Transcript Chapter 32: Pediatric Assessment and Management Part B

Child CPR (1 of 2)
• Place child on firm surface and
maintain airway with one
hand.
• Place heel of other hand over
lower half of the sternum.
– Avoid the xiphoid process.
• Compress chest 1/3 to 1/2 the
depth of the chest at a rate of
100/min.
Child CPR (2 of 2)
• Coordinate compressions with ventilations in a
30:2 ratio for one rescuer, 15:2 for two rescuers,
pausing for ventilations.
• Reassess for breathing and pulse after every 2
minutes of CPR.
• If the child resumes effective breathing, place child
in recovery position.
AED Use in Children (1 of 2)
• Can be safely used in children older than 1
year of age
• Use pediatric-sized pads and a doseattenuating system for children 1-8 years old.
– If not available, use adult AED.
• AED is not indicated for use in infants less
than 1 year of age.
AED Use in Children (2 of 2)
• AED should be applied to
children over 1 year of age after
the first 2 minutes of CPR.
• After 2 minutes of CPR, AED is
used to deliver shocks in the
same manner as with an adult
patient.
Trauma (1 of 2)
Extremity injuries in children are generally
managed in the same manner as those in adults.
Trauma (2 of 2)
• Be alert for airway problems on all children
with traumatic injuries.
• Give supplemental oxygen to all children with
possible:
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–
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Head injuries
Chest injuries
Abdominal injuries
Shock
• If ventilation is required, provide at 20
breaths/min.
Immobilization
• Any child with a head or back injury
should be immobilized.
• Young children may need padding
beneath their torso.
• Children may need padding along the
sides of the backboard.
Immobilization in a Child Safety Seat
• Assess child for injuries and
seat for visible damage.
• If child is injured or seat is
damaged, remove child to
another transport device
• Apply padding around child to
minimize movement.
• Move seat to ambulance and
secure according to the
manufacturer’s instructions.
Removing a Child from
a Child Safety Seat
• Remove both the child and the seat from
the vehicle.
• Place immobilization device behind the
child.
• Slide child into place on device.
Signs and Symptoms
of Respiratory Emergencies
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•
•
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Nasal flaring
Grunting respirations
Use of accessory muscles
Retractions of rib cage
Tripod position in older
children
Emergency Care
• Provide supplemental oxygen in the
most comfortable manner.
• Place child in position of comfort.
– This may be in caregiver’s lap.
• If patient is in respiratory failure,
begin assisted ventilation
immediately.
– Continue to provide supplemental
oxygen.
Shock
• Circulatory system is unable to deliver
sufficient blood to organs.
• Many different causes
• Patients may have increased heart rate,
respirations, and pale or mottled skin.
• Children do not show decreased blood
pressure until shock is severe.
Assessing Circulation
• Pulse: Above 160 beats/min suggests
shock
• Skin signs: Assess temperature and
moisture
• Capillary refill: Is it delayed?
• Color: Is skin pink, pale, ashen, or
mottled?
Emergency Medical Care
for Shock
• Ensure airway.
• Give supplemental oxygen.
• Provide immediate
transport.
• Continue monitoring vital
signs en route.
• Contact ALS for backup as
needed.
Seizures
• May present in several different ways
• A postictal period of extreme fatigue
or unresponsiveness usually follows
seizure.
• Be alert to presence of medications,
poisons, and possible abuse.
Febrile Seizures
• Febrile seizures are most common in
children from 6 months to 6 years.
• Febrile seizures are caused by fever.
• Generally last less than 15 minutes
• Assess ABCs and begin cooling
measures.
• Provide prompt transport.
Emergency Medical Care
of Seizures
(1 of 2)
• Perform initial assessment, focusing on
the ABCs.
• Securing and protecting the airway is
the priority.
• Place patient in the recovery position.
• Be ready to suction.
Emergency Medical Care
of Seizures
(2 of 2)
• Deliver oxygen by mask, blow-by, or nasal
cannula.
• Begin BVM ventilation if no signs of
improvement.
• Call ALS for backup if appropriate.
Dehydration
• Determine if child is vomiting or has
diarrhea and for how long.
• “How many wet diapers has the child
had during the day?” (6 to 10 is normal)
• “What fluids are the child taking?”
• “What was the child’s weight before the
symptoms started?”
• “Has the child been normally active?”
Emergency Medical Care
for Dehydration
• Assess the ABCs.
• Obtain baseline vital signs.
• ALS backup may be needed
for IV administration.
Review
1. The pediatric assessment triangle (PAT) is used to:
A. rapidly categorize a pediatric patient’s problem as
being medical or trauma in nature.
B. assess an infant’s or child’s vital functions by
performing a rapid hands-on physical exam.
C. rapidly form a general impression of an infant’s or
child’s condition without touching him or her.
D. determine a pediatric patient’s level of consciousness
and make a rapid transport decision.
Review
Answer: C
Rationale: The pediatric assessment triangle (PAT) is
a structured assessment tool that allows you to
rapidly form a general impression of an infant’s or
child’s condition without touching him or her. The
intent of the PAT is to provide a “first glance”
assessment to identify the general category of the
child’s physiologic problem and establish urgency
for treatment and/or transport. The PAT—which
consists of assessing appearance, work of
breathing, and skin circulation—is a visual
assessment of the child before performing a
hands-on assessment.
Review (1 of 2)
1.
The pediatric assessment triangle (PAT) is used to:
A. rapidly categorize a pediatric patient’s problem as being medical or
trauma in nature.
Rationale: This allows the provider to rapidly form a general impression.
B. assess an infant’s or child’s vital functions by performing a rapid handson physical exam.
Rationale: PAT is a from-the-door approach that occurs without touching
the patient.
Review (2 of 2)
1.
The pediatric assessment triangle (PAT) is used to:
C. rapidly form a general impression of an infant’s or child’s condition
without touching him or her.
Rationale: Correct answer
D. determine a pediatric patient’s level of consciousness and make a rapid
transport decision.
Rationale: This allows providers to categorize the pediatric patient’s
physiologic problem and establish the urgency for treatment and
transport.
Review
2. You should position an unresponsive 2-yearold child’s airway by:
A. hyperextending the head to align the airway.
B. hyperflexing the head to prevent obstruction.
C. placing the head in a slightly flexed position.
D. placing the head in a neutral sniffing position.
Review
Answer: D
Rationale: Position a child's airway in a neutral
sniffing position. This accomplishes two goals
at once. It keeps the trachea from kinking
when the neck is hyperextended or flexed,
and it maintains the proper alignment if you
have to immobilize the spine.
Review
2. You should position an unresponsive 2-year-old child’s airway by:
A. hyperextending the head to align the airway.
Rationale: This will kink the airway and cause an obstruction.
B. hyperflexing the head to prevent obstruction.
Rationale: This will kink the airway and cause an obstruction.
C. placing the head in a slightly flexed position.
Rationale: This will kink the airway and cause an obstruction.
D. placing the head in a neutral sniffing position.
Rationale: Correct answer
Review
3. A 6-year-old boy presents with severe respiratory
distress. His level of consciousness is markedly
decreased and his respirations are 40 breaths/min
with reduced tidal volume. You should:
A. apply oxygen with a pediatric nonrebreathing mask.
B. begin assisting his ventilations with a bag-mask
device.
C. assess his oxygen saturation level with a pulse
oximeter.
D. put him in a position that facilitates breathing and
give blow-by oxygen.
Review
Answer: B
Rationale: As evidenced by his decreased level of
consciousness, respiratory distress, and
reduced tidal volume (shallow breathing), this
child is not breathing adequately and needs
some form of positive-pressure ventilation.
Use a bag-mask device and assist ventilations
with 100% oxygen. Remember that respiratory
failure is the most common cause of cardiac
arrest in the pediatric population.
Review
3. A 6-year-old boy presents with severe respiratory distress. His level of
consciousness is markedly decreased and his respirations are 40
breaths/min with reduced tidal volume. You should:
A. apply oxygen with a pediatric nonrebreathing mask.
Rationale: The patient is in respiratory failure. Ventilations need to be
assisted.
B. begin assisting his ventilations with a bag-mask device.
Rationale: Correct answer
C. assess his oxygen saturation level with a pulse oximeter.
Rationale: Assisted ventilations must be initiated. Oxygen saturation can
be determined while ventilations take place.
D. put him in a position that facilitates breathing and give blow-by oxygen.
Rationale: The patient needs assisted ventilations.
Review
4. Your assessment of a newborn’s heart rate
reveals that it is 80 beats/min. You should:
A. transport immediately.
B. begin chest compressions.
C. aggressively warm the newborn.
D. begin positive-pressure ventilations.
Review
Answer: D
Rationale: If a newborn's heart rate falls below 100
beats/min, you must initiate positive-pressure
ventilations with a bag-mask device and highflow oxygen. Bradycardia in the pediatric patient
is an indicator of significant hypoxemia. If the
newborn’s heart rate falls below 60 beats/min,
you must begin chest compressions as well.
Review
4. Your assessment of a newborn’s heart rate reveals that it is 80
beats/min. You should:
A. transport immediately.
Rationale: Positive pressure ventilations are initiated if the heart rate
falls below 100 beats/min.
B. begin chest compressions.
Rationale: Chest compressions are started if the heart rate falls below
60 beats/min, despite adequate ventilations.
C. aggressively warm the newborn.
Rationale: Warming is done upon delivery of the newborn. Ventilations
must take place when a newborn’s heart rate is below 100
beats/min.
D. begin positive-pressure ventilations.
Rationale: Correct answer
Review
5. When performing two-rescuer CPR on an
infant, you should:
A. use your thumbs to compress the chest.
B. compress the chest to a depth of 2 inches.
C. deliver each rescue breath over 2 seconds.
D. use a compression to ventilation ratio of 30:2.
Review
Answer: A
Rationale: When performing two-rescuer infant
CPR, use a compression to ventilation ratio of
15:2 (30:2 for one rescuer). Compress the chest
using the two thumb-encircling hands technique,
at a depth equal to one-third to one-half the
depth of the chest. Deliver each rescue breath
over a period of 1 second—just enough to
produce visible chest rise.
Review
5. When performing two-rescuer CPR on an infant, you should:
A. use your thumbs to compress the chest.
Rationale: Correct answer
B. compress the chest to a depth of 2 inches.
Rationale: The depth is ⅓ to ½ the depth of the infant’s chest.
C. deliver each rescue breath over 2 seconds.
Rationale: Breaths are delivered over a period of 1 second.
D. use a compression to ventilation ratio of 30:2.
Rationale: The compression to ventilation ratio is 15:2.
Review
6. You respond to a sick child late at night. The child
appears very ill, has a high fever, and is drooling.
He is sitting in a tripod position, struggling to
breathe. You should suspect:
A. croup.
B. pneumonia.
C. epiglottitis.
D. severe asthma.
Review
Answer: C
Rationale: This child has all the classic signs of
epiglottitis: high fever, drooling, and severe
respiratory distress. Epiglottitis is a potentially
life-threatening bacterial infection that causes
the epiglottis to swell rapidly and potentially
obstruct the airway.
Review
6. You respond to a sick child late at night. The child appears very ill, has a
high fever, and is drooling. He is sitting in a tripod position, struggling
to breathe. You should suspect:
A. croup.
Rationale: This is a viral disease characterized by edema of the upper
airways, a barking cough, and stridor.
B. pneumonia.
Rationale: This is an inflammation of the lungs caused by bacteria, viruses,
fungi, and other organisms.
C. epiglottitis.
Rationale: Correct answer
D. severe asthma.
Rationale: This is a lower airway condition resulting in intermittent
wheezing and excess mucus production.
Review
7. Treatment for an semiconscious child who
swallowed an unknown quantity of pills
includes:
A. administering 1 g/kg of activated charcoal and
rapidly transporting.
B. monitoring the child for vomiting,
administering oxygen, and transporting.
C. positioning the child on his left side, elevating
his legs 6”, and transporting.
D. contacting medical control and requesting
permission to induce vomiting.
Review
Answer: B
Rationale: If a semi- or unconscious child has ingested
pills, poisons, or any other type of harmful
substance, closely observe him or her for vomiting,
give high-flow oxygen (assist ventilations if
necessary), and rapidly transport to the emergency
department. Do not give activated charcoal to any
patient who is not conscious and alert enough to
swallow. Induction of vomiting is not indicated for
anyone—regardless of age.
Review (1 of 2)
7. Treatment for an semiconscious child who swallowed an unknown
quantity of pills includes:
A. administering 1 g/kg of activated charcoal and rapidly transporting.
Rationale: Do not give anything by mouth to an individual who is not
conscious and alert enough to swallow.
B. monitoring the child for vomiting, administering oxygen, and
transporting.
Rationale: Correct answer
Review (2 of 2)
7. Treatment for an semiconscious child who swallowed an unknown
quantity of pills includes:
C. positioning the child on his left side, elevating his legs 6”, and
transporting.
Rationale: Placing the child in the recovery position is acceptable if
vomiting is possible, but the patient’s legs should remain flat.
D. contacting medical control and requesting permission to induce
vomiting.
Rationale: Inducing vomiting is not indicated for anyone at any age.
Review
8. A 4-year-old girl fell from a second-story balcony and landed on her
head. She is unresponsive; has slow, irregular breathing; a large
hematoma to the top of her head; and is bleeding from her nose. You
should:
A. immediately perform a rapid trauma assessment to detect other lifethreatening injuries, administer high-flow oxygen, and transport at
once.
B. apply a pediatric-sized cervical collar, administer high-flow oxygen via
pediatric nonrebreathing mask, and prepare for immediate transport.
C. manually stabilize her head, open her airway with the jaw-thrust
maneuver, insert an airway adjunct, and begin assisting her
ventilations with a bag-mask device.
D. suction her airway for up to 10 seconds, insert a nasopharyngeal
airway, apply a pediatric-sized cervical collar, and administer oxygen via
pediatric nonrebreathing mask.
Review
Answer: C
Rationale: This child has a severe head injury and is not
breathing adequately. You must manually stabilize her
head to protect her spine, open her airway with the
jaw-thrust maneuver, suction her airway if needed,
insert an oropharyngeal airway, and assist her
ventilations with a bag-mask device. The rapid trauma
assessment is performed after you have performed an
initial assessment and corrected any life threats. The
nasopharyngeal airway is contraindicated for this child;
she has a head injury and is bleeding from her nose.
Review (1 of 2)
8. A 4-year-old girl fell from a second-story balcony and landed on her
head. She is unresponsive; has slow, irregular breathing; a large
hematoma to the top of her head; and is bleeding from her nose. You
should:
A. immediately perform a rapid trauma assessment to detect other lifethreatening injuries, administer high-flow oxygen, and transport at
once.
Rationale: A rapid trauma exam is performed after the initial assessment
and life-threats are corrected.
B. apply a pediatric-sized cervical collar, administer high-flow oxygen via
pediatric nonrebreathing mask, and prepare for immediate transport.
Rationale: Assisted ventilations must be started on a patient with slow,
irregular respirations.
Review (2 of 2)
8. A 4-year-old girl fell from a second-story balcony and landed on her
head. She is unresponsive; has slow, irregular breathing; a large
hematoma to the top of her head; and is bleeding from her nose. You
should:
C. manually stabilize her head, open her airway with the jaw-thrust
maneuver, insert an airway adjunct, and begin assisting her
ventilations with a bag-mask device.
Rationale: Correct answer
D. suction her airway for up to 10 seconds, insert a nasopharyngeal
airway, apply a pediatric-sized cervical collar, and administer oxygen via
pediatric nonrebreathing mask.
Rationale: A nasopharyngeal airway is contraindicated with potential
facial injuries. Ventilations need to be maintained with a bag-mask
device.
Review
9. A child with severe croup would MOST likely
present with:
A. a high fever, difficulty breathing, and wheezing.
B. a low-grade fever, respiratory distress, and
stridor.
C. a high fever, chest congestion, and respiratory
distress.
D. an absence of fever, drooling, and difficulty
breathing.
Review
Answer: B
Rationale: Croup—also called
laryngotracheobronchitis—is a viral infection
of the upper airway. It is characterized by a
slow onset of low-grade fever, a seal-bark
cough, and varying degrees of respiratory
distress. In severe cases, airway swelling may
be so severe that the child has stridor—a highpitched sound heard during inhalation.
Wheezing—a whistling sound heard while
auscultating the lungs—indicates a lower
airway problem (ie, asthma, bronchiolitis), not
croup.
Review
9. A child with severe croup would MOST likely present with:
A. a high fever, difficulty breathing, and wheezing.
Rationale: Wheezing indicates a lower airway condition (ie, asthma,
bronchiolitis).
B. a low-grade fever, respiratory distress, and stridor.
Rationale: Correct answer
C. a high fever, chest congestion, and respiratory distress.
Rationale: Croup is an upper airway condition not associated with
chest congestion.
D. an absence of fever, drooling, and difficulty breathing.
Rationale: The child will have a low-grade fever and possibly stridor in
severe cases.
Review
10. A 7-year-old boy is apneic and pulseless, possibly due to an ingestion
of his father’s high blood pressure medication. You should:
A. analyze his cardiac rhythm with the AED after 5 minutes of high-quality
CPR, deliver up to 3 shocks in a row, and then resume CPR.
B. perform CPR, avoid the use of the AED since the child’s cardiac arrest
was likely caused by a toxic ingestion, and transport immediately.
C. apply the AED and immediately deliver a shock, begin high-quality CPR,
and then contact medical control for further direction.
D. begin CPR, apply the AED, analyze his cardiac rhythm after 2 minutes,
defibrillate one time if indicated, and immediately resume CPR.
Review
Answer: D
Rationale: The treatment sequence for a child in
cardiac arrest is no different from that of an
adult. Begin CPR, apply the AED, analyze the
child’s cardiac rhythm after 2 minutes, defibrillate
one time if indicated, and immediately resume
CPR starting with chest compressions. If you
suspect a toxic ingestion, ask the parent to
retrieve any medication bottles and bring them
with you to the hospital.
Review (1 of 2)
10. A 7-year-old boy is apneic and pulseless, possibly due to an ingestion
of his father’s high blood pressure medication. You should:
A. analyze his cardiac rhythm with the AED after 5 minutes of highquality CPR, deliver up to 3 shocks in a row, and then resume CPR.
Rationale: Perform quality CPR for 2 minutes, analyze the rhythm with an
AED, and deliver 1 shock if indicated.
B. perform CPR, avoid the use of the AED since the child’s cardiac arrest
was likely caused by a toxic ingestion, and transport immediately.
Rationale: After 2 minutes of quality CPR, deliver 1 shock with an AED if
indicated.
Review (2 of 2)
10. A 7-year-old boy is apneic and pulseless, possibly due to an ingestion
of his father’s high blood pressure medication. You should:
C. apply the AED and immediately deliver a shock, begin high-quality CPR,
and then contact medical control for further direction.
Rationale: Provide 2 minutes of quality CPR, initiated before a shock is
delivered.
D. begin CPR, apply the AED, analyze his cardiac rhythm after 2 minutes,
defibrillate one time if indicated, and immediately resume CPR.
Rationale: Correct answer