Pediatric and Geriatric Emergencies

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Pediatric and Geriatric Emergencies

• Chapter 22

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Assessing the child

• Not small adults!
• Less blood
• Faster heart rates
• Immature temperature regulation
• Head is larger
• Smaller airways
• Faster respiration
• Easy dehydration
• Must also deal with the PARENTS

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Special assessment techniques

• Children
• Lack body awareness to locate pain
• Lack vocabulary to describe pain
• Confidence and friendliness
• Dont like strangers
• Eye level
• Save painful examination to the end
• Include parents in the exam
• Be honest and gentle
• Vital sign differences
• Respiration
• Pulse
• Temperature

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Emergencies in children

• Managed same way as adults
• Head and c-spine injury likely
• Internal organs susceptible to trauma
• Large skin surface
• Injuries to growth plates
• Abdominal trauma can compromise diaphragm
• Smaller blood volume
• Airway obstruction

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Sudden infant death syndrome

• SIDS
• 1 cause of death (4 weeks to 7 months)
• Cannot be predicted or prevented
• Likely causes
• Sleep apnea
• Irregular heart rhythm
• Altered brain activity
• Low blood oxygen level
• Care
• EMS
• Begin CPR

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Child abuse and neglect

• Thousands of cases each year
• Identifying abuse
• Who is the abuser?
• What types of abuse?
• How does the child act?
• What types of injuries are common?
• Unusual wounds
• Injuries that dont match the mechanism described
• Care
• Dont confront the abusive adult
• Call police or report to your school/organization
  authorities

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Geriatric emergencies

• Represent special challenges
• 10 of population
• Take 30 of Rx meds
• Account for 25 of fatal injuries
• Have 3 chronic co-morbid conditions
• Different S/S
• MI less pain, more indigestion
• CHF little to no dyspnea
• Pneumonia no fever, limited cough

• Physiological changes
• Altered LOC and brain changes
• Hypertension
• GI problems
• Osteoporosis, OA
• Diminished air exchange
• Renal decline
• Skin changes
• Less ability to fight disease
• Absent fever with infections common

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Special considerations for the elderly

• Become more debilitated more rapidly
• Take many medications
• Have psychiatric disorders
• Difficult to separate aging from disease
• CC may seem trivial or generic
• Likely not to report symptoms
• Suffer from multiple diseases
• Communication problems common
• Never underestimate illness severity

• Exam considerations
• May fatigue easily
• Wear several layers
• Explain your actions
• They may minimize symptoms
• Trauma considerations
• Slower reflexes
• Failing senses
• Fragile tissues and bones
• Risk for assault
• Prone to head injury
• Have degenerated C-spine

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Bites and Stings

• Chapter 23

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Snakebite

• 50,000 people are bitten each year in the US
• 8,000 are poisonous
• Types of poisonous snakes
• Coral snakes
• Most poisonous
• Copperheads
• Rattlesnakes
• Most fatalities
• Water moccasins (cottonmouths)
• Nonpoisonous snakebites are treated as minor
  wounds
• Only 1/3 of poisonous bites have venom injected

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Characteristics of poisonous snakes

• Large fangs
• Elliptical pupils
• Pit between the eye and mouth
• Variety of differently shaped blotches on skin
  pattern
• Triangular shaped head
• Coral snake is the exception to all of these rules

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Snakebite

• Severity
• Gauged by how rapidly symptoms develop
• Location of bite
• Presence of disease organisms in venom
• Size and weight of victim
• General condition of victim
• Amount of physical activity post-bite

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Signs and symptoms

• Pit viper bite
• Distinct fang marks
• Pain and swelling
• Discoloration
• Numbness and blistering
• Nausea, vomiting, fainting
• Headache, dimmed vision
• Tingling of tongue and mouth
• Excessive sweating, chills
• Convulsions, twitching
• Minty, metallic, rubber taste

• Coral snakebite
• Scratch marks
• Little or no pain and swelling
• No discoloration
• Blurred vision, slurred speech
• Drooping eyelids
• Difficulty breathing
• Delayed symptoms

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Insect bites and stings

• Treated like any other wound
• When to seek medical help
• Itching 2 days
• Infection
• Allergic reaction
• Poisonous insect
• Poisonous insects in the USA
• Black widow
• Brown recluse
• Scorpion
• Fire ants
• Ticks
• Bees and wasps

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Brown Recluse Bite
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Marine life stings

• 2,000 poisonous marine animals
• Most not aggressive
• Venom causes more extensive tissue damage
• Poisonous marine animals
• Jellyfish
• Stingray
• Man-of-war
• Sea anemone
• Fire coral
• Sea urchin
• Crown-of-thorns

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General care for bites and stings

• Activate EMS if necessary
• Remove stinger/marine material
• Wash area with soap and water
• Can apply baking soda paste or steroid cream
• Remove jewelry and lower wound site
• Insect bites
• Use ice
• Snakebites
• Wrap in elastic bandage
• Marine stings
• Use heat or vinegar
• Do not remove embedded spines
• Tick removal
• No twistingpull out firmly
• Keep victim calm and limit activity