Pediatric Patients

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Pediatric Patients

• Emergencies

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Family Matters

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

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Anatomic Differences

• Less circulating blood
• Lose body heat more easily
• Bones are more flexible
• Less fat surrounding organs
• Could be much internal damage with little
  external visible trauma

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Skeletal Differences

• Bones are prone to fracture with stress.
• Infants have two openings in the skull called
  fontanels.
• close by 18 months.

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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.

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Breathing Differences

• Infants breathe faster than children or adults.
• Infants use the diaphragm when they breathe.
• Sustained, labored breathing may lead to
  respiratory failure.

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Circulation Differences

• The heart rate increases for illness and injury
• Very effective vasoconstriction keeps vital
  organs nourished
• Pale, extremities, decreased cap refill are early
  signs of perfusion problems

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Approach to Assessment

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

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Capillary Refill
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Treatment Considerations

• Oxygen - treat same as adult Use blow-by
  administration if needed
• Patient position - same as adult
• Remember airway and breathing are focus

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Growth and Development

• Usually grouped into stages
• Infant
• Toddler
• Preschool
• School-age
• Adolescent

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Infant

• first year of life
• respond physical stimuli
• crying is main means of expression
• have caregiver hold pt

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Toddler

• 1 to 3 years of age
• mobile
• may resist separation
• dont like being restrained
• can be distracted

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Preschool

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

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School-Age Child

• 6 to 12 years of age
• begin to think like adults
• can be included when taking medical history
• should be familiar with physical exam
• allow them to make choices when possible

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The Adolescent

• 12 to 18 years of age
• concerned about body image
• may have strong feelings about being observed
• respect their privacy
• they understand pain
• explain any procedure

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Notes

• never lie to a child

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Vital Signs
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Respirations

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

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Respiration Notes

• Less than 12 breaths/min
• More than 60 breaths/min,
• ALOC and/or an inadequate tidal volume
• ventilation with a BVM device

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Pulse

• Infants -brachial or femoral
• Child- use carotid
• Count at least 1 minute
• Note strength

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Blood Pressure

• Use right size cuff
• Difficult scene? Dont waste time
• Under 3? No BP

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Skin Signs

• important sign
• feel for temperature and moisture
• always check capillary refill

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Pediatric Problems
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Fever

• Common Causes
• Infections
• Neoplasm (cancer)
• Drug ingestion
• Collagen vascular disease
• High environmental temperatures

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Emergency Care for Fever

• Ensure BSI
• Begin passive cooling
• Remove clothing/coverings
• Damp towels
• No ice
• No alcohol
• No cold water baths

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Febrile Seizures

• common in children 6 months to 6 years
• most caused by high fever
• hx of infection
• generalized grand mal seizure
• less than 15 minutes

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Treatment

• ABCs
• protect patient
• recovery position
• high flow oxygen
• suction prn
• passive cooling measures
• transport

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Dehydration

• Dry lips and gums
• Fewer wet diapers
• Sunken eyes
• Poor skin turgor
• Sleepy or irritable
• Sunken fontanels

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Care for Dehydration

• Assess the ABCs
• Obtain baseline vital signs
• ALS backup may be needed for IV administration

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Airway Obstruction

• Croup
• An infection of the airway below the level of the
  vocal cords, caused by a virus
• Epiglottitis
• Infection of the soft tissue in the area above
  the vocal cords
• Foreign body Aspiration

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Croup

• barking cough
• stridor
• wheezing
• rales
• accessory muscle use
• nasal flaring
• grunting

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Epiglottitis

• severe dyspnea
• stridor
• inability to swallow - DROOLING
• fever
• tripod position

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Foreign body aspiration

• Partial Blockage
• coughing
• accessory muscle use
• nasal flaring
• wheezing

• Complete Blockage
• no sound
• no cry
• stridor
• cyanosis
• loss of consciousness

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treatment

• ABCs
• high flow oxygen
• position of comfort
• do not attempt to visualize the throat!
• do not put anything into patients mouth.

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Asthma

• dyspnea
• wheezing
• accessory muscle use
• nasal flaring
• respiratory rate - observe

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Treatment

• ABCs
• high flow oxygen
• position of comfort
• transport

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What is the most frequent cause of cardiac arrest
in pediatrics?
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Respiratory arrest!
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want to save a pediatric patient?

• aggressive ventilation high flow oxygen

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USC video!

• Pediatric respiratory distress

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Meningitis

• Inflammation of meninges
• Bacterial or viral
• Permanent brain damage/death

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Signs and Symptoms of Meningitis

• Fever
• ALOC
• Headache
• Seizure
• Stiff neck

• Vomiting
• Photophobia
• Irritability
• Bulging fontanel

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Neisseria meningitidis

• rapid onset
• pinpoint cherry-red spots or larger purple/black
  rash
• sepsis, shock, and death
• all suspected cases considered contagious

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Treatment

• BSI
• ABCs
• protect patient
• high flow oxygen
• passive cooling for fever
• monitor for shock
• Transport
• Call ALS for backup if unstable

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Submersion Injury

• Drowning or near drowning
• Second most common cause of unintentional death
• ABCs
• May be in respiratory or cardiac arrest
• C-spine precautions?
• Be ready to suction
• Keep warm

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Poisoning

• Poisoning is common in children
• Ask specific questions of caregivers
• Focus on the ABCs
• Give oxygen
• Provide transport
• Childs condition could change at any time

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Pediatric Resuscitation Tape Measure (Aka
Broslow tape)

• Used to determine height, weight, and proper
  equipment.

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Interossius IV

• Used if traditional IV sites are difficult to
  assess
• Medication delivered into bone marrow
• Painful

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Interossius
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Transporting Infants and Children

• Children require padding under the torso
• Newborns should be in special incubators
• Do not hold child during the actual transport
• Drive with due care
• Do not allow your emotions to take control

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Sudden Infant Death Syndrome

• SIDS - crib death

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SIDS

• Definition - unexplained death of an apparently
  healthy infant.
• 7500 cases per year in U.S.
• Leading cause of death in infants lt1 year old
• more cases in winter months

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Sudden Infant Death Syndrome (SIDS)

• 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

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Tasks at Scene

• Assess and manage patient
• Communicate with and support the family
• Assess the scene

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Assessment and Management

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

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Communication and Support of Family

• The death of child is very stressful for the
  family
• Parents guilt is overwhelming
• Provide support in whatever ways you can
• IT IS NOT YOUR PLACE TO JUDGE
• Use the infants name
• Allow family time with the infant

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Scene Assessment

• Inspect the environment, noting
• Signs of illness, including medications
• General condition of the house
• Family interaction
• Site where infant was discovered

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Support Groups

• Know your local phone numbers for referrals
• Arrange for proper debriefing

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Child Abuse

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

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Questions Regarding Signs of Abuse (1 of 4)

• Is the injury typical?
• Is reported method of injury consistent with
  injuries?
• Is the caregiver behaving appropriately?
• Is there evidence of drinking or drug abuse?

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Questions Regarding Signs of Abuse (2 of 4)

• Delay in seeking care?
• Good relationship between child and caregiver?
• Multiple injuries at various stages of healing?
• Any unusual marks or bruises?

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Questions Regarding Signs of Abuse (3 of 4)

• Are there several types of injuries?
• Any burns on the hands or feet involving a glove
  distribution?
• Unexplained decreased level of consciousness?

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Questions Regarding Signs of Abuse (4 of 4)

• Is the child clean and an appropriate weight?
• Any rectal or vaginal bleeding?
• What does the home look like?

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Other Indicators

• Withdrawn, fearful or hostile child
• Refusal to discuss MOI
• History of accidents
• Conflicting stories
• Caregiver lack of concern

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Emergency Medical Care

• ABCs
• Transport if you suspect child abuse
• Do not make accusations
• EMT-Bs must report all suspected cases of child
  abuse

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Sexual Abuse

• Children of any age or either gender can be
  victims
• Limit examination
• Do not allow child to wash, urinate, or defecate
• Document carefully
• Transport

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EMS Response to Pediatric Emergencies

• You may experience a wide range of emotions
• You may feel anxious
• Practice helps
• After difficult incidents, a debriefing may be
  helpful

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stop

• questions?