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Pediatric emergencies
Dr. Miada Mahmoud Rady
Introduction
 Children differ from adults in their anatomy, physiology,
and emotions and experience a range of illnesses and
injuries that varies across the pediatric age span.
 So paramedic approach to pediatric patients must be
based on their age and accommodate their unique
developmental and social issues.
Why paramedic cases represent
challenge ?!
1. Children perceive their illness or injury differently than
adults.
2. Young children may not be able to report what is
bothering them.
3. Fear or pain may slow down assessment.
4. Stressed or frightened parents and caregivers may also
pose challenges.
Pediatric Age Categories
1. Newborns and infants: birth to 1 year
2. Toddlers: 1–3 years
3. Preschool: 3–6 years
4. School age: 6–12 years
5. Adolescent: 12–18 years
Neonate and Infant
1. Neonatal period: first month.
2. Infancy: first 12 months.
Assessment of neonates and infants
1. Keep
child
warm
and
warm
your
hands
stethoscope.
2. Support a young infant’s head and neck.
3. infants will be calmest in a parent’s arms.
4. If child is quiet, listen to heart and lungs first.
5. Try to quiet crying baby as much as possible
and
Toddler
 Ages 1 to 3.
Toddler
 Use the Pediatric Assessment Triangle (PAT) to assess the
child ( measure the child’s interactions with the caregiver,
vocalizations, and mobility ).
 Strategies for examination:
1. Examine on parent’s lap and have a parent assist if
possible.
2. Get down to the child’s level and be flexible.
Preschool-Age Child
 Ages 3 to 5
 Becoming verbal and active
 Respect modesty.
 Let child participate.
 Set limits on behavior if the child acts out.
School-Age Child
(Middle Childhood)
 Ages 6 to 12.
 Greater understanding may increase fear.
 By age 8, anatomy and physiology is similar to adults.
 Explain steps in simple language.
Adolescence
1. Ages 13 to 17
2. With
respect
to
CPR,
once
secondary
characteristics have developed, treat as an adult.
3. Address and reassure patient.
4. Offer as much control as appropriate.
sexual
Pediatric Anatomy, Physiology, and
Pathophysiology
The head
 Child head is larger relative to the rest of his body and
larger than adult head ( till age of 4 ) :
1. Larger surface area  more heat loss so the head must
be covered.
2. children often fall head first  suspect head injury
whenever there is a serious MOI.
3. proportionally larger occiput  Take care when positioning
the airway
 During infancy, the anterior and posterior fontanelles are
open  Bulging suggests increased intracranial pressure
and sunken fontanelles suggest dehydration.
The neck and airway
1. Children have short neck  can be difficult to feel carotid
pulse or see jugular veins.
2.
air way is smaller than the adult and tongue occupies larger
space  More prone to obstruction.
3. During the first few months of life, infants are obligate nose
breathers  Nasal obstruction with mucus can result in
significant respiratory distress
4. Epiglottis is long and floppy  difficult to see vocal cords
during intubation.
The Respiratory System
1. Smaller tidal volume, double metabolic oxygen demand.
2. Smaller functional residual capacity.
3. Faster breathing.
4. Infants use diaphragm during inspiration.
5. Experience muscle fatigue quicker .
6. Highly susceptible to hypoxia.
Cardiovascular system
1. Children rely mainly on pulse rate to maintain adequate
cardiac output and compensate for decreased oxygenation.
2. Children have limited but vigorous cardiac reserves.
3. Injured children can maintain blood pressure for longer
periods than adults, even though they are in shock
(hypoperfusion).
4. Proportionally larger circulating blood volume compared with
adults.
Cardiovascular System
1. A larger proportional volume of fluid/blood loss is needed
to cause shock.
2. Hypotension is warning sign of imminent cardiac arrest.
3. Suspect shock if tachycardia is present.
4. Bradycardia usually indicates severe hypoxia.
5. Monitor
the
pediatric
patient
development of hypotension.
carefully
for
the
The Nervous System
1. Neural tissue and vasculature are fragile and brain, spinal
cord is not as well protected  takes less force to cause
brain and spinal cord injuries and brain injuries are
frequently more devastating.
2. Pediatric brain requires nearly twice the blood flow 
makes even minor injuries significant and Increases risk of
hypoxia
The Abdomen and Pelvis
1. Organs are situated more anteriorly ( less bony
protection ) and are relatively large also liver and spleen
extend below rib cage  so insignificant forces can
cause serious internal injury.
2. Kidneys are also more vulnerable to injury as it is more
mobile and Less well supported.
Musculoskeletal system
1. Bones of growing children are weaker than their ligaments
and tendons  makes fractures more common than sprains.
2. Joint dislocations without associated fractures are not
common.
3. Growth plate fractures can be seen with low-energy MOIs
and may be lacking the degree of tenderness, swelling, and
bruising usually associated with a broken bone.
4. Immobilize all sprains or strains, and suspect fractures.
Respiratory Emergencies
1. Frequently encountered and so early identification and
intervention are critical.
2. Respiratory failure and arrest precede majority of
cardiopulmonary arrests.
3. Use PAT to determine severity before touching the
patient ( Distress, failure, or arrest ).
Respiratory distress
 Respiratory distress means
increased work of breathing to
maintain oxygenation and/or ventilation.
 Classified as mild, moderate, or severe.
 Signs of respiratory distress :
1. Retractions (suprasternal, intercostal, subcostal).
2. Abdominal breathing.
3. Nasal flaring.
4. Grunting.
Respiratory failure
 Condition in which patient can no longer compensate by
increased work of breathing so hypoxia and/or carbon
dioxide retention occur.
Signs may include:
1. Decreased or absent retractions due to respiratory
muscle fatigue.
2. Altered
mental
status
due
oxygenation .
3. Abnormally low respiratory rate.
to
inadequate
brain
Respiratory arrest
 Condition
in
which
the
patient
is
not
breathing
spontaneously.
 Administer
immediate
bag-mask
ventilation
with
supplemental oxygen to prevent cardiopulmonary arrest.
 Resuscitation of a child is often successful.
Assessment
A. Using PAT before touching patient :
1. Appearance : gives an idea about brain oxygenation and
ventilation i.e. sleepy child is mostly hypoxic child.
2. Assess the work of breathing via
• Patient’s position of comfort
• Presence or absence of retractions
• Grunting or flaring
 A patient who prefers to sit upright, in the sniffing position,
or to use arms for support is trying to optimize breathing
mechanics ( indicates respiratory distress ).
 Deep retractions indicates the use of accessory muscles.
3. Look for pallor or cyanosis: provides information on
adequacy of oxygenation.
Assessment
B. Assess the airway:
 Listen for stridor in
awake patients.
 Check for obstruction in
obtunded patients.
C. Assess breathing:
 Determine respiratory
rate.
 Listen for air entry and
abnormal breath sounds.
 Check pulse oximetry.
Foreign Body Aspiration or Obstruction
 Infants and toddlers have a high risk of foreign body aspiration.
 Signs of mild obstruction:
1. Awake
2. Stridor
3. Increased work of breathing
4. Good color
 Signs of severe obstruction
1. Cyanotic.
2. Unconscious .
Foreign Body Aspiration or Obstruction
1. For removing a foreign body from responsive infants
 Deliver five back slaps and five chest thrusts.
2.Removing a foreign body in unresponsive infant :
a. look inside the mouth and If you see the object, remove it.
b. If not, start CPR
c. assess for a pulse If there is no pulse, or the pulse rate is
less than 60 beats/min, begin CPR
Removing a foreign body in children
1. If the child is responsive  use abdominal thrust maneuver
( the Heimlich maneuver)
2. If the child becomes unresponsive:
 Position supine and start chest compression .
 Open airway , if you see the object remove it , and if not
attempt ventilation.
 If unable to relieve sever obstruction  proceed with
laryngoscopy and removal with Magill forceps.
Anaphylaxis
 Definition : Potentially life-threatening allergic reaction
triggered by exposure to an antigen.
 Onset of symptoms occurs immediately.
 Delayed effects may occur after 8 hours so patient transport
is crucial even if they are asymptomatic
Clinical presentation
1. Skin rash ( hives )
2. Respiratory distress ( stridor , wheezy chest )
3. Circulatory compromise ( hypotension , shock )
4. Swelling of tongue , oral mucosa and puffy eye lids
5. Cardiorespiratory failure in sever cases
Management
1. Address ABCS .
2. Ensure patent air way
3. High flow oxygen .
4. I.V fluids via large bore cannula
5. Vasopressors in case of shock.
6. Pharmacological therapy

Epinephrine ( gold standard and main line ).

Diphenhydramine

Corticosteroids

Inhaled beta 2 agonist .
7. Rapid transport to appropriate facility .
Croup
 Definition : inflammation of the upper airway , mostly viral .
 Clinical presentation :
a. Audible stridor with activity or agitation
b. Barky cough
c. Mild respiratory distress and normal skin color .
 Management:
a. Position of comfort and avoid agitating the child.
b. Nebulized epinephrine
c. Assisted ventilation with bag-mask ventilation
d. Rapid transport.
Epiglotittis
• Definition : Inflammation of the supraglottic structures
• Classic presentation:
a. Sick, anxious; sitting in sniffing position
b. Drooling .
c. Increased work of breathing and pallor or cyanosis
• Management :
• Epiglotittis is major emergency , it could be fatal
a. Symptoms progress rapidly so rapid transport is crucial
b. Bag – mask ventilation may be necessary
c. Be prepared with endotracheal intubation.
Bacterial Tracheitis
• Definition : Bacterial infection of soft tissues of trachea
• Clinical presentation:
– Cough, stridor, respiratory distress
– History of preceding viral infection
• Management : Keep patient as calm and comfortable as
possible.
Asthma
 Definition : disease of small airway characterized by :
a. Bronchospasm
b. Increased mucous production
c. Airway hyper reactivity leading to hypoxia.
 Triggering factor : Smoke , dust , common cold and upper
respiratory infection.
 Clinical presentation :
1. Cough
2. Wheezy chest
3. Signs of respiratory distress.
 Management :
1. O2 via mask .
2. Inhaled
bronchodilator
corticosteroids.
and
or
Inhaled
Bronchiolitis
 Definition : Inflammation or swelling of small airways in
lower respiratory tract due to viral infection.
 Clinical presentation :
1. Mild to moderate retractions
2. Tachypnea
3. Diffuse wheezing and crackles
4. Mild hypoxia
Complication
 Complication : respiratory failure .
 Signs of impending respiratory failure :
1. Sleepy.
2. Severe retractions
3. Diminished breath sounds
4. Moderate to severe hypoxia
 Risk factors for respiratory failure :
1. First months of life
2. Prematurity
3. Lung disease
4. Congenital heart disease
5. Immunodeficiency
Management
 Mainly supportive :
1. Position of comfort
2. Supplemental oxygen
3. Inhaled albuterol or Nebulized racemic epinephrine
may be given for moderate to severe respiratory
distress.
Cardiopulmonary Arrest
 Mostly associated with respiratory failure and arrest
 Manifestation : hypoxia and bradycardia
 Child must be ventilated early with sever hypoxia or
bradycardia .
 Survival rate is bad .
Shock
 Definition : Inadequate delivery of oxygen and nutrients
to tissues to meet metabolic demand
 classification :
A. Etiological :
1. Hypovolemic
2. Distributive
3. Cardiogenic
B. Clinical classification :
 Compensated : Body is able to maintain adequate perfusion
to vital organs.
 Decompensated : State of inadequate perfusion.
C. Signs :
1. Hypotension
2. Poor peripheral perfusion
3. Hypotension ( late signs and sever sign )
Hypovolemic shock
 Most common type in infant and children .
 Due to volume loss e.g. hemorrhage , diarrhea and
vomiting.
 Signs :
a. Lethargic
b. Pale, mottled, or cyanotic
c. Dehydration.
Management
1. Position of comfort
2. Supplemental oxygen
3. Keep the child warm.
4. Direct pressure to stop external bleeding
5. Volume replacement
Distributive Shock
 Due to sever vasodilatation
 Occurs in children with sepsis and anaphylactic shock
 Fever is main symptoms in case of sepsis.
Management
 Supportive and rapid transport :
1. Address ABCS
2. High flow oxygen
3. Fluids via large bore cannula
4. Vasopressors in sever shock
Cardiogenic shock
 Shock due to pump failure ( heart failure )
 Occurs in children with underlying heart disease :
1. Congestive heart failure .
2. Cardiomyopathy .
3. Sever arrhythmias.
Clinical presentation
1. Listless or lethargic
2. Increased work of breathing
3. Impaired circulation
4. Skin pale, mottled, or cyanotic
5. Sweating with feeding
Sure signs of cardiogenic shock
1. Increased work of breathing
2. Drop in oxygen saturation
3. Worsening perfusion
……………………………………All after a fluid bolus
Management
1. Position of comfort
2. Supplemental oxygen
3. Transport to facility which offer pediatric critical care.
4. No fluid should be given with sure diagnosis of
cardiogenic shock
Bradysrhythmias
• Pulse rate is lower than normal for age.
• Often secondary to hypoxia in children
• Initial treatment:
1. Airway management
2. Supplemental oxygen
3. Assisted ventilation as needed.
Bradysrhythmias
4. Initiate electronic cardiac monitoring.
5. If child is asymptomatic, no further treatment is
indicated in the field.
6. If the child exhibits symptoms of poor perfusion :
Begin chest compressions.
Attempt IV or IO access.
Tachydysrhythmias
• Pulse rate is higher than normal for age.
• Assessment should include pulse rate monitoring and an
ECG or rhythm strip.
Cyanotic Disease
1. Hypoplastic left heart syndrome (HLHS)
2. Tricuspid atresia
3. Transposition of the great arteries (TGA)
4. Tetralogy of Fallot (TOF)
5. Total anomalous pulmonary vascular return .
6. Truncus arteriosus
Cyanotic Disease
• Presents in neonatal period with:
1. Increasing respiratory distress
2. Poor perfusion
3. Cyanosis
4. Cardiovascular collapse if unrecognized
• Emergency
management
support and monitoring.
includes
Cardiorespiratory
Noncyanotic Disease
• Examples include:
1. Atrial septal defects (ASDs)
2. Ventricular septal defects (VSDs)
3. Patent ductus arteriosus (PDA)
• Clinical presentation varies.
Coarctation of the aorta
• Definition : a discrete narrowing of the thoracic aorta.
• Major clinical finding:
1.
Difference in systolic blood pressure between upper
and lower extremities.
2. Most older infants and children remain asymptomatic.
Congestive Heart Failure
• Definition : failure of the heart to meet metabolic
demands at normal physiologic venous pressures.
• Signs and symptoms :
1. Infants
: Tachypnea, retractions, grunting and
interrupted feeding .
2. Children: Profuse sweating, increased work of
breathing during feedings.
3. Older children: Tachycardia, crackles
Congestive Heart Failure
• Initial management
1. Assessment of ABCs
2. Place the patient in semisetting position
3. Provide oxygen.
4. Diuretics in consultation with a cardiologist
Myocarditis
• Definition : Condition caused inflammation of the heart
muscle that results in myocardial dysfunction and
eventually can lead to heart failure
• Mostly caused by viral infections
Myocarditis clinical presentation
• Present with CHF signs and symptoms:
1. Dyspnea at rest
2. Syncope
3. Tachycardia
4. Hepatomegaly
5. Galloping heart or new murmur
Myocarditis
1. Transport on Cardiorespiratory monitors.
2. Obtain vascular access.
3. Patients will often need inotropic support.
4. Apply oxygen during transport.
Altered LOC and Mental Status
General lines of management
1. Assess and support airway and breathing.
2. Establish vascular access and if hypoglycemic, give
glucose.
3. Transport all patients expeditiously.
4. Assess for increased ICP.
Seizures
• Definition : Abnormal movements that result from
abnormal electrical discharges in the brain.
• Causes :
1. Trauma
2. Metabolic disturbances
3. Ingestion
4. Infection
Seizures
• Types of seizures :
A. Generalized seizures : involve the entire brain.
B. Partial seizures : involve only part of the brain.
1. Simple partial seizures: no loss of consciousness
2. Complex partial seizures: loss of consciousness
Febrile convulsion
• To diagnose febrile convulsions the following
condition must be present in child :
I.
Feverish
II. Between 6 months and 6 years of age
III. Have no other identifiable cause.
IV. Positive family history is highly suggestive.
Types of febrile seizers
 Simple febrile seizures: Brief, generalized tonic-clinic
seizures
occurring
without
underlying
neurologic
abnormalities
 Complex febrile seizures: Longer, focal or occur with
baseline developmental or neurologic abnormality
Assessment of patient with seizers
• The following must be covered in history taking :
1. Prior seizures
2. Anticonvulsant medications
3. Recent illness, injury, or suspected ingestion of
toxic substance.
4. Duration of seizure activity
5. Character of the seizure
• Management :
1. Provide 100% supplemental oxygen; bag-mask
ventilation as indicated for hypoventilation.
2. Measure serum glucose; treat hypoglycemia.
3. Consider administering a benzodiazepine.
4. If seizures do not stop, a second-line agent is
necessary
e.g.
Fosphenytoin
Phenobarbital
,Phenytoin
and
Meningitis
Definition : inflammation of the meninges.
Causative organism : many , commonest is meningococci
( responsible for epidemic form).
Method of transmission :
1. Direct contact with infected nasopharyngeal secretion.
2. Droplet infection.
Assessment
Clinical presentation include:
1. Fever
2. Headache
3. Neck stiffness
4. Skin rash
5. Kernig sign
6. Brudzinski sign
7. seizures
Meningitis
1. Perform a glucose check.
2. Provide lifesaving interventions as needed, and
transport quickly.
3. Patient may need oxygen, airway management,
and ventilation support.
4. Infection control measure must be properly
followed
Hydrocephalus
• Definition : accumulation of CSF that results from
impaired circulation and absorption of cerebrospinal fluid
(CSF) Leading to enlargement of ventricles and increased
ICP
• Clinical presentation : symptoms of increased ICP
• Treatment : Cerebral shunt often used to decrease ICP
1. Ventriculoperitoneal (VP) shunts
2. Ventriculoatrial (VA) shunts
Management
1. Address ABCS
2. Rapid transport
Ventricular shunts
 Used to drain excess cerebrospinal fluid .
 Two types :
1.Ventriculoperitoneal (VP) shunts.
2.Ventriculoatrial (VA) shunts.
 Complication : infection and obstruction .
 Management of complicated shunt:
1. Manage ABCS
2. Rapid transport
Head trauma
 Common in children ( large sized head)
 Even children who appear normal , may have significant
intracranial injury
 Children with head trauma , should be evaluated for signs of
abuse.
Closed head trauma
1. Epidural hematoma :
 Hemorrhage into space between the dura and skull.
 Almost exclusively caused by trauma.
2. Subdural hematoma :
 Hemorrhage
into
space
between
membranes
 Suspect abuse until proven otherwise.
dura
and
arachnoid
Assessment of pediatric trauma case
1. Begin with a thorough scene size-up.
2. Use PAT to form a general impression .
3. If findings are grossly abnormal, move to ABCs and initiate
life support interventions:
a. Circulation : Any trauma patient should be considered to be
at risk for developing shock , so continuously assess
circulation , the only sign for shock might be tachycardia.
Primary assessment
Identify and
manage life
threats
Form a
general
impression
Address
ABC
TRANSPORT
DECISION
b. Breathing :
 Pneumothorax may be present with penetrating trauma of the
chest or upper abdomen.
Signs : Tachycardia ,Jugular vein distention and Pulsus
paradoxus
Treatment : Perform needle decompression.
4. Once ABCs are stabilized, continue assessment of disability
with AVPU.
5. Place a cervical collar, and immobilize on a long backboard as
indicated.
6. Perform rapid exam to identify all injuries.
7. Cover the child with blankets.
8. Treat any fractures.
Transport Considerations
 Some traumas are load-and-go because of severe injuries and
unstable condition Perform lifesaving steps on scene or en route
and transfer quickly.
 All trauma victims with suspected spinal injury require spinal
stabilization ( use only appropriate collar size).
History Taking and Secondary
Assessment
 If patient is stable:
1. Obtain additional history
2. Perform a more thorough physical exam.
3. Look for bruises, abrasions, other subtle signs of injury that
may have been missed.
Hyperglycemia and diabetes
 Type 1 diabetes or juvenile diabetes
 Symptoms of diabetes include : polyuria , polydepsia ,
polyphagia and unexplained weight loss.
 Complication : untreated hypoglycemia can lead to
1. Dehydration
2. Acid base disorders
3. Diabetic ketoacidosis
Assessment
 History taking may reveal :
1. Missed insulin dose .
2. Greater proportion of food was eaten.
3. Insulin pump malfunctioned.
4. Ask about the following during assessment :
 Urine out put , mental status , insulin pump function ,
compliance with treatment , last glucose check and last insulin
take)
Management of hyperglycemia
1. Ensure patent airway and administer 100% oxygen.
2. Assisted ventilation may be needed
3. Obtain an I.V access and start isotonic fluid administration
4. Avoid rapid fluid administration as it may lead to brain edema
and brain stem herniaition
5. Monitor vital signs closely .
6. If patient reports worsening of a headache or mental status
deteriorates : Discontinue fluids
increased ICP.
, assess and treat for
Hypoglycemia
 Normal blood glucose levels: 80 to 120 mg/dl.
 Hypoglycemia : low blood glucose level ( ＜ 80mg/dl ).
 Clinical presentation :
1. Sweating .
2. Tremors .
3. Tachycardia and palpitation.
4. Hunger and weakness.
5. Finally confusion and coma.
 Complication : brain damage if prolonged , due to low glucose
reserve.
 Management :
1. Maintain patent airway and give high flow oxygen.
2. Give glucose :
 Orally if the child is completely alert and able to swallow.
 I.V if child is confused
 I.M glucagon if an I.V access cannot be obtained.
3. Monitor vital signs closely.
Sickle cell disease
• Definition : Autosomal recessive disorders , caused by
abnormal adult hemoglobin , abnormal hemoglobin is known as
hemoglobin S.
• Pathophysiology : abnormal shape of the RBCS make them
more liable for destruction and they can easily obstruct small
blood vessels.
• Present with ischemia and painful crises .
Sickle Cell Disease (SCD)
• Infants may present with:
1. Fussiness
• Older children may report:
1. Pain in specific
2. Irritability
locations, including
3. Crying
joints, back, and chest.
4. Poor feeding
5. Nonspecific findings
Sickle Cell Disease (SCD)
 Priapism: Caused by sickling of cells within the penis
characterized by painful sustained erection and can lead to damage
of penile tissues.
 Treatment includes:
1. Gentle hydration
2. Supplemental oxygen
3. Anti-inflammatory medications and narcotics
4. Transport .
Thrombocytopenia
 Abnormally low number of platelets ( normal platelet count:
150,000 to 450,000/ul ) .
 Bleeding is proportional to the degree of thrombocytopenia.
 Causes include:
1. Infections ,cancers .
2. Rheumatologic diseases .
3. Inherited conditions , Medications and chemotherapy drugs.
• Treatment :
1. Treating the underlying cause if present.
2. Transfusing platelets if bleeding cannot be controlled.
3. Transport for consultation with a hematologist.
Von Willebrand Disease
 Most common heritable disorder of coagulation caused by
Decreased or abnormal production of Von Willebrand factor
 Presentation can mimic hemophilia A.
 Presentation : range from mild (nosebleeds) to severe
uncontrolled bleeding tendencies.
Treatment : control bleeding and transport to a hospital with
hematology services.
Leukemia/Lymphoma
• Management consideration:
1. Patients are often immunocompromized secondary to the
leukemic cells overtaking the bone marrow
2. Patients need antibiotics at the first sign of illness.
3. Fluid therapy should be aggressive in pediatric patients who
are tachycardic.
Leukemia/Lymphoma
1. Consider tumor lysis syndrome (TLS).
– Condition that can occur after treatment of certain cancers.
– Can lead to acute renal injury and failure
– If suspected, institute rapid fluid therapy and transport
rapidly .
Toxicologic Emergencies
• Toxic exposures account for a
significant number of
pediatric emergencies.
1. Ingestion
2. Inhalation
3. Injection
4. Application
Assessment of Toxicologic
Emergencies
1. Evaluation follows standard assessment sequence.
2. Attend to ABCs as indicated.
3. Treat documented hypoglycemia.
4. If child is stable, obtain additional history and
perform secondary assessment.
Assessment of Toxicologic
Emergencies
5. Look for toxidromes by assessing:
A. Mental status
B. Pupillary changes
C. Skin CTC
D. Gastrointestinal activity
E. Abnormal odors
6. Reassess frequently.
5. Reduce absorption by decontamination.
6. Enhance elimination
7. Provide an antidote.
Methods of decontamination
• With skin exposure, remove all clothing and wash skin.
• With ocular exposure, wash out the eyes.
3. For ingested toxins, reduce gastric absorption by :
a. Dilution
b. Gastric lavage
c. Activated charcoal
d. Syrup of ipecac is not recommended.
Decontamination
• For substances that are renally excreted : diuresis may be
beneficial.
• Dialysis is required for some overdoses:
1. Salicylates
2. Lithium
3. Methyl alcohol
4. Ethylene glycol
5. Barbiturates
Decontamination
• If inhaled, assess respiratory status :
– Bronchodilators may be needed for bronchial irritation and
bronchospasm.
– Monitoring of oxygen saturations and intubation may be
necessary.
Enhanced Elimination
• Cathartics are sometimes combined with activated charcoal.
– Work by speeding up elimination.
– Not recommended for young children.
• Additional options include whole bowel irrigation and urinary
alkalinization.
Antidotes
• Can be lifesaving
• Available for only a few
poisonings
• Reverse or block effects of
ingested toxins
• Dose
weight.
depends
on
child’s
Psychiatric emergency approach
1. Safety is your first priority.
2. Approach the child calmly, and explain you are there to help.
3. Address patient directly.
4. Answer questions honestly.
5. Some children must be mechanically restrained ,so carefully
document the reason.
Psychiatric emergency approach
6. PAT will give you a general impression of mental status and
cardiovascular stability.
7. Assessment is based on observation and history.
8. Treat problems or injuries with standard protocols
Fever Emergencies
• Record temperature.
• Life-threatening signs may include:
– Respiratory distress
– Seizures
– Petechial or purpuric rash
– Bulging fontanelles in an infant
Fever Emergencies
1. History taking and secondary assessment will help determine
the underlying cause and severity of illness.
2. Perform on scene if child is stable.
3. Perform en route if seriously ill.
Fever Emergencies
• May require little intervention :
1. Support ABCs.
2. Provide temperature control : consider acetaminophen or
ibuprofen.
3. Transport to an appropriate medical facility.
Child Abuse and Neglect
• Child abuse : Any improper or excessive action that injures or
harms a child or infant
• Types of child abuse
1. Physical abuse
2. Sexual abuse
3. Emotional abuse
4. Neglect
Risk Factors for Abuse
• Risk factors for abuse:
1. Younger children
2. Children who require extra attention
3. Lower socioeconomic status
4. Divorce, financial problems, and illness
5. Drug and alcohol abuse
6. Domestic violence in the home
Suspecting Abuse or Neglect
• If you suspect abuse,
trust your instincts.
• Look for “red flags”
that
could
suggest
maltreatment. ( table
27)
Red flags of child abuse
1. Inconsistency of the injury with child developmental age .
2. History inconsistent with the injury.
3. Inappropriate parental concern.
4. Delay in seeking care and injuries of different age.
5. Lack of supervision
6. Unusual injury pattern
7. Suspicious circumstances and environmental clues
Assessment and
Management of Abuse and
Neglect
1. Carefully document what you see regarding :
a. Child’s environment
b. Condition of home
c. Interactions among caregivers, child and EMS crew.
2. Prehospital personnel are legally obligated to report suspicion
of abuse.
Assessment and
Management of Abuse and
Neglect
3. Involve police early to secure the scene.
4. Approach emergency department staff with concerns.
5. Be aware of local regulations.
6. Focus on assessment and management.
7. Be aware of history inconsistent with type of injury and
multiple burises
Mimics of Abuse
• Definitions : Situation in
which it is difficult to
distinguish some normal skin
findings from inflicted
injuries.
• Example :
Examples of mimics of
Abuse
1. Medical conditions can mimic bruises e.g. Purpura and
Petechiae
2. Exposure to sun can cause reactions with certain medications or
fruits.
3. Mongolian spots may be mistaken for bruises.
4. Certain cultural customs produce skin markings e.g. Coining
and Cupping
Mimics of Abuse
Sudden Infant Death Syndrome
• Definition : sudden and unexpected death of an infant
younger than 1 year for whom a thorough autopsy fails
to demonstrate an adequate cause of death.
Causes
• Exact cause is unknown several theories are
proposed :
1. Developmental abnormality especially of the brain
2. Sleep patterns e.g. sleep on stomach , on soft surface
or with the parents.
3. Respiratory problems.
Sudden Infant Death Syndrome
• Risk factors include:
1. Prematurity; low birth weight
2. Young maternal age
3. Sleeping prone or with soft, bulky blankets
4. Exposure to tobacco smoke
Assessment and Management of SIDS
1. Be alert to other potential causes of death.
2. Decision to start or stop resuscitative efforts should be guided
by local protocols
3. Thorough scene size-up and history are important.
Apparent Life-Threatening Event
• Definition : episode during which an infant:
1. Becomes pale or cyanotic
2. Chokes, gags, or has an apneic spell, or
3. Loses muscle tone
• Causes: range from benign to serious diagnoses.
Apparent Life-Threatening Event
management ( ALTE)
1. Provide life support with signs of cardiorespiratory
compromise or altered mental status.
2. Transport all infants with a history of ALTE.
Assessment and Management of Burns
• Burns suggestive of abuse : are burns where the mechanism
or pattern observed does not match history or child’s
capabilities
• Management :
1. Remove burning clothing support ABCs.
2. Give 100% supplemental oxygen.
Management of Burns
3. Clean burned areas minimally.
4. Avoid lotions or ointments.
5. Cover burn and patient as needed.
6. Analgesia is a critical part of management.
7. Transport to an appropriate medical facility.
Children with Special Health Care Needs
• Definition : they are children with physical,
developmental, and learning disabilities .
• Examples : children with tracheostomy tubes , those
on artificial ventilation and gastrostomy .
Tracheostomy Tubes and
Artificial Ventilators
• Tracheostomy
:
It
means
surgical creation of a stoma
through which a tracheostomy
tube can be placed for long-term
ventilatory needs.
Dealing with child with Tracheostomy Tubes
and Artificial Ventilators
1. Caregivers are a source of valuable information so allow them
to participate .
2. Most common problem: obstruction of tube with secretions
3. Child may breathe spontaneously with room air or depend on a
home ventilator and supplemental oxygen.
4. With respiratory distress, assess tube position and suction tube.
5. If child does not improve, you may need to remove and
replace the tube.
Gastrostomy Tubes
• Definition : surgically
placed directly into the
stomach to provide nutrition
or medications
• Management : usually
includes supportive care
and transport.
Central Venous Catheters
• Function : usually inserted for long-term IV access for
medications or nutrition
• Placed into large central veins e.g. jugular vein
• Complications :
include infections, obstruction, and
dislodged or broken catheters.
Assessment and Management of Children
With Special Health Care Needs
1. Follow standard assessment sequence.
2. Ask parent questions to establish baseline neurologic function
and physiologic status.
3. Meet child at his or her developmental level.
4. Work with parents to restore child to his or her own
physiologic baseline.
Transport of Children With Special Health
Care Needs
1. Transport to the child’s medical home.
2. If this is not possible, take along any medical records
and assistive devices.
3. Most important, take the caregiver!