Pediatrics for Prehospital Providers

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Pediatrics for Prehospital Providers

• Paul B. Davenport BSN,RN,EMT-C

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Triage

• Across the room assessment
• Airway
• Respiratory
• Cardiac
• Disability
• Expose
• Vitals

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Pediatric Respiratory Section
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Respiratory Distress vs. Failure

• Increased rate
• Nasal flaring
• Use of accessory muscles
• Grunting

• Decreased L.O.C.
• Persistent cyanosis with supplemental oxygen
• Decreased breath sounds

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Croup vs. Epiglottis

• 3 months to 3 years
• Gradual onset
• Low grade fever
• Stridor
• Fall / Winter

• 3 years to 7 years
• Acute onset
• High fever
• Hoarse
• Drooling
• All year long

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Respiratory-Asthma

• Obstructive airway disease with hypereactivity of
  the bronchi and trachea.

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Respiratory-RSV

• 0-4 years of age
• December - April
• S/S of respiratory infection, thick secretions,
  and wheezing

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Respiratory Summary

• What does your patient look like?
• What do you hear?
• PMH

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Pediatric Cardiac Section
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Cardiac Dysrhythmia Treatment

• Vital signs, 100 Oxygen
• Stable vs. unstable
• Airway
• Vascular access
• Synchronized cardioversion 0.5 - 1.0 J/kg
• Defibrillation (2J/kg, 4J/kg, 4J/kg)
• Medications

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Disability
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Disability

• AVPU
• GCS
• Seizures
• Hypoglycemia
• Drug ingestion
• Dehydration

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Pediatric Assessment

• Expose

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Expose

• Evaluation of respiratory status
• Skin color(central and extremities)
• Rashes
• Trauma
• Burns

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Pediatric Assessment

• Vital Signs

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Pediatric Vital Signs

• L.O.C.
• Respiratory rate quality
• Heart Rate
• Blood Pressure
• systolic BP 70 (2 X age in years)
• Temperature
• IV access

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Hypothermia Hyperthermia

• Core Temp.lt95F
• Newborns
• Mild, Moderate, Severe
• Frostbite
• Management

• Core Temp. gt101.5F
• Infection
• Poisoning
• Heat stroke
• Seizures
• Effects of hyperthermia

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IV Access
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IV Access in Pediatrics

• Attempts at peripheral IV access should not
  exceed 90 seconds--with decompensated
  shock/cardiac arrest.
• Children lt6 years of age place IO cannula
• Location, location, location

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Case Scenarios
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Case Studies

• A woman runs into the station on a hot summer
  day, holding her 9 month old child in her arms.
  She states she left her child in the car while
  she went shopping. When she returned to the car
  the child was unresponsive.

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Case Study 2

• Your unit is called to the scene of a 3 year old
  found outside. Patient was missing since early
  afternoon. It is now 9 p.m. Temperature outside
  is 32 degrees F. The patient is cold and
  unresponsive.

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Case Studies 3

• You arrive on scene of a 2 month-old infant in
  cardiac arrest. CPR is in progress. The infant
  is intubated, however no IV access has been
  obtained. The monitor is showing VFIB.

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Case Studies 4

• You are called to the scene of a house-fire. The
  firefighters pull a 5-year-old from the burning
  building. He has flame burns to the face, chest,
  abd., and both thighs. The patient is
  unresponsive with a weak pulse of 150bpm.

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Case Studies 5

• You are called to the scene for a 1-year-old,
  unknown type problem. You arrive and find mother
  holding the 1-year-old female patient. Mother
  states that the patient has had a high fever for
  a week. The patient is lethargic and does not
  react when you pick her up. Vitals HR 160 ST,
  BP 60/P, Resp. 40.