Pediatrics

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45
Pediatrics
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Objectives

• Discuss how to approach the pediatric patient.
• Review the Pediatric Assessment Triangle and how
  to implement it with pediatrics.
• Discuss common pediatric pathologies and their
  corresponding management.

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Introduction

• Managing pediatrics requires
• Personal preparation
• EMS system preparation
• Hospital network system preparation

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Approach First Impression

• First impressions matter more to children.
• They don't have the experiences to make correct
  judgments.
• Get down to their level with the caregiver
  present.
• Assessment starts as soon as you arrive.

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Approach a young child on the childs level, with
the caregiver present.
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Parents and Caretakers

• Parents and caretakers know you are there to
  help.
• It doesn't mean they trust you.
• Gaining parent's trust will help in gaining the
  child's trust.

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Assessment

• Assessment of the pediatric patient differs from
  that of the adult patient.
• Rapid changes in anatomy, physiology, and
  cognitive ability.
• Vitals change during development.

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Assessment (contd)

• Pediatric Assessment Triangle
• Modifies traditional ABCs of airway-breathing-circ
  ulation to appearance-breathing-circulation.
• Outside APGAR, PAT allows for objective and
  reproducible evaluation of sick pediatrics.

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The Pediatric Assessment Triangle (PAT). (Used
with permission of the American Academy of
Pediatrics.) Source General Approach to
Pediatric Assessment
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Assessment (contd)

• Appearance
• Often the first clues to a problem are found in
  the appearance.
• TICLS mnemonic can help.
• Tone
• Interactiveness
• Consolability
• Look/Gaze
• Speech/Cry

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Assessment (contd)

• Breathing
• Ventilation needed for respiration.
• Respiration needed for energy and cellular
  activity.
• Pediatric respiratory system is ill-equipped to
  handle significant disturbances.

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Assessment (contd)

• Circulation
• Relationship of pump, pipes, and fluid.
• When one fails, the other two have to cover.
• Causes
• Volume loss
• Pump failure
• Low vascular tone
• IV versus IO access.

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Case Study

• You are called to the home of a 5-year-old child
  who reportedly fell off a climbing gym in his
  back yard, and now has abdominal pain. The
  parents are gone and the child is in the care of
  the babysitter.

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Case Study (contd)

• Scene Size-Up
• Standard precautions taken.
• Scene is safe, no entry or egress problems.
• 5-year-old male, about 40-45 pounds.

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Case Study (contd)

• Scene Size-Up
• Patient found sitting under tree in back yard.
• MOI is fall from a jungle gym (fall lt5 feet).
• Parents on way home, per babysitter.

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Case Study (contd)

• Primary Assessment Findings
• Patient is responsive.
• Airway is clear.
• Breathing adequate, patient crying, calms with
  babysitter.

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Case Study (contd)

• Primary Assessment Findings
• Carotid pulse 120/min, peripheral pulse present.
• Peripheral skin warm and slightly diaphoretic.
• Good muscle tone.

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Case Study (contd)

• How would you characterize this patient according
  to PAT?
• What are the patient's life threats, if any?
• What care should be administered immediately?

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Case Study (contd)

• Medical History
• None per babysitter
• Medications
• None per babysitter
• Allergies
• None per babysitter

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Case Study (contd)

• Pertinent Secondary Assessment Findings
• Pupils reactive to light, membranes hydrated.
• Airway patent, patient breathing at 24/min.
• Central and peripheral pulses present, 90/minute.
• Skin is still warm, not as diaphoretic.

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Case Study (contd)

• Pertinent Secondary Assessment Findings
  (continued)
• Pulse ox 100 with low-flow oxygen.
• Patient markedly calmer, interacting
  appropriately.
• Abdomen is tender to lower quadrants, no
  bruising, guarding, nor rigidity.
• Parents arrive home and consent to transport.

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Case Study (contd)

• Is the child improving or deteriorating?
• Is there any additional treatment or change in
  treatment required?
• What is the likely underlying cause for the
  emergency?

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Case Study (contd)

• Care provided
• Patient immobilized supine, secured for
  transport.
• Low-flow oxygen.
• Transported with parent in front of ambulance.
• Nonemergent transport to the hospital.

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Summary

• Pediatric emergencies can be stressful for the
  provider, the parent, and the child.
• Approach to treatment of the pediatric patient
  should follow the PAT (Pediatric Assessment
  Triangle).
• Interventions should be provided based upon need,
  and in concert with the patient and/or parents if
  possible.