Compiled from “Brady Emergency Care – Ninth Edition” 2001 Chapter 31 – Infants and Children

Assessment Pediatric Vital signs differ slightly from adults with typically higher pulse and respiration rates, and lower blood presssures. Younger patients may not be able to convey symptoms well making assessment more critical. Respiratory failure and shock can occur more easily in children and should be top of mind. Assess children with the assistance of parent or caregiver when possible.

Vital Signs – Respiration rates Newborn Infant (1-5 mos) mos – 5 yrs yrs15-30 Adolescent12-20 Note these are normal rates – conditions/stress may elevate these. Lower rates should prompt consideration of assisted ventilations.

Vital Signs – Pulse Rates Newborn Infant (1-5 mos) mos Toddler (1-3 yrs) Preschool (3-5 yrs) School age (6-10yrs) Adolescent (11-14)60-105

Vital Signs – Blood Pressure 3-5yrs yrs yrs Notes – BP rarely measured on children under 3 Above numbers are systolic. Diastolic is typically 2/3 systolic.

Respiratory Difficulty - Symptoms Stridor / crowing / grunting Muscle retractions in ribs/shoulders Flared nostrils Cyanosis Decreased or increased rate

Respiratory Difficulty - Treatment Treat with O2, maintain airway, consider blocked airway for young children. Ventilate at 20 breaths/min Use pediatric BVM – watch rise/fall – appropriate volume Position head neutral / sniffing position Small trachea / large tongue

Shock Causes dehydration infection trauma blood loss allergy poisoning Signs rapid respirations cold weak peripheral pulse decreased urine output altered mental status no tears when crying

Ventilate an infant and child mannequin.

Shock - Treatment Maintain Airway High flow O2 Keep warm Immediate transport Suction carefully – vegas nerve

Fever Various causes Cool cautiously

Seizures Various causes – History? Maintain airway Treat for shock Transport – Epilepsy patients or other history may defer transport.

Altered Mental Status Causes Poisoning Injury Illness Treatment Airway Treat for shock Transport (Immediate) – Diabetic deferral

Poisoning Determine substance if possible Call Medical Control (ER Doc on duty) or AMR Treatment Maintain airway Treat for shock Transport

Near Drowning Rule out causes Injuries Illness Treatment CPR Maintain airway Treat for hypothermia Treat for shock Treat any trauma

Trauma - Injury Patterns / anatomy Head – larger in proportion / lead with their head Chest – elastic ribs allow internal injuries with no outer signs Abdomen – belly breathers, watch abdomen for respirations

Burns Consider percentages of burned area – rule of nines. Sterile dry dressings Avoid hypothermia

Abuse and Neglect Psychological Neglect Physical Sexual

Physical Abuse Injury Patterns shaped welts swelling poorly/partially healed bruises high instance of broken bones or injuries bites burns

Determining Signs of Abuse Multiple visits for the same patient or siblings Past injuries – note back and buttocks Poorly healed wounds/fractures (i.e. no treatment received) Cigarette burns, bilateral burns, glove/stocking pattern. Caregiver responses: Different stories for the same injury Unconcerned Difficulty controlling anger Depression Refusal of transport / reluctant to give history

Physical Abuse – Treatments and Procedures Treat injuries as per protocols Document well Gather information in a passive manner DO NOT accuse or pass judgment DO report your suspicions to AMR staff and IC Verify documentation

Special Needs Children Tracheostomy tubes –obstruction, dislodged, bleeding. Suction tube, maintain airway Ventilators – maintain airway and manually ventilate as needed. Central IV line – infection, bleeding, clooted, cracked. Apply pressure and dress as needed. Gastric tubes – Assure airway, asses mental status – hypoglycemic Shunts – Maintain airway as necessary