2. pediatrics Pediatric Patients & Emergencies

3. pediatrics Family Matters l When a child is ill or injured, you may have several patients, not just one. l Children mimic caregiver behavior l Be calm, professional, and sensitive.

4. pediatrics Anatomic Differences l Less circulating blood l Lose body heat more easily l Bones are more flexible l Less fat surrounding organs l Could be much internal damage with little external visible trauma

5. pediatrics Skeletal Differences l Bones are prone to fracture with stress. l Infants have two openings in the skull called fontanels. –close by 18 months.

6. pediatrics 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.

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

8. pediatrics Circulation Differences l The heart rate increases for illness and injury l Very effective vasoconstriction keeps vital organs nourished l Pale, extremities, decreased cap refill are early signs of perfusion problems

9. pediatrics Approach to Assessment level of activity, work of breathing, and skin color level of activity, work of breathing, and skin color l cap refill l ALS backup or immediate transport? l Pediatric patients crash harder than adults l Transport to peds facilities when possible

10. pediatrics Capillary Refill

11. pediatrics Treatment Considerations l Oxygen - treat same as adult – Use “blow-by” administration if needed l Patient position - same as adult l *Remember* airway and breathing are focus

12. pediatrics Growth and Development l Usually grouped into stages – Infant – Toddler – Preschool – School-age – Adolescent

13. pediatrics Infant l first year of life l respond physical stimuli l crying is main means of expression l have caregiver hold pt

14. pediatrics Toddler l 1 to 3 years of age l mobile l may resist separation l don’t like being restrained l can be distracted

15. pediatrics Preschool l 3 to 6 years of age l can understand directions l can identify painful areas l fearful of pain l allow them to handle equipment l explain what you are going to do

16. pediatrics School-Age Child l 6 to 12 years of age l begin to think like adults l can be included when taking medical history l should be familiar with physical exam l allow them to make choices when possible

17. pediatrics The Adolescent l 12 to 18 years of age l concerned about body image l may have strong feelings about being observed l respect their privacy l they understand pain l explain any procedure

18. pediatrics Notes l never lie to a child

19. pediatrics Vital Signs

20. pediatrics Respirations l Abnormal respirations are a common sign of illness or injury l Less than 3, count rise and fall of abdomen l Note effort of breathing/noises l Note if they are crying

21. pediatrics Respiration Notes l Less than 12 breaths/min l More than 60 breaths/min, l ALOC and/or an inadequate tidal volume = ventilation with a BVM device

22. pediatrics Pulse l Infants -brachial or femoral l Child- use carotid l Count at least 1 minute l Note strength

23. pediatrics Blood Pressure l Use right size cuff l Difficult scene? Don’t waste time l Under 3? No BP

24. pediatrics Skin Signs l important sign l feel for temperature and moisture l always check capillary refill

25. pediatrics Pediatric Problems

26. pediatrics Fever –Common Causes l Infections l Neoplasm (cancer) l Drug ingestion l Collagen vascular disease l High environmental temperatures

27. pediatrics Emergency Care for Fever l Ensure BSI l Begin passive cooling –Remove clothing/coverings –Damp towels l No ice l No alcohol l No cold water baths

28. pediatrics Febrile Seizures l common in children 6 months to 6 years l most caused by high fever l hx of infection l generalized grand mal seizure l less than 15 minutes

29. pediatrics Treatment l ABC’s l protect patient l recovery position l high flow oxygen l suction prn l passive cooling measures l transport

30. pediatrics Dehydration l Dry lips and gums l Fewer wet diapers l Sunken eyes l Poor skin turgor l Sleepy or irritable l Sunken fontanels

31. pediatrics Care for Dehydration l Assess the ABCs l Obtain baseline vital signs l ALS backup may be needed for IV administration

32. pediatrics Airway Obstruction l Croup –An infection of the airway below the level of the vocal cords, caused by a virus l Epiglottitis –Infection of the soft tissue in the area above the vocal cords l Foreign body Aspiration

33. pediatrics Croup l barking cough l stridor l wheezing l rales l accessory muscle use l nasal flaring l grunting

34. pediatrics Epiglottitis l severe dyspnea l stridor l inability to swallow - DROOLING l fever l tripod position

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37. pediatrics Foreign body aspiration l Partial Blockage –coughing –accessory muscle use –nasal flaring –wheezing l Complete Blockage - no sound - no cry - stridor - cyanosis - loss of consciousness

38. pediatrics treatment l ABC’s l high flow oxygen l position of comfort do not attempt to visualize the throat! do not put anything into patient’s mouth.

39. pediatrics Asthma l dyspnea l wheezing l accessory muscle use l nasal flaring l respiratory rate - observe

40. pediatrics Treatment l ABC’s l high flow oxygen l position of comfort l transport

41. pediatrics What is the most frequent cause of cardiac arrest in pediatrics?

42. pediatrics Respiratory arrest !

43. pediatrics want to save a pediatric patient? aggressive ventilation & high flow oxygen

44. pediatrics USC video! Pediatric respiratory distress

45. pediatrics Meningitis l Inflammation of meninges l Bacterial or viral l Permanent brain damage/death

46. pediatrics Signs and Symptoms of Meningitis l Fever l ALOC l Headache l Seizure l Stiff neck l Vomiting l Photophobia l Irritability l Bulging fontanel

47. pediatrics Neisseria meningitidis l rapid onset l pinpoint cherry-red spots or larger purple/black rash l sepsis, shock, and death l all suspected cases considered contagious

48. pediatrics Treatment l BSI l ABC’s l protect patient l high flow oxygen l passive cooling for fever l monitor for shock l Transport l Call ALS for backup if unstable

49. pediatrics Submersion Injury l Drowning or near drowning l Second most common cause of unintentional death l ABC’s l May be in respiratory or cardiac arrest l C-spine precautions? l Be ready to suction l Keep warm

50. pediatrics Poisoning l Poisoning is common in children l Ask specific questions of caregivers l Focus on the ABCs l Give oxygen l Provide transport l Child’s condition could change at any time

51. pediatrics Pediatric Resuscitation Tape Measure (Aka: Broslow tape) l Used to determine height, weight, and proper equipment.

52. pediatrics Interossius IV l Used if traditional IV sites are difficult to assess l Medication delivered into bone marrow l Painful

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55. pediatrics Transporting Infants and Children l Children require padding under the torso l Newborns should be in special incubators l Do not hold child during the actual transport l Drive with due care l Do not allow your emotions to take control

56. pediatrics Sudden Infant Death Syndrome SIDS - “crib death”

57. pediatrics SIDS l Definition - unexplained death of an apparently healthy infant. l 7500+ cases per year in U.S. l Leading cause of death in infants <1 year old l more cases in winter months

58. pediatrics Sudden Infant Death Syndrome (SIDS) l Several known risk factors: –Mother younger than 20 years old –Mother smoked during pregnancy –Low birth weight –Putting babies to sleep on stomach –Siblings of SIDS babies

59. pediatrics Tasks at Scene l Assess and manage patient l Communicate with and support the family l Assess the scene

60. pediatrics Assessment and Management l Diagnosis of exclusion l Can be other causes of condition l Regardless of cause, TX is same l Infant may have signs of postmortem changes l It is ok to work up an obviously dead baby l If no postmortem changes, begin CPR immediately

61. pediatrics Communication and Support of Family l The death of child is very stressful for the family l Parents guilt is overwhelming l Provide support in whatever ways you can l IT IS NOT YOUR PLACE TO JUDGE l Use the infant’s name l Allow family time with the infant

62. pediatrics Scene Assessment l Inspect the environment, noting: –Signs of illness, including medications –General condition of the house –Family interaction –Site where infant was discovered

63. pediatrics Support Groups l Know your local phone numbers for referrals l Arrange for proper debriefing

64. pediatrics Child Abuse l Any improper or excessive action that injures or harms a child or infant l physical, sexual, emotional abuse and neglect l More than 2 million cases reported annually l Be aware of signs of child abuse and report it to authorities

65. pediatrics Questions Regarding Signs of Abuse (1 of 4) l Is the injury typical? l Is reported method of injury consistent with injuries? l Is the caregiver behaving appropriately? l Is there evidence of drinking or drug abuse?

66. pediatrics Questions Regarding Signs of Abuse (2 of 4) l Delay in seeking care? l Good relationship between child and caregiver? l Multiple injuries at various stages of healing? l Any unusual marks or bruises?

67. pediatrics Questions Regarding Signs of Abuse (3 of 4) l Are there several types of injuries? l Any burns on the hands or feet involving a glove distribution? l Unexplained decreased level of consciousness?

68. pediatrics Questions Regarding Signs of Abuse (4 of 4) l Is the child clean and an appropriate weight? l Any rectal or vaginal bleeding? l What does the home look like?

69. pediatrics Other Indicators l Withdrawn, fearful or hostile child l Refusal to discuss MOI l History of “accidents” l Conflicting stories l Caregiver lack of concern

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77. pediatrics Emergency Medical Care l ABCs l Transport if you suspect child abuse l Do not make accusations l EMT-Bs must report all suspected cases of child abuse

78. pediatrics Sexual Abuse l Children of any age or either gender can be victims l Limit examination l Do not allow child to wash, urinate, or defecate l Document carefully l Transport

79. pediatrics EMS Response to Pediatric Emergencies l You may experience a wide range of emotions l You may feel anxious l Practice helps l After difficult incidents, a debriefing may be helpful

80. pediatrics stop questions?