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Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 44-1 Chapter 44 Pediatrics.

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Presentation on theme: "Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 44-1 Chapter 44 Pediatrics."— Presentation transcript:

1 Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display Chapter 44 Pediatrics

2 44-2 Objectives

3 Introduction Children are not just small adults Children have unique physical, mental, emotional, and developmental characteristics 44-3

4 Life StageAge Newly born Birth to several hours after birth NeonateBirth to 1 month Infant1 to 12 months of age Young infant: 0 – 6 months Older infant: 6 months – 1 year Toddler1 to 3 years of age Preschooler4 to 5 years of age School-age child 6 to 12 years of age Adolescent13 to 18 years of age

5 Anatomical and Physiological Differences in Children 44-5

6 Head 44-6

7 Face Nasal passages –Small, short, and narrow –Easily obstructed –Can lead to respiratory difficulty –Make sure a newborn’s nose is clear to avoid breathing problems 44-7

8 Face Mouth opening is usually small Tongue –Fills the majority of space in the mouth of an infant or child –Most common cause of upper airway obstruction in unconscious child 44-8

9 Airway Opening between the vocal cords is higher in the neck and more toward the front than in adults –Flap of cartilage that covers this opening, the epiglottis, is long, floppy, narrow and extends at a 45-degree angle into airway in children –Damage or swelling in this area can block the airway 44-9

10 Airway Trachea (windpipe) –Softer, more flexible, smaller diameter, and shorter length than in adults –Rings of cartilage keep windpipe open Soft and collapses easily in children Extending or flexing the neck too far can block the airway 44-10

11 Breathing Ribs –Soft, flexible –Made up mostly of cartilage –Trauma to the chest is transmitted to lungs and other internal structures more easily 44-11

12 Breathing Intercostal muscles –Not fully developed until later in childhood Diaphragm –Primary muscle of breathing 44-12

13 Normal Respiratory Rates in Children at Rest Life StageAgeBreaths per Minute NewbornBirth to 1 month Infant1 to 12 months20-40 Toddler1 to 3 years20-30 Preschooler4 to 5 years20-30 School-age child 6 to 12 years16-30 Adolescent13 to 18 years

14 Breathing Higher oxygen demand per kilogram of body weight –About twice that of an adolescent or adult Smaller lung oxygen reserves Increased risk of hypoxia with apnea or ineffective bag-mask ventilation 44-14

15 Circulation Infants and child have a blood volume of about 80 mL/kg –Serious volume loss: Child – sudden loss of 1/2 L (500 mL) Infant – sudden loss of mL 44-15

16 Normal Heart Rates in Children at Rest Life StageAgeBeats per Minute NewbornBirth to 1 month Infant1 to 12 months Toddler1 to 3 years Preschooler4 to 5 years School-age child 6 to 12 years Adolescent13 to 18 years

17 Blood Pressure Measure the blood pressure (BP) in children older than 3 years of age The BP of a child is normally lower than that of an adult 44-17

18 Blood Pressure Use the following formula to determine the lower limit of a normal systolic blood pressure in children 1 to 10 years of age: Systolic Pressure= 70 + (2 X child’s age in years) 37-18

19 Metabolism and Temperature Regulation Limited glucose stores Sensitive to extremes of heat and cold – Large body surface area (BSA) when compared with weight Greater area of heat loss –Poorly developed temperature-regulating mechanisms 44-19

20 Skin Pale (whitish) –Shock, fright, anxiety Bluish (cyanotic) –Inadequate breathing or poor perfusion –Critical sign; requires immediate treatment Blotchy (mottled) –Shock, hypothermia, or cardiac arrest Flushed (red) –Fever, heat exposure, allergic reaction 44-20

21 Abdomen Abdominal muscles less developed –Situated more anteriorly –Provide less protection of rib cage Seemingly insignificant forces can cause serious internal injury Liver and spleen are proportionally larger –More frequently injured –Multiple organ injury common 44-21

22 Extremities Bones softer Growth plates of the bones are weaker than ligaments and tendons –Injury to the growth plate can result in differences in bone length Immobilize a sprain or strain because it is more likely a fracture 44-22

23 Assessment of Infants and Children 44-23

24 Scene Size-Up 44-24

25 Scene Size-Up In most situations, include the patient’s caregiver Watch the interaction between the caregiver and the child –Agitated caregiver = agitated child –Calm caregiver = calm child 44-25

26 Primary Survey General Impression Appearance (Work of) Breathing Circulation Sick or not sick? 44-26

27 Level of Responsiveness (Mental Status) An alert infant or young child (younger than 3 years of age) –Smiles –Orients to sound –Follows objects with her eyes –Interacts with those around her 44-27

28 Level of Responsiveness (Mental Status) Most children will be agitated or resist your assessment 44-28

29 Cervical Spine Protection Take spinal precautions if: –You suspect trauma to head, neck, or back –The child is unresponsive with an unknown nature of illness 44-29

30 Airway If child’s airway is open, check breathing If the airway is not open, listen for sounds of an airway problem –Snoring –Gurgling 44-30

31 Airway Sniffing position 44-31

32 Airway Tripod position 44-32

33 Airway If unresponsive, open the airway: –If no trauma is suspected, use the head tilt-chin lift maneuver –if trauma is suspected, use the jaw thrust without head tilt 44-33

34 Airway 44-34

35 Clearing the Airway Recovery position Finger sweeps Suctioning 44-35

36 Airway Adjuncts Oral airway Nasal airway 44-36

37 Breathing Observe the chest and abdomen Count the ventilatory rate 44-37

38 Circulation Compare central and peripheral pulses If no pulse, or if a pulse is present but the rate is less than 60 beats/min with signs of shock, begin chest compressions Control severe bleeding, if present 44-38

39 Common Problems in Infants and Children 44-39

40 Airway Obstructions Most episodes of choking in infants and children occur during eating or play 44-40

41 Airway Obstructions Complete airway obstruction –Patient is unable to speak, cry, cough, or make any other sound Partial airway obstruction –Patient has noisy breathing 44-41

42 Airway Obstructions Signs of a partial obstruction with poor air exchange may include: –Weak, ineffective cough that sounds like gasping –High-pitched noise on inhalation (stridor) –Difficulty breathing or speaking –Turning blue (cyanosis) 44-42

43 Respiratory Emergencies Upper airway problems usually occur suddenly Lower airway problems usually take longer to develop 44-43

44 Respiratory Emergencies Three levels of severity: 1.Respiratory distress Increased work of breathing (respiratory effort) 2.Respiratory failure Patient becomes tired and can no longer maintain good oxygenation and ventilation Not enough oxygen in the blood and/or ventilation to meet the demands of body tissues 3.Respiratory arrest Patient stops breathing 44-44

45 Signs of Respiratory Distress Alertness, irritability, anxiousness, restlessness Noisy breathing Breathing rate faster than normal for the patient’s age Increased depth of breathing Nasal flaring Mild increase in heart rate Retractions Head bobbing See-saw ventilations (abdominal breathing) The use of neck muscles to breathe Changes in skin color 44-45

46 Signs of Respiratory Failure Sleepiness or agitation Combativeness Limpness; the patient may be unable to sit up without help A breathing rate is initially fast with periods of slowing and then eventual slowing An altered mental status A shallow chest rise Nasal flaring Retractions Head bobbing Pale, mottled, or bluish skin Weak peripheral pulses 44-46

47 Care of Respiratory Distress Place the patient in a position of comfort Reposition the patient’s airway for better airflow if necessary Give oxygen if indicated –Maintain an oxygen saturation level of 95% or higher The patient with asthma may need assistance using his metered-dose inhaler 44-47

48 Care of Respiratory Failure/Arrest Assist breathing with a bag-mask device Deliver each breath over 1 second Breathing rate: –12 to 20 breaths per minute –1 breath every 3 to 5 seconds Check pulse every few minutes 44-48

49 Cardiopulmonary Failure Respiratory failure + shock 44-49

50 Cardiopulmonary Failure Signs and Symptoms Mental status changes A weak ventilatory effort Slow, shallow breathing Pale, mottled, or bluish skin A slow pulse rate Weak central pulses and absent peripheral pulses Cool extremities Delayed capillary refill 44-50

51 Care of Cardiopulmonary Failure Make sure the patient’s airway is open Take spinal precautions as necessary Assist breathing –Bag-mask device Perform chest compressions if necessary 44-51

52 Possible Causes of Altered Mental Status Low blood oxygen level Head trauma Seizures Infection Shock Low blood sugar Drug or alcohol ingestion Abuse Fever Respiratory failure 44-52

53 Care of Patient with Altered Mental Status Scene size-up Perform a primary survey Make sure the patient’s airway is open Perform a physical exam Be prepared to suction If no trauma suspected, place patient in recovery position Comfort, calm, and reassure the patient Transport 44-53

54 Shock Common causes of shock in infants and children: –Diarrhea –Dehydration –Trauma –Vomiting –Blood loss –Infection –Abdominal injuries 44-54

55 Shock Signs and Symptoms Rapid ventilatory rate Pale, cool, clammy skin Weak or absent peripheral pulses Delayed capillary refill Decreased urine output Mental status changes Absence of tears, even when crying 44-55

56 Emergency Care of Shock Request ALS personnel Give oxygen Quickly control any bleeding, if present Shock position if no trauma If anaphylaxis, contact medical direction for epinephrine order Keep the patient warm Transport rapidly 44-56

57 Fever Common reason for infant or child calls Febrile seizures –Seizures caused by fever –Should be considered potentially life- threatening 44-57

58 Meningitis 44-58

59 Emergency Care of Fever Use personal protective equipment Remove excess clothing Be alert for seizures Treat for shock if indicated Begin cooling measures if instructed to do so by medical direction Transport 44-59

60 Seizures Common in children Should be considered potentially life- threatening May be brief or prolonged Assess for injuries that may have occurred during the seizure(s) 44-60

61 Seizures History Ask the following questions: –Is this the child’s first seizure? –If the child has a history of seizures, is he on a seizure medication? –Is this the child’s normal seizure pattern? –What did the caregiver do for the child during the seizure? –Could the child have ingested any medications, household products, or any potentially toxic item? –How long did the seizure last? –Does the child have a fever? 44-61

62 Care of Seizures Scene size-up Perform a primary survey Give oxygen if indicated Perform a physical exam Observe and describe seizure Comfort, calm, and reassure patient Protect the patient from injury 44-62

63 Emergency Care of Seizures Make sure the patient’s airway is open Place the patient in the recovery position if there is no possibility of trauma Do not restrain the patient Do not put anything in the patient's mouth Have suction available If patient is bluish, ensure the patient’s airway and assist breathing 44-63

64 Poisonings Ask questions –Who? –What? –Where? –When? –Why? –How? 44-64

65 Emergency Care of Poisonings Use personal protective equipment Follow proper decontamination procedures, if necessary Establish and maintain an open airway Give oxygen if indicated If ingested poison (and patient is awake), consult medical direction about giving activated charcoal If the patient is unresponsive or seizing, consult medical direction about checking the child’s blood sugar 44-65

66 Drowning Signs and Symptoms Altered mental status, seizures, unresponsiveness Coughing, vomiting, choking, or airway obstruction Absent or inadequate breathing Difficulty breathing Fast, slow, or absent pulse Cool, clammy, and pale or cyanotic skin Vomiting Possible abdominal distention 44-66

67 Emergency Care of Drowning Ensure scene safety Keep on scene time to a minimum Protect patient from temperature extremes Give oxygen if indicated Remove wet clothing, dry patient Begin CPR if indicated Transport 44-67

68 Sudden Infant Death Syndrome (SIDS) According to the National Institute of Child Health and Human Development, SIDS is: –Sudden and unexpected death of an infant that remains unexplained after: A thorough case investigation, including performance of a complete autopsy, Examination of the death scene, and Review of the clinical history 44-68

69 Sudden Infant Death Syndrome (SIDS) Most deaths occur between 2 and 4 months of age Occurs in apparently healthy infants Boys are affected more often than girls Most SIDS deaths occur at home Baby is often discovered in the early morning 44-69

70 Sudden Infant Death Syndrome (SIDS) Cause is not clearly understood Research is ongoing Number of deaths has decreased since

71 Common Physical Findings of SIDS Unresponsive baby who is not breathing and has no pulse Blue or mottled skin Frothy sputum or vomitus around the mouth and nose Underside of the baby’s body may look dark and bruised General stiffening of body (rigor mortis) may be present 44-71

72 Emergency Care of SIDS Attempt to resuscitate unless obvious signs of death are present –Check local protocol Find out the baby’s name –Refer to baby by name, not as the baby or it Avoid comments that might suggest the caregiver is to blame 44-72

73 Care of SIDS Provide emotional support to the caregiver If the baby is obviously dead, notify the caregiver Arrange for grief support Assess your own emotional needs 44-73

74 Questions? 44-74


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