PEDIATRICS…... more than just little people

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.

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

Circulation Differences The heart rate increases for illness and injury. Vasoconstriction keeps vital organs nourished. Constriction of the blood vessels can affect blood flow to the extremities.

Skeletal Differences Bones are weaker and more flexible. They are prone to fracture with stress. Infants have two small openings in the skull called fontanels. Fontanels close by 18 months.

Growth and Development Thoughts and behaviors of children usually grouped into stages Infancy Toddler years Preschool age School age Adolescence

Infant First year of life They respond mainly to physical stimuli. Crying is their main avenue of expression. They may prefer to be with caregiver. If possible, have caregiver hold the infant as you start your examination.

Toddler 1 to 3 years of age They begin to walk and explore the environment. They may resist separation from caregivers. Make any observations you can before touching a toddler. They are curious and adventuresome.

Preschool 3 to 6 years of age They can use simple language effectively. They can understand directions. They can identify painful areas when questioned. They can understand what you are going to do using simple descriptions. They can be distracted by using toys.

School-Age Child 6 to 12 years of age They begin to think like adults. They can be included with the parent when taking medical history. They may be familiar with physical exam. They may be able to make choices.

The Adolescent 12 to 18 years of age They are very concerned about body image. They may have strong feelings about being observed. Respect an adolescent’s privacy. They understand pain. Explain any procedure that you are doing.

Approach to Assessment Obtain a complete set of baseline vitals. Assess the need for ALS backup or immediate transport. A child’s condition may deteriorate rapidly during transport. Have pediatric resuscitation equipment ready.

Vital Signs by Age

Appearance Breathing Pediatric Triangle The Pediatric Triangle Circulation/Skin Color

Appearance Look at the patient from across the room… …this is an important indicator of oxygenation, brain perfusion, and overall CNS function

Appearance Alertness Eye contact Distractibility Consolability Speech/Cry Spontaneous motor activity

Sick or Not Sick!

Breathing Abnormal body position Audible or abnormal airway sounds Retractions Effort/work of breathing

Breathing A child with abnormal breath sounds needs high flow oxygen and immediate ALS intervention!

Sick or Not Sick?

Circulation & Skin Signs Color Temperature Capillary refill time Pulse quality

Skin Signs Feel for temperature and moisture. Estimate capillary refill.

Pulse In infants, feel over the brachial or femoral area. In older children use the carotid artery. Count for at least 1 minute. Note strength of the pulse.

Blood Pressure Use a cuff that covers two thirds of the arm. If scene conditions make it difficult to measure blood pressure accurately, do not waste time trying.

Circulation & Skin Signs Poor color equals… poor circulation… equals… SICK!

DECIDE SICK NOT SICK Appearance Breathing Circulation/Skin Color Pediatric Triangle Short Report to ALS Short Report to ALS 100% O2 NRM or BVM Focused Hx/ Physical Exam Appropriate Position Rapid Trans- port/ALS Detailed Physical Exam Ongoing Assess Keep Warm *Rapid medical assessment *Baseline vitals *SAMPLE history Focused Hx/ Physical Exam Appropriate Treatment Appropriate Transport Detailed Physical Exam Low/Moderate Flow O2 *Focused medical assessment *Baseline vitals *SAMPLE history *OPQRST Ongoing Assess Keep Warm Medical Patients

DECIDE SICK NOT SICK Appearance Breathing Circulation/Skin Color Pediatric Triangle Short Report to ALS Short Report to ALS 100% O2 NRM or BVM Focused Hx/ Physical Exam Appropriate Position Rapid Trans- port/ALS Detailed Physical Exam Ongoing Assess Keep Warm *Rapid medical assessment *Baseline vitals *SAMPLE history Focused Hx/ Physical Exam Appropriate Treatment Appropriate Transport Detailed Physical Exam Low/Moderate Flow O2 *Focused medical assessment *Baseline vitals *SAMPLE history *OPQRST Ongoing Assess Keep Warm Medical Patients

DECIDE SICK NOT SICK Appearance Breathing Circulation/Skin Color Pediatric Triangle Short Report to ALS Short Report to ALS Rapid Extrication Focused Hx/ Physical Exam Spinal Immobilization Rapid Trans- port/ALS Detailed Physical Exam *Rapid trauma assessment *Baseline vitals *SAMPLE history Focused Hx/ Physical Exam Detailed Physical Exam Appropriate Transport Extricate/ Immobilize Low/Moderate Flow O2 *Focused trauma assessment *Baseline vitals *SAMPLE history 100% O2 NRM or BVM Spinal Stabilization Ongoing Assess Keep Warm Trauma Patients

DECIDE SICK NOT SICK Appearance Breathing Circulation/Skin Color Pediatric Triangle Short Report to ALS Short Report to ALS Rapid Extrication Focused Hx/ Physical Exam Spinal Immobilization Rapid Trans- port/ALS Detailed Physical Exam *Rapid trauma assessment *Baseline vitals *SAMPLE history Focused Hx/ Physical Exam Detailed Physical Exam Appropriate Transport Extricate/ Immobilize Low/Moderate Flow O2 *Focused trauma assessment *Baseline vitals *SAMPLE history 100% O2 NRM or BVM Spinal Stabilization Ongoing Assess Keep Warm Trauma Patients

Sick or Not Sick? Make a decision within 60 seconds!

Children With Special Needs Children born prematurely who have associated lung problems Small children or infants with congenital heart disease Children with neurologic diseases Children with chronic diseases or with functions that have been altered since birth

Tracheostomy Tube

Artificial Ventilators Provide respirations for children unable to breathe on their own If ventilator malfunctions, remove child from the ventilator and begin ventilations with a BVM device. Ventilate during transport.

Central IV Lines

Gastrostomy Tubes

Shunts Tubes that drain excess fluid from around brain If shunt becomes clogged, changes in mental status may occur. Patient may go into respiratory arrest.

Remember, family does matter… When a child is ill or injured, you may have several patients, not just one. Children often mimic the behavior of their caregivers. Be calm, professional, and sensitive.

Thanks for all that you do!