1. 1 Ch. 22-Pediatric and Geriatric Emergencies

2. 2 22.1 Assessing the Child Special Assessment Techniques Special Assessment Techniques Does the child look sick? Does the child look sick? Is the child in shock? Is the child in shock? Is the child in extreme pain? Is the child in extreme pain? How is the child breathing? How is the child breathing?

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4. 4 Obtaining a History Do not let upset parents and a screaming child unnerve you; take the time you need to get the information you need. Do not let upset parents and a screaming child unnerve you; take the time you need to get the information you need. Get information from parents or other witnesses, not the child. Get information from parents or other witnesses, not the child. Ask when symptoms developed, how they progressed, and what care has already been given. Ask when symptoms developed, how they progressed, and what care has already been given. If there was an accident, determine the details of the accident, the mechanism of injury, and what first aid care has already been given. If there was an accident, determine the details of the accident, the mechanism of injury, and what first aid care has already been given.

5. 5 Taking Vital Signs Respirations Respirations Pulse Pulse Temperature Temperature Neurological assessment Neurological assessment

6. 6 PROGRESS CHECK 1. When assessing a child, you should position yourself ____________. (above the child/below the child/at the child’s eye level) 2. During assessment, check the most painful part ____________. (quickly/last/first) 3. You should check a child’s vital signs more ____________ than you do an adult’s. (frequently/thoroughly/quickly) 4. A child breathes ____________ than an adult. (slower/faster/more deeply) 5. Check a child’s respiratory rate by placing your hand on the child’s ____________. (chest/stomach/back) 6. Take an infant’s pulse at the ____________ pulse. (carotid/radial/brachial)

7. 7 Vocabulary Croup- A viral infection that causes swelling beneath the glottis and progressive narrowing of the airway Croup- A viral infection that causes swelling beneath the glottis and progressive narrowing of the airway Epiglottitis- A bacterial infection that causes swelling of the epiglottis and blocking of the airway Epiglottitis- A bacterial infection that causes swelling of the epiglottis and blocking of the airway Sudden infant death syndrome (SIDS)- Sudden death of an apparently healthy infant, usually while asleep Sudden infant death syndrome (SIDS)- Sudden death of an apparently healthy infant, usually while asleep

8. 8 Asthma care includes: 1. Allow the child to assume the position of greatest comfort— almost always sitting or semisitting. Additionally, give an asthma victim plenty of fluids, which help loosen and thin mucus in the air passages. 2. Be calm and reassuring. 3. Activate the EMS system or take the child to a medical facility. 4. If allowed as part of your training, assist the patient with his/her inhaler. Even retrieving an inhaler and bringing it to the patient is valuable.

9. 9 Cardiac Arrest The signs and symptoms of cardiac arrest in a child include: Unresponsiveness Unresponsiveness Seizure (early in onset of arrest due to hypoxia) Seizure (early in onset of arrest due to hypoxia) Gasping or absent respiratory sounds Gasping or absent respiratory sounds Absence of chest movement Absence of chest movement Pale or blue skin Pale or blue skin Absent pulse Absent pulse

10. 10 Seizures 1. Turn the child onto his or her side to prevent the tongue from relaxing and shifting backward, blocking the air passage. 2. Do not hold the child down, but place the child where he or she will not fall or strike something. A rug on the floor is excellent; so is a crib with padded sides. 3. Loosen tight or restrictive clothing. 4. Sponge a feverish child with lukewarm water.

11. 11 Shock The signs and symptoms of shock in a child include: Paleness Paleness Cold, moist skin Cold, moist skin Low blood pressure Low blood pressure A rapid, thready pulse A rapid, thready pulse Lack of vitality Lack of vitality Extreme anxiety Extreme anxiety Unconsciousness Unconsciousness *To care for shock, activate the EMS system, have the child lie flat, keep the child warm and as calm as possible, and monitor vital signs frequently.

12. 12 PROGRESS CHECK 1. Injuries of the extremities in a child can also damage the ____________. (bone marrow/growth plates/large ball-and-socket joints) 2. An infant has a proportionally large ____________, which can block the airway. (tongue/epiglottis/larynx) 3. Most children involved in trauma have an enlarged ___________, which can interfere with breathing. (tongue/larynx/stomach) 4. A characteristic “seal bark” cough is a sign of ____________. (asthma/croup/epiglottitis) 5. A child who is drooling, having difficulty speaking, and having difficulty swallowing probably has _________. (asthma/croup/epiglottitis) 6. Seizures in a child can be caused by _________, which rarely causes seizures in an adult. (head injury/oxygen deficiency/fever) 7. ____________, which does not usually cause shock in older victims, can cause shock in an infant. (Blood loss/Loss of body heat/Major trauma)

13. 13 Sudden Infant Death Syndrome 1. Even if the child is obviously dead, have someone activate the EMS system and immediately begin infant CPR. 2. Be aware of the parents’ extreme distress; the best first aid is to make them feel that everything possible has been done for their child. Leave no room for “ifs” and “maybes.” Parents will often feel guilt. Be careful not to make judgmental statements that add to guilt. 3. After the ambulance arrives, encourage the parents to accompany their baby in the ambulance and arrange for someone to stay with other children at the home.

14. 14 Identifying Child Abuse The child is fretful, frightened of parents, afraid to go home, wary of adults, or apathetic (a child who does not cry, despite injuries) The child is fretful, frightened of parents, afraid to go home, wary of adults, or apathetic (a child who does not cry, despite injuries) Abrasions, lacerations, incisions, bruises, broken bones, or multiple injuries in various stages of healing Abrasions, lacerations, incisions, bruises, broken bones, or multiple injuries in various stages of healing Injuries on both the front and the back or on both sides Injuries on both the front and the back or on both sides Unusual wounds, such as circular burns Unusual wounds, such as circular burns Injuries to the head, back, and abdomen, including the genitals Injuries to the head, back, and abdomen, including the genitals Pain, itching, bruises, or bleeding in the genital, vaginal, or anal areas Pain, itching, bruises, or bleeding in the genital, vaginal, or anal areas Injuries that do not match the mechanisms of injury described by the parents or caregivers Injuries that do not match the mechanisms of injury described by the parents or caregivers

15. 15 First Aid Care for Child Abuse 1. Calm the parents; let them know by your actions that you are there to help and render first aid care. Speak in a low, firm voice. 2. Focus attention on the child; speak softly to the child, using the first name. Never ask the child to recreate the situation while in the crisis environment or with the suspected abuser still present. 3. Conduct a thorough, head-to-toe exam; care for injuries appropriately. 4. It is not your responsibility to confront any adult with the charge of child abuse; be supportive and nonjudgmental while at the scene. 5. Always report your suspicions of child abuse to the proper authorities, and maintain total confidentiality with others regarding the incident.

16. 16 PROGRESS CHECK 1. Sudden infant death syndrome occurs when an apparently ____________ infant dies while sleeping. (distressed/healthy/ill) 2. Even if a victim of SIDS is obviously dead, you should ____________. (begin infant CPR/treat for shock/do a primary survey) 3. An abuser often shows ____________ toward the child. (compassion/guilt/hostility) 4. Suspect child abuse if the child is ____________. (frightened of parents/clinging to parents/affectionate to parents) 5. If you suspect child abuse, you should _________. (confront the parents at the scene/report your suspicions to authorities/ask the child to confirm your suspicions)

17. 17 Differing Signs and Symptoms In myocardial infarction: Pain is less common. Pain is less common. Aching shoulders and indigestion are common. Aching shoulders and indigestion are common. The most common symptoms are shortness of breath, fatigue, and anxiety. The most common symptoms are shortness of breath, fatigue, and anxiety. In congestive heart failure: Little or no dyspnea is present. Little or no dyspnea is present. In pneumonia: Fever is usually absent (it is a classic sign of pneumonia in other age groups). Fever is usually absent (it is a classic sign of pneumonia in other age groups). Chest pain is much less common. Chest pain is much less common. Cough is much less common. Cough is much less common.

18. 18 Special Assessment Considerations The elderly become debilitated much more rapidly; a minor problem can become major within a few hours. The elderly become debilitated much more rapidly; a minor problem can become major within a few hours. The victim may be taking a number of medications. The victim may be taking a number of medications. As many as one in four elderly have psychiatric disorders, which can be the cause of some symptoms (such as clouding of consciousness). As many as one in four elderly have psychiatric disorders, which can be the cause of some symptoms (such as clouding of consciousness). It can be difficult to separate the effects of aging from the consequences of disease. It can be difficult to separate the effects of aging from the consequences of disease. The victim’s chief complaint may seem trivial. The victim’s chief complaint may seem trivial. The victim may fail to report important symptoms. The victim may fail to report important symptoms. The geriatric victim is likely to suffer from more than one disease at a time. The geriatric victim is likely to suffer from more than one disease at a time. Aging may change the victim’s response to illness and injury, causing you to underestimate the severity of the victim’s condition. Aging may change the victim’s response to illness and injury, causing you to underestimate the severity of the victim’s condition.

19. 19 Special Examination Considerations The victim may be fatigued easily. The victim may be fatigued easily. The victim may be wearing several layers of clothing. The victim may be wearing several layers of clothing. You need to explain actions clearly before assessing the elderly victim. You need to explain actions clearly before assessing the elderly victim. The victim may minimize or deny symptoms out of fear of being bedridden or institutionalized or of losing a sense of self-sufficiency. The victim may minimize or deny symptoms out of fear of being bedridden or institutionalized or of losing a sense of self-sufficiency.

20. 20 Special Trauma Considerations They may have slower reflexes, failing eyesight and hearing, arthritis, less elastic blood vessels, and fragile tissues and bones. They may have slower reflexes, failing eyesight and hearing, arthritis, less elastic blood vessels, and fragile tissues and bones. They are at higher risk for trauma from criminal assault. They are at higher risk for trauma from criminal assault. They are prone to head injury, even from relatively minor trauma; signs and symptoms of brain compression develop more slowly, sometimes over days or weeks. They are prone to head injury, even from relatively minor trauma; signs and symptoms of brain compression develop more slowly, sometimes over days or weeks. They often have a significant degree of degenerative disease of the cervical vertebrae, which can gradually compress the roots of nerves to the arms or possibly to the spinal cord itself. Sudden neck movement, with or without fracture, can cause spinal cord injury. They often have a significant degree of degenerative disease of the cervical vertebrae, which can gradually compress the roots of nerves to the arms or possibly to the spinal cord itself. Sudden neck movement, with or without fracture, can cause spinal cord injury.

21. 21 PROGRESS CHECK PROGRESS CHECK 1. ____________ is less common in elderly victims of myocardial infarction. (Pain/Indigestion/Shortness of breath) 2. There is usually little or no ____________ in elderly victims of congestive heart failure. (edema/cyanosis/dyspnea) 3. ____________, a classic sign of pneumonia, is usually absent in the elderly. (Weakness/Pain/Fever) 4. Signs or symptoms may be masked in elderly victims because they usually ____________. (take multiple medications/ are immobile/have failing eyesight)