Chapter 39 Pediatric Medical Emergencies

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Normal Childhood Development  General Considerations  Airway Problems  Hypoperfusion

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3 Overview  Cardiac Arrest  SIDS  Altered Mental Status  Stress in Caring for Children

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4

5 Normal Childhood Development  Neonate: 0 to 1 month old –Allow mother to hold child during assessment –Common illnesses: jaundice, vomiting, respiratory distress, fever –Congenital birth defects begin to appear

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 6  Young infant: 1 to 5 months old –Growing rapidly and becoming increasingly aware of the surrounding environment –Common illnesses: SIDS, vomiting, diarrhea, meningitis, child abuse, accidents Normal Childhood Development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7  Young infant: 1 to 5 months old –Make slow movements and use gentle handling –Keep covered as much as possible Normal Childhood Development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8  Older infant: 6 to 12 months old –Becoming more active and walking –Exhibit stranger anxiety –Common illnesses: febrile seizures, vomiting, diarrhea, dehydration, bronchiolitis, MVCs, croup, child abuse, poisoning, falls Normal Childhood Development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9  Toddler: 1 to 3 years old –Constantly moving, becoming more independent –Needs encouragement and reassurance –May believe illness is punishment Normal Childhood Development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 10  Toddler: 1 to 3 years old –Take a toe-to-head approach –Common illnesses: MVCs, vomiting, diarrhea, febrile seizures, ingestions, falls, child abuse, croup, meningitis, FBAO Normal Childhood Development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11  Preschooler: 3 to 5 years old –Play is more sophisticated –Very attached to parents and possessions –Explain in simple and honest terms –Common illnesses: croup, asthma, ingestions, MVCs, burns, child abuse, FBAO, drownings, epiglottitis, febrile seizures, meningitis Normal Childhood Development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12  School age: 6 to 12 years old –Growing quickly and very active –Increase in injuries –Get as much history information for child as possible –Common emergencies: drowning, motor vehicle collisions, bicycle accidents, fractures, falls, sports injuries, child abuse, burns Normal Childhood Development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13  Adolescent: 12 to 15 years old –Body image is very important –Peers are very important –Risk taking behavior is common –Common illnesses: mononucleosis, asthma, motor vehicle collisions, sports injuries, suicide gestures, sexual abuse, pregnancy Normal Childhood Development

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Stop and Review  What are the developmental differences among the various age groups of children?  What are the anatomical differences between children and adults?  What is a child’s typical response to illness?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 General Considerations  Initial approach –Place yourself at eye level with child –Introduce yourself to both child and parent –Explain why you are there

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 16 General Considerations  Gathering a history –Alter technique based upon age –Question the child in a friendly manner –Ask the parent for confirmation

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 General Considerations  Performing a physical examination –Carefully observe the child –The child’s behavior can tell a lot about how she is feeling –Try to gain child’s confidence –Anything that may cause pain should be done last

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Stop and Review  What are some techniques for assessment and examination in children of various developmental ages?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Airway Problems  Foreign body airway obstruction –May be complete or partial obstruction –Open the airway and check for breathing –Reposition the airway

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Airway Problems  Foreign body airway obstruction –For an infant, provide back blows and chest thrusts –For an older child, perform the Heimlich maneuver

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Trouble Breathing  Croup –Viral illness causes swelling of the airways –Fall and winter are prime times –Lasts several days

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Trouble Breathing  Croup –Harsh sounding cough –Worse at night than in the day –Humidified oxygen and transport

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 23 Trouble Breathing  Epiglottitis –Bacterial infection –Inflammation of the epiglottis causes airway obstruction –Sudden fever, brassy cough, and sore throat –Ventilate and transport to the nearest hospital

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Pediatric Asthma  Asthma –Reversible spasm of smaller airways –Wheezing –Child works harder to breathe –May have a bronchodilating medication

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Pediatric Asthma  Upper respiratory infection –Inflammation and secretions

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 Hypoperfusion  The most common cause is large fluid loss from dehydration due to vomiting, diarrhea or blood loss  Tachycardia, pale skin, delayed capillary refill, nausea  Will progress to altered mental status and a fall in blood pressure

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 27 Cardiac Arrest  Most common cause is respiratory arrest  Respiratory failure leads to hypoxia, which leads to cardiac failure and cardiac arrest  100% oxygen and chest compressions

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 SIDS  Leading cause of death in children one week to one year in age  Usually occurs during sleep; more frequent in winter months  Cause of death is unknown

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29 Altered Mental Status  Seizures –The most common are febrile seizures brought on by a rapid increase in body temperature –Attend to the ABCs, undress the child, wipe with moist cloths, fan the child

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 30 Altered Mental Status  Diabetes –The result of altered glucose utilization –If conscious, provide sugar by mouth –If unconscious, transport immediately

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 31 Altered Mental Status  Behavioral –If the altered mental status is the result of a behavioral disorder, there will generally be a history of similar episodes

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 32 Altered Mental Status  Poisoning –Signs include spilled bottle of chemical or medications, a smell on the breath, discoloration of mouth or lips, or vomitus with pill fragments or a chemical smell –Maintain airway and breathing, then follow local protocol

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 33 Altered Mental Status  Infections –Colds, flu, gastroenteritis, strep throat, mononucleosis, chicken pox –Most are not life threatening –Meningitis affects the brain and is very serious

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 34 Stress in Caring for Children  Child –The illness is frightening, but the examination by a stranger can be even more so –Try to put the child at ease by being calm and honest

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 35 Stress in Caring for Children  Family –Allow to participate in care of child –Keep informed of what is going on –If the parent cannot be calmed, separate her from the child

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 36 Stress in Caring for Children  Provider –Often invokes feelings of fear or anxiety –After the call, talk about feelings with coworkers

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 37 Stop and Review  How are airway emergencies handled?  How are respiratory emergencies treated?  How is hypoperfusion in children handled?  What is the most common cause of cardiac arrest?  How is altered mental status managed in a child?