shock, and death all suspected cases considered contagious

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Treatment
BSI ABCs protect patient high flow oxygen passive cooling for fever monitor for shock Transport Call ALS for backup if unstable

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Submersion Injury

Drowning or near drowning Second most common cause of unintentional death ABCs May be in respiratory or cardiac arrest C-spine precautions?

Be ready to suction Keep warm

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Poisoning

Poisoning is common in children Ask specific questions of caregivers Focus on the ABCs Give oxygen Provide transport Childs condition could change at any time

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Pediatric Resuscitation Tape Measure (Aka: Broslow tape)

Used to determine height, weight, and proper equipment.

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Interossius IV

Used if traditional IV sites are difficult to assess Medication delivered into bone marrow Painful

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Interossius

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Transporting Infants and Children

Children require padding under the torso Newborns should be in special incubators Do not hold child during the actual transport Drive with due care Do not allow your emotions to take control

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Sudden Infant Death Syndrome

SIDS - crib death

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SIDS
Definition

- unexplained death of an apparently healthy infant. 7500+ cases per year in U.S. Leading cause of death in infants <1 year old more cases in winter months
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Sudden Infant Death Syndrome (SIDS)

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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Tasks at Scene
Assess and manage patient Communicate with and support the family Assess the scene

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Assessment and Management

Diagnosis of exclusion Can be other causes of condition Regardless of cause, TX is same Infant may have signs of postmortem changes It is ok to work up an obviously dead baby If no postmortem changes, begin CPR immediately

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Communication and Support of Family

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The death of child is very stressful for the family Parents guilt is overwhelming Provide support in whatever ways you can IT IS NOT YOUR PLACE TO JUDGE Use the infants name Allow family time with the infant

Scene Assessment

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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Support Groups
Know

your local phone numbers for referrals

Arrange

for proper debriefing

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Child Abuse

Any improper or excessive action that injures or harms a child or infant physical, sexual, emotional abuse and neglect More than 2 million cases reported annually Be aware of signs of child abuse and report it to authorities

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Questions Regarding Signs of Abuse (1 of 4)

Is the injury typical? Is reported method of injury consistent with injuries? Is the caregiver behaving appropriately?

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Is there evidence of drinking or drug abuse?

Questions Regarding Signs of Abuse (2 of 4)

Delay in seeking care? Good relationship between child and caregiver? Multiple injuries at various stages of healing? Any unusual marks or bruises?

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Questions Regarding Signs of Abuse (3 of 4)

Are there several types of injuries? Any burns on the hands or feet involving a glove distribution? Unexplained decreased level of consciousness?

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Questions Regarding Signs of Abuse (4 of 4)

Is the child clean and an appropriate weight? Any rectal or vaginal bleeding? What does the home look like?

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Other Indicators
Withdrawn, fearful or hostile child Refusal to discuss MOI History of accidents Conflicting stories Caregiver lack of concern

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Emergency Medical Care

ABCs Transport if you suspect child abuse Do not make accusations

EMT-Bs must report all suspected cases of child abuse

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Sexual Abuse

Children of any age or either gender can be victims Limit examination Do not allow child to wash, urinate, or defecate Document carefully Transport

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EMS Response to Pediatric Emergencies

You may experience a wide range of emotions You may feel anxious Practice helps After difficult incidents, a debriefing may be helpful

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stop
questions?

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