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2003Oklahoma EMSC Resource Center1 Oklahoma Prehospital Pediatric Supplement Developed by the Oklahoma EMSC Resource Center for the: “Infants and Children.

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Presentation on theme: "2003Oklahoma EMSC Resource Center1 Oklahoma Prehospital Pediatric Supplement Developed by the Oklahoma EMSC Resource Center for the: “Infants and Children."— Presentation transcript:

1 2003Oklahoma EMSC Resource Center1 Oklahoma Prehospital Pediatric Supplement Developed by the Oklahoma EMSC Resource Center for the: “Infants and Children Module of the 1994 EMT-Basic Curriculum” PART 2: RESPIRATORY +

2 2003Oklahoma EMSC Resource Center2 PART 2: Respiratory + This section covers the following informational areas. - Respiratory Distress / Failure - Respiratory Emergencies - Dehydration - Altered Temperature Regulation

3 2003Oklahoma EMSC Resource Center3 Objectives Evaluate the signs of respiratory insufficiency / failure in pediatric patients.Evaluate the signs of respiratory insufficiency / failure in pediatric patients. –Objective: A Describe the four most common respiratory emergencies in children, the signs and symptoms, and management.Describe the four most common respiratory emergencies in children, the signs and symptoms, and management. –Objective: A

4 2003Oklahoma EMSC Resource Center4 Objectives (Continued) Differentiate among mild, moderate, and severe dehydration.Differentiate among mild, moderate, and severe dehydration. –Objective: A Describe the management of Infants and Children with Altered Temperature Control.Describe the management of Infants and Children with Altered Temperature Control. –Objective: A

5 2003Oklahoma EMSC Resource Center5 Respiratory Distress/Failure OBJECTIVE: A DefinitionDefinition –Hypoventilation –Hypoxemia Early Signs and SymptomsEarly Signs and Symptoms –Respiratory Rate (Age Dependent) and Work TachypneaTachypnea BradypneaBradypnea Nasal FlaringNasal Flaring Accessory Muscle UseAccessory Muscle Use

6 2003Oklahoma EMSC Resource Center6 Distress/Failure (Continued) –Heart Rate (Age Dependent) TachycardiaTachycardia –Behavioral CombativeCombative RestlessRestless AnxiousAnxious FearfulFearful ConfusedConfused

7 2003Oklahoma EMSC Resource Center7 Distress/Failure (Continued) Late SignsLate Signs –Apnea –Cyanosis –Altered Mental Status (AMS) –Bradycardia Birth to 12 months = HR <80 bpmBirth to 12 months = HR <80 bpm > 1 year age = HR 1 year age = HR < 60 bpm –Cardiopulmonary Arrest

8 2003Oklahoma EMSC Resource Center8 Distress/Failure (Continued) Predisposing FactorsPredisposing Factors –Upper Airway Obstruction Severe Partial or CompleteSevere Partial or Complete CausesCauses –Croup –Epiglottitis –FBAO SignsSigns –Severe Stridor –Totally Absent Breath Sounds

9 2003Oklahoma EMSC Resource Center9 Distress/Failure (Continued) –Lower Airway Obstruction Severe Partial or CompleteSevere Partial or Complete CausesCauses –Asthma –Bronchiolitis –FBAO Aspiration –Toxic Gas Inhalation SignsSigns –Tachypnea –Rales –Wheezes

10 2003Oklahoma EMSC Resource Center10 Distress/Failure (Continued) –Lung Disease CausesCauses –Pneumonia –CHF –Near Drowning SignsSigns –Rales –Hypopnea –Other Causes TraumaTrauma Neurologic InsultNeurologic Insult DehydrationDehydration Metabolic InsultMetabolic Insult

11 2003Oklahoma EMSC Resource Center11 Respiratory Emergencies OBJECTIVE: A Most Encountered ConditionsMost Encountered Conditions –Asthma –Bronchiolitis –Laryngotracheobronchitis (CROUP) –Epiglottitis –Foreign Body Airway Obstruction (FBAO)

12 2003Oklahoma EMSC Resource Center12 Asthma DefinitionDefinition –Chronic recurrent lower airway disease with episodic attacks of bronchial constriction. EdemaEdema Increased Thick Mucus SecretionIncreased Thick Mucus Secretion Bronchi and Bronchiole Constriction from SpasmsBronchi and Bronchiole Constriction from Spasms Historical DataHistorical Data –Same as for adults plus Exhibited concern of caregiver regarding this attack relative to other attacksExhibited concern of caregiver regarding this attack relative to other attacks

13 2003Oklahoma EMSC Resource Center13 Asthma (Continued) AssessmentAssessment –Respiratory TachypneaTachypnea HypopneaHypopnea S O BS O B Intercostal RetractionsIntercostal Retractions Episodic Coughing (May Induce Vomiting)Episodic Coughing (May Induce Vomiting) Prolonged Expiratory PhaseProlonged Expiratory Phase Generalized Inspiratory and Expiratory WheezingGeneralized Inspiratory and Expiratory Wheezing

14 2003Oklahoma EMSC Resource Center14 Asthma (Continued) –Circulation Pale or MottledPale or Mottled Lips may appear deep, dark red initiallyLips may appear deep, dark red initially –Progresses to Cyanotic –Hypoxemia Increases –Mental Status ApprehensionApprehension ConfusionConfusion

15 2003Oklahoma EMSC Resource Center15 Asthma (Continued) ManagementManagement –A-B-C’s Assess and Continued MonitoringAssess and Continued Monitoring Maintain Airway PatencyMaintain Airway Patency –Heightened Awareness Possible Emetic Episode High Flow, High Concentration O 2 (Humidified Preferred)High Flow, High Concentration O 2 (Humidified Preferred) Assist Ventilations as NeededAssist Ventilations as Needed –Medication Therapy Prescribed MedicationsPrescribed Medications –Ensure Prescribed to Patient and Not Expired –Max Dose Not Exceeded and Protocols Allow to Assist –Immediate Transport to Appropriate Facility Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable

16 2003Oklahoma EMSC Resource Center16 Bronchiolitis DefinitionDefinition –Infection of the lower respiratory tract. AssessmentAssessment –Fever and Cough –Inspiratory and Expiratory Wheezing –Acute Respiratory Distress with Difficulty Breathing TachypneaTachypnea Mild to Moderate HypopneaMild to Moderate Hypopnea Costal RetractionsCostal Retractions CyanosisCyanosis

17 2003Oklahoma EMSC Resource Center17 Bronchiolitis (Continued) ManagementManagement –A-B-C’s Assess and Continued MonitoringAssess and Continued Monitoring Maintain Airway PatencyMaintain Airway Patency –Nares –Oral High Flow, High Concentration O 2 (Humidified Preferred)High Flow, High Concentration O 2 (Humidified Preferred) Assist Ventilations as NeededAssist Ventilations as Needed –Immediate Transport to Appropriate Facility Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable

18 2003Oklahoma EMSC Resource Center18 Laryngotracheobronchitis DefinitionDefinition –Upper respiratory viral infection. Swelling and inflammation of larynx, subglottic tissue, and occasionally the trachea and bronchi. Historical DataHistorical Data –Etiology 6 months to 3 years age6 months to 3 years age Spring and Fall monthsSpring and Fall months Following cold symptoms by 2-3 daysFollowing cold symptoms by 2-3 days –Questions to Answer Difficulty Swallowing Fluids?Difficulty Swallowing Fluids? Evident Drooling?Evident Drooling?

19 2003Oklahoma EMSC Resource Center19 Croup (Continued) AssessmentAssessment –Hoarse Cry/Voice –Seal-Like Barking Cough –Low-Grade Fever –Inspiratory Stridor Expiratory in Severe CasesExpiratory in Severe Cases –Respiratory Distress Nasal FlaringNasal Flaring Costal RetractionsCostal Retractions TachypneaTachypnea TachycardiaTachycardia Pallor/CyanosisPallor/Cyanosis

20 2003Oklahoma EMSC Resource Center20 Croup (Continued) ManagementManagement –A-B-C’s Assess and Continued MonitoringAssess and Continued Monitoring Maintain Airway PatencyMaintain Airway Patency –DO NOT Agitate with Excessive Exam or Handling –DO NOT Attempt Any Visualization High Flow, High Concentration O 2 (Humidified Preferred)High Flow, High Concentration O 2 (Humidified Preferred) –Non-Rebreather Mask if Tolerated –Flow-By if Mask NOT Tolerated Assist Ventilations as NeededAssist Ventilations as Needed –Urgent Transport to Appropriate Facility Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable

21 2003Oklahoma EMSC Resource Center21 Epiglottitis DefinitionDefinition –Bacterial infection localized in the epiglottis, usually caused by Hemophilus Influenza Type B (H-Flu). Historical DataHistorical Data –Questions to Answer Fever Present?Fever Present? –Sudden or Gradual Onset? –How High Temperature? Sore Throat and NOT Swallowing?Sore Throat and NOT Swallowing?

22 2003Oklahoma EMSC Resource Center22 Epiglottitis (Continued) –Etiology TRUE MEDICAL EMERGENCYTRUE MEDICAL EMERGENCY Acute Edema above GlottisAcute Edema above Glottis –May Result Complete Airway Obstruction Ages 3-6 years most commonAges 3-6 years most common –Can occur in younger or older Sudden OnsetSudden Onset Rapid Progression Respiratory Distress & Airway ObstructionRapid Progression Respiratory Distress & Airway Obstruction Heightened Danger during SleepHeightened Danger during Sleep –Awaken with High Temperature –Sore Throat –Difficulty Breathing and Swallowing

23 2003Oklahoma EMSC Resource Center23 Epiglottitis (Continued) AssessmentAssessment –High Temperature –Tripod Position TachypneaTachypnea HypopneaHypopnea –Open Mouth with Slightly Protruding Tongue –Extremely Sore Throat Refusal to SwallowRefusal to Swallow Excessive SalivationExcessive Salivation

24 2003Oklahoma EMSC Resource Center24 Epiglottitis (Continued) ManagementManagement –A-B-C’s Assess and Continued MonitoringAssess and Continued Monitoring –DO NOT Manipulate Airway –DO NOT Insert Anything in Mouth –DO NOT Make Child Lie Down –DO NOT Agitate & Minimize Handling High Flow, High Concentration O 2 (Humidified Preferred)High Flow, High Concentration O 2 (Humidified Preferred) –Non-Rebreather Mask if Tolerated –Flow-By if Mask NOT Tolerated –Positive Pressure B-V-M Ventilations: Obstruction Occurs –Immediately Urgent Transport Appropriate Facility for Condition of PatientAppropriate Facility for Condition of Patient Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable

25 2003Oklahoma EMSC Resource Center25 Dehydration OBJECTIVE: A DefinitionDefinition –Overtly excessive displacement of bodily fluids due to any one or more of various insults to homeostasis. Historical DataHistorical Data –Physiology Majority of Total Body Weight = H 2 OMajority of Total Body Weight = H 2 O –Birth to 12 months = 75% »Infants MOST SUSCEPTIBLE to Dehydration than any other age group. –> 1 year of age = 60%

26 2003Oklahoma EMSC Resource Center26 Dehydration (Continued) –Etiology Excessive Body TemperaturesExcessive Body Temperatures Excessive Sweating, Vomiting, and/or DiarrheaExcessive Sweating, Vomiting, and/or Diarrhea Traumatic InsultTraumatic Insult Medical Emergencies such as DKAMedical Emergencies such as DKA –Questions to Answer Number Diaper Changes Last 4-6 hours?Number Diaper Changes Last 4-6 hours? Quantity & Consistency (smell) of Urine Last 2 hours?Quantity & Consistency (smell) of Urine Last 2 hours? Amount of Fluid Intake Last 4-6 hours?Amount of Fluid Intake Last 4-6 hours? Infant - 18 mos: Fontanelle Appearance (Depressed)?Infant - 18 mos: Fontanelle Appearance (Depressed)?

27 2003Oklahoma EMSC Resource Center27 Dehydration (Continued) AssessmentAssessment –Mild Dehydration Physical signs barely identifiablePhysical signs barely identifiable History provides more than physically assessableHistory provides more than physically assessable –Moderate Dehydration Poor Skin Color and Turgor > 3 secondsPoor Skin Color and Turgor > 3 seconds Mucous Membranes Dry and NO TEARSMucous Membranes Dry and NO TEARS Decreased Urine Output with Increased ThirstDecreased Urine Output with Increased Thirst Increasing Tachypnea without Accessory Muscle UseIncreasing Tachypnea without Accessory Muscle Use Increasing Tachycardia with Diminishing Peripheral Pulses PalpableIncreasing Tachycardia with Diminishing Peripheral Pulses Palpable –Severe Dehydration Life-Threatening Hypovolemic Shock Imminent w/o TxLife-Threatening Hypovolemic Shock Imminent w/o Tx

28 2003Oklahoma EMSC Resource Center28 Dehydration (Continued) ManagementManagement –Mild or Moderate Dehydration A-B-C’sA-B-C’s –Assess and Continued Monitoring –Maintain Airway Patency –High Flow, High Concentration O 2 (Humidified Preferred) Urgent Transport to Appropriate FacilityUrgent Transport to Appropriate Facility Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable –Severe Dehydration Same As Stated for Mild or ModerateSame As Stated for Mild or Moderate Be Prepared to Initiate CPR for Circulatory Collapse and Respiratory ArrestBe Prepared to Initiate CPR for Circulatory Collapse and Respiratory Arrest

29 2003Oklahoma EMSC Resource Center29 Body’s Thermal Regulation OBJECTIVE: A HYPERTHERMIAHYPERTHERMIA –Definition Fever: Body’s response to infection or from alteration in CNS regulation of body temperatureFever: Body’s response to infection or from alteration in CNS regulation of body temperature –Protective Response –Drug Toxicity Induced »Antihistamines »ASA »Belladonna Agents –Environmental or Man-Made Response Heightened Concern for Rectal Temperature > 39.6º C (103º F)Heightened Concern for Rectal Temperature > 39.6º C (103º F)

30 2003Oklahoma EMSC Resource Center30 Thermal Regulation (Continued) –Historical Data Rise in Body’s Core TemperatureRise in Body’s Core Temperature –Increases O 2 Demand –Increases Metabolic Acidosis –Increases Risk of Febrile Seizure »6 months to 5 years age »Temperatures > 39.6º C Stresses Cardiac and Respiratory SystemsStresses Cardiac and Respiratory Systems –Respiratory Fatigue to Failure –Assessment A-B-C-D-EA-B-C-D-E Response to Fever Indicates Seriousness of ConditionResponse to Fever Indicates Seriousness of Condition

31 2003Oklahoma EMSC Resource Center31 Thermal Regulation (Continued) –Management FeverFever –O 2 as Clinically Indicated –Monitor A-B-C’s and VS repeatedly –Remove Heavy Clothing –Cooling Techniques –Comfort and Positioning –Transport HyperthermiaHyperthermia –Monitor A-B-C’s and VS Frequently –Administer High Flow, High Concentration O 2 –Promote Rapid Cooling »Remove Clothing and Place in Cool Environment –Transport to Appropriate Facility

32 2003Oklahoma EMSC Resource Center32 Thermal Regulation (Continued) HYPOTHERMIAHYPOTHERMIA –Definition Body Core Temperature < 35º C (95º F)Body Core Temperature < 35º C (95º F) –Historical Data Regulatory Mechanism Lacks Complete DevelopmentRegulatory Mechanism Lacks Complete Development Larger Ratio of BSA than AdultsLarger Ratio of BSA than Adults Newborns Have Less Body Fat to InsulateNewborns Have Less Body Fat to Insulate Abdomen LAST AREA to Get ColdAbdomen LAST AREA to Get Cold CausesCauses –Prolonged Exposure Below Norm Environmental Temps –Metabolic Anomalies Induced by Hypoglycemia, Drugs, EtOH, etc –CNS Trauma / Sepsis

33 2003Oklahoma EMSC Resource Center33 Thermal Regulation (Continued) Physiologic ResponsePhysiologic Response –Increased Muscle Rigidity and Higher Metabolic Rate –Shivering –Slowing CNS Response –Decreased Respiratory / Cardiovascular Response –Assessment S-A-M-P-L-ES-A-M-P-L-E A-B-C-D-EA-B-C-D-E Length of ExposureLength of Exposure Ingestion/Absorption of Drugs or EtOHIngestion/Absorption of Drugs or EtOH EnvironmentEnvironment

34 2003Oklahoma EMSC Resource Center34 Thermal Regulation (Continued) –Management Mild HypothermiaMild Hypothermia –Move to Warmer Environment –Remove Wet Clothing –Give Warm Fluids Orally if Alert »Non-Caffeinated »Non-Alcoholic Moderate to Severe HypothermiaModerate to Severe Hypothermia –Monitor A-B-C’s and VS Frequently –Administer High Flow, High Concentration,Warmed, and Humidified O 2 –Assist with Ventilatory Support as Indicated –Perform CPR as Indicated –Transport to Appropriate Facility

35 2003Oklahoma EMSC Resource Center35 Summary (Continued) Signs of Respiratory Distress/FailureSigns of Respiratory Distress/Failure Most Common Respiratory EmergenciesMost Common Respiratory Emergencies –Recognition –Assessment –Management Dehydration Recognition and DifferentiationDehydration Recognition and Differentiation –Mild –Moderate –Severe

36 2003Oklahoma EMSC Resource Center36 Summary Insult to the Body’s Thermal Regulation MechanismInsult to the Body’s Thermal Regulation Mechanism –Recognition –Assessment –Management


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