Transcript Pediatrics - Advocate Health Care

Pediatric
Challenges
October 2012 CE
Condell Medical Center
EMS System
Site Code: 107200E -1212
Prepared by Sharon Hopkins, RN, BSN, EMT-P
1
Objectives
Upon successful completion of this module, the EMS
provider will be able to:
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1. Describe developmental stages in the
pediatric population.
2. Describe anatomical differences in the pediatric
population.
3. Describe components and purpose of the pediatric
assessment triangle.
4. Describe the ABC assessment relative to the
pediatric patient.
2
Objectives cont’d
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5. Differentiate between respiratory distress and
respiratory failure in the pediatric population.
6. Discuss a variety of pediatric challenges (ie:
FBAO, asthma, RSV, meningitis, chicken pox)
7. Discuss appropriate interventions for a variety of
pediatric emergencies.
8. Discuss rationale for using 250 ml IV bags in pediatric
populations
9. Actively participate in scenarios of the
pediatric population.
10.Successfully complete the post quiz with a
score of 80% or better.
3
So, what’s a normal kid like?
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We know each of our own children are
different
We know each of our patients are different
We know every call we go on is unique to
itself
BUT…
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There are similarities that can be drawn for
comparison
4
Growth and Development
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Developmental stages
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Newborn – first hours after birth
Neonates – birth to one month
Infants – 1-12 months
Toddlers – 1 – 3 years
Preschoolers – 3 - 5 years
School-age – 6 – 12 years
Adolescents – 13 – 18 years
5
Newborn – First Hours After Birth
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Typical assessment tool – APGAR
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Helps identify newborns from those that need
routine care at birth from those that need more
assistance
Can predict long-term survival
Resuscitation, if needed, follows inverted
pyramid for the newborn

Drying, warming, positioning, suction, tactile
stimulation are interventions are the first steps
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These are usually the only interventions needed for the
majority of newborns
6
Inverted Pyramid of Neonatal
Resuscitation
7
Neonate – Birth to 1 Month

Common illnesses
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Jaundice
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Vomiting
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Yellow coloring from breakdown of old red blood cells
called bilirubin
Bilirubin is broken down by the liver for excretion in
stool
Lab test may be required to determine levels
May lead to dehydration
Respiratory distress
8
Neonate cont’d
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Fever may be only sign of a problem
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ALL infants with fevers need to be evaluated
9
Neonate Assessment
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Keep newborn warm
Absence of tears may indicate dehydration
To auscultate breath sounds, helpful to have
newborn suck on pacifier
Keep newborn with parent/caregiver to keep
child calm
Obtain history from parents/caregiver but
observe child for important clues
10
Infant – 1 – 12 months
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Double weight by 6 months; triple by 1 year
Should follow movements with their eyes
Muscle development moves from head to toes
and from trunk toward extremities
FB obstruction risk high – this population
explores their world with their mouths
Increased anxiety to strangers
11
Infant cont’d
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Common illnesses and accidents
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Febrile seizures
Diarrhea
Bronchiolitis
Croup
Poisonings
Airway obstruction
Vomiting
Dehydration
Car crashes
Child abuse
Falls
Meningitis
Keep child with parent
Assess toe to head to gain their trust
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Toddler – 1 – 3 years
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Increase in motor development
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Language development begins
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Always seem to be on the move
Becoming braver, more curious & stubborn
Can understand better than they can speak
Avoid questions that allow the child to say “no”
EMS can ask the patient simple questions
 Still rely on parent/caregiver for information
Perform exam toe to head approach
Allow child to hold a favorite object if possible
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Preschooler – 3 – 5 years
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Increase in fine and gross motor movement
Language skills increase
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Vivid imaginations
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If frightened, may not speak especially to strangers
“Monsters” are part of their world
Fear mutilation
Child can provide more information regarding
the nature of the call; note the imagination
factor though
14
Preschooler cont’d
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Allow child to hold some of the equipment
Assess starting with the chest; assess the head
last
Watch for misleading comments – remember
the wild imagination
Explain what you are doing immediately
before performing a task
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School-aged – 6 – 12 years
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Developing personality
Values peers but protective and proud of
family
Interview child for history but they may hold
back if they were involved in forbidden
activity
Be respectful of child’s modesty
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Adolescent – 13 – 18 Years
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This age group begins with puberty
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Highly variable age – can begin at various ages
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Typically 13 for males
Typically 11 for females
Physical maturity does not always equal
emotional maturity!
Demanding more independence from
parents/caregivers
This group is body conscious and concerned
over disfigurement
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Respect their sense of privacy
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Common Fears of Children
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Fear of being separated from
parents/caregivers
Fear of being removed from family
Fear of being hurt
Fear of being mutilated or disfigured
Fear of the unknown
18
Approach to the Child
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Children have a right to be informed
Be as honest as possible but in the appropriate
manner
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If something will hurt, tell them right before it is
done and then quickly perform the task
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Don’t want anticipation fear to build
Use plain language appropriate to the age
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Also helpful for the parents
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Metabolic Differences Increasing
Risk of Hypothermia
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Limited store of glycogen and glucose used for
energy
Greater body surface area by weight
Volume loss due to vomiting and diarrhea
Inability to shiver in newborns and neonates
 Unable to generate additional heat if needed
when cold
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Typical Anatomical Differences
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Larger body surface
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Tongue proportionately larger & floppier
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Straight blade preferred during intubation
Smaller airway structures
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More prone to hypothermia
Airway more easily blocked by minimal swelling
Head heavier and neck muscles less well
developed
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Higher incidence of head injuries
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Anatomical Differences cont’d
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Head larger in proportion to body
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Shorter, more flexible trachea
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Head extension may close off trachea
Abdominal breathers
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When flat, neck flexes; neutral alignment difficult
Less developed chest muscles
Not typically seen in the adult population
Faster respiratory rate
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Muscles tire easily
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Airway Differences
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Infant larynx higher which facilitates infants
being nose breathers
23
Primary Assessment
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Pediatric assessment triangle
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An assessment from across the room when first
observing the patient
Visual assessment prior to patient contact
Helps in forming your general impression
Appearance
Breathing
Circulation
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Pediatric Assessment Triangle
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Appearance
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Breathing
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Mental status and muscle tone
Work of breathing
Respiratory rate and effort
Circulation
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Circulatory status
Skin signs and color
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Continuing the Assessment
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Level of consciousness
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Can still use AVPU scale
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“A” if eyes are open; can be alert or confused
“V” if there is a response to noise or yelling when
eyes are closed
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Response may be whimpering or crying
“P” for any response to noxious/painful/tactile
stimuli
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Technique adjusted based on child’s age
This includes withdrawal or any muscle twitch
“U” when they are flaccid and unresponsive
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Assessment cont’d
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A-B-C’s
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Airway and respiratory problems are the most
common causes of arrest in infants and children
 Is airway open?
 Is airway patent?
 Does the patient require positioning?
 Suctioning?
 Limit to <10 seconds
 Adjuncts?
 If yes, which ones???
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Neutral Position for Airway Control
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Jaw thrust with gentle support
 Padding
under shoulders and back
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Craniofacial Anomalies
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Anomalies may alter
normal approaches and
cause creative use of
equipment
This patient has Crouzon’s
syndrome
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Malformation of the skull
and facial bones
How would you adjust
your techniques?
29
Assessing Breathing
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Look at the chest
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Listen for breath sounds
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Is the chest rising and falling?
Do you hear anything? Normal? Abnormal?
Feel for air movement at the patient’s mouth
Evaluate respiratory rate, effort, & color
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Cyanosis is a late sign of respiratory failure
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Noticed first in mucous membranes of mouth and nail
beds
Cyanosis of extremities more likely from shock
30
Assessing Circulation
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Visually check the color
Check capillary refill in a central area
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Evaluate heart rate
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Bradycardia indicates hypoxia & impending arrest
Evaluate peripheral pulses
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More reliable checking the chest or forehead area
Loss of central pulses is ominous sign
 <1 check brachial or femoral pulses
 >1 check carotid pulses
Evaluate end-organ perfusion – skin and brain
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Check mental status
31
Respiratory Distress
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Most notable sign is an increased work of
breathing
Respiratory rates often underestimated
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Best to count the rate for a full minute in children
Note a normal mental status increasing to
irritability or anxiety
Respiratory rate increasing
32
Respiratory Distress
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Retractions
Nasal flaring in infants
Head bobbing – trying to inhale more oxygen
Grunting – increasing peep on exhalation
Wheezing
Gurgling
Stridor
33
Respiratory Distress
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Sternal retractions
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Nasal flaring
Tripod position
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Signs of Respiratory Distress
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Children use tremendous energy
to maintain homeostasis
When compensatory mechanisms
have been exhausted, they crash
fast
If you were surprised the patient
crashed, then you probably
missed the signs
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Respiratory Failure
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Uncorrected respiratory distress
Irritability/anxiety deteriorating to lethargy
Marked tachypnea now presenting as bradypnea
Marked retractions now presenting as agonal
respirations
Poor muscle tone
Marked tachycardia now presenting as bradycardia
Central cyanosis
Hypoxia
36
Respiratory Failure cont’d
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If immediate and appropriate interventions are
not taken, the patient will respiratory arrest
The pediatric patient that moves into
respiratory arrest is difficult to manage
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Outcomes are not predictable
The best treatment is prevention and avoidance
of this stage
37
Pediatric Challenges
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Foreign bodies with airway obstruction
Asthma
Dehydration
Meningitis
Chicken pox
38
Airway Obstruction
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Could be from foreign body or internal swelling
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Typical sequence of events from aspiration
 Coughing
 Choking
 Gagging
 Wheezing
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Complete occlusion
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Views of Epiglottis
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Normal view epiglottis and vocal cords on left
Collapse of the epiglottis on right
40
Foreign Body Airway Obstruction
FBAO
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You never know what they put in their mouths
Case file:
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2 year-old presents with acute airway obstruction
History of noisy breathing and hoarseness for
multiple months
Patient presents with labored breathing, rapid
respiratory rate, very anxious appearing, is
drooling
What intervention is required in the field?
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FBAO
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If patient is able to exchange air, provide rapid
transport in position of comfort
If unable to breath, provide abdominal thrusts if <1
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Continue thrusts until improvement or collapse
 If patient collapses and stops breathing, perform CPR
 Stop to look in mouth prior to the ventilations
Prepare equipment
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Magill forceps
Intubation equipment
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FBAO
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Lateral x-ray results
reveal FB
Surgical intervention to
remove FB swallowed
by 2 y/o
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Asthma
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Lower airway disease
Reversible chronic inflammatory disorder
Evidence of bronchospasm and excessive
mucous production
Can be induced by multiple triggers
Symptoms represent phases of the attack
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Asthma
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First phase – release of histamines
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Bronchoconstriction
Bronchial edema
May respond to inhaled bronchodilators
Second phase – inflammation of bronchioles
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Additional edema decreasing more airflow
Need anti-inflammatory agent (ie: corticosteroids)
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Asthma
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Continued attack
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Continued swelling of mucous membranes in
bronchioles
Plugging of airways by mucous plugs
Sputum production increases
Airflow restricted in exhalation
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Lungs hyperinflated on exhalation
Vital capacity decreased
Gas exchange decreased in alveoli
Hypoxemia worsens
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Asthma
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Important assessment aspects
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Ask if the patient has ever been intubated for an
attack
 Clue patient may deteriorate quickly
What is their posture/positioning?
 Sitting up & leaning forward (tripod) indicates
respiratory distress
Are they able to speak in full sentences?
 2-3 word sentences indicate respiratory distress
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Asthma Diagnosis
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Differentiated usually by history taking
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History of previous episodes
Use of inhalers
Usually sitting up, leaning forward, tachypneic
Unproductive cough
Use of accessory muscles
Bilateral wheezing
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Silence is ominous – exchange of air is limited
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Asthma Management
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Goals:
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Correct hypoxia
 Provide supplemental oxygen
Reverse bronchospasm
 Administer nebulized bronchodilator
medications
Decrease inflammation
 Medication added at the hospital
49
Bronchodilator
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DuoNeb
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Albuterol 2.5 mg / 3 ml
Atrovent (Ipratropium) 0.5 mg / 2.5 ml
 Document by name of meds used and dosage
May repeat Albuterol neb treatment if no
improvement
In severe cases, prepare for intubation with in-line
treatment
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May bag the patient forcing medication into the airway
while preparing the intubation equipment
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Nebulizer
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Need to be able to assemble the various parts
Aerosol mask versus mouthpiece
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Aerosol Mask
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Used when the patient cannot tolerate putting
their lips around the mouthpiece
Aerosol mask designed for nebulizer use
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Specific exhalation port hole size
No rubber valves
Aerosol mask
Non-rebreather mask
not the same device!!!
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Nebulizer Kit vs In-line Kit
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Standard Neb treatment
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In-line set-up pieces to
add
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Increasing Success Rate of Nebulizer
Use
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Assist patient in sitting upright
Coach patient through procedure with calm,
quiet, firm tone of voice
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Coach patient into slowing respiratory rate
Coach patient into inhaling deeper
Coach patient into holding their breath and
eventually increasing the timing
Need to get the medications into the lungs to
have any effect
54
RSV
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Respiratory syncytial virus
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A common virus
In older healthier persons produces mild, cold-like
symptoms
Can be serious in young babies
 Causes lung infection
Infections begin in fall and run into spring
Spread by tiny droplets
 Coughing, sneezing, blowing nose
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RSV
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Transmission
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Exposure to the tiny droplets
Touching, kissing, shaking hands with infected
person
Touching contaminated surface (i.e.: doorknob,
phone) and then touching your mucous membranes
 Virus lives ½ hour plus on hands
 Virus lives several hours on used tissues
 Virus lives up to 5 hours on countertops
56
RSV
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Symptoms appear 4-6 days after contact
Infants <1 have more severe symptoms
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Cyanosis
Dyspnea
Cough
Fever
Nasal flaring
 Tachypnea
 Shortness of breath
 Stuffy nose
 Wheezing
57
RSV
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Treatment
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Antibiotics do not help (this is a virus)
Humidified oxygen
IV fluids
Prevention
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Frequent hand washing especially before touching
infants
Avoid direct contact with infants if you have a cold
or fever
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Meningitis
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Inflammation of the protective covering of the
brain and spinal cord
Bacterial form – the more deadly
Transmission – droplets with close contact
Prevention – immunization
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Routine in childhood since 1980’s
Treatment – antibiotics
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High mortality rate if untreated
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Meningitis
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Typical presentation
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Severe headache
Stiff neck – unable to flex forward without pain
Fever
Confusion
Vomiting
Light sensitivity
Sometimes a rash
If suspected, then EMS provider to put on N95 mask
and then place a surgical mask on the patient
60
Chicken Pox
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Viral infection with development of itchy
blisters – varicella zoster virus
Transmission
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Contagious until all lesions have crusted over
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Airborne with coughing and sneezing or with
direct contact with secretions from the blisters
Infectious starting 1-2 days before rash develops
Rarely fatal but can include more severe
complications in adults
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Late complication in adults is shingles
61
Chicken Pox
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If you are caring for a patient with chicken pox, is
there concern for transporting the virus home to your
family?
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NO!
 The virus does not live long out of it’s host and is only a
risk to the ones directly exposed to respiratory droplets
or the moist blisters
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You are at risk of contracting chicken pox if you
have never had the disease or been vaccinated
Handwashing remains a very important part of
infection control practices
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Chicken Pox
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In children, first sign is usually the rash
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Small red dots on face, scalp, torso, upper arms,
upper legs
In older persons, early signs present
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Nausea
Loss of appetite
Aching
Headache
63
Chicken Pox
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Prevention
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Isolate cases
Virus easily killed with disinfectants (ie: chlorine
bleach
Antiviral meds if started soon after rash noticed
Shingles – herpes zoster
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Affects 1 in 3 adults
Can be very painful
 Causes nerve and skin inflammation
64
Shingles
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Painful, blistering skin rash from varicellazoster virus
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Same virus as chicken pox
Virus dormant in body for years after incident
of chicken pox
Vulnerable persons
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Age over 60
Having chicken pox under the age of 1
 Less developed immune system
Immunocompromised person
65
Shingles
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Pain may last for months or years
66
Shingles
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If you are in contact with lesions you can
develop chicken pox; not shingles
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First symptoms usually one-sided pain
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More likely if you have never had chicken pox or
have not been vaccinated
Rash develops after the pain
Treatment
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Antiviral medications if started soon enough
Anti-inflammatory (corticosteroids) for comfort
Pain medications
67
Trauma
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Trauma is the number one cause of deaths in
infants and children
Most injuries are from blunt forces
Pediatric differences
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Thinner cavity walls –forces more easily
transmitted
More trauma to the underlying organs than there
are to bony ribs
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Ribs more pliable in the peds population than adult
68
Cardiac Contusion
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Similar to any other muscle that has been
bruised
BUT…
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This injury may reduce cardiac contractile strength
and reduce cardiac output
Electrical conduction system may be disrupted
Carefully monitor cardiac rhythm
69
Commotio Cordis
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Rare event
VF induced by a blow to the chest wall
Leading cause of death in young athletes
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Average age 13 years
Only 15% of victims successfully resuscitated
 Condition usually unrecognized initially or
misdiagnosed leading to a delay in CPR and
defibrillation
GOAL: CPR and immediate defibrillation

Treat like VF from any other cause
70
Pediatric VF SOP
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Prepare to defibrillate as soon as possible
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CPR if any delay
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1 man CPR peds 30:2
2 man CPR peds 15:2
Once intubated, asynchronous compressions; ventilate
once every 6-8 seconds
Defib 2 j/kg or equivalent biphasic
Resume chest compressions immediately after
each defib attempt
Successful defib attempts at 4 j/kg
Establish IV/IO access
71
Peds VF cont’d
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Meds
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Epinephrine 1:10,000 - 0.01 mg/kg IVP/IO
 Repeat every 3-5 minutes
Amiodarone 5 mg/kg IVP/IO
 Adult max is 300 mg first dose
 Repeat dose in 3-5 minutes at 5 mg/kg IVP/IO
Alternate the above 2 drug categories during rounds
of CPR
Search for treatable causes (i.e.: H’s and T’s)
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Consider causes of arrest as soon as situation identified
72
Resources for Pediatric Arrest
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Broselow tape to determine size of child and
recommended size of equipment to use
SOP drug reference charts

Use charts in the SOP’s for specific drug dosing
following Region X SOP’s
 Broselow tape may follow a different schedule of
dosing based on weight when range of dosing is
listed
 Suggest use of TB syringe for dosages under 1 ml
 Suggest use of 3 ml syringe for doses 1-3 ml
73
Fluid Challenges in the Pediatric
Population

Remember
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Total blood volume is relative to body size
 Total blood volume typically 85 ml/kg
An infant has approximately 350 ml total blood
volume
 Equivalent to 1 can of soda
A child has approximately 2 L total blood volume
 Equivalent to a large bottle of soda
74
Total Blood Volume

Probably less volume per the unique
population than you would visualize
75
Blood Loss – Typical 6 year old
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Average weight 62 pounds = 28 kg
 Total blood volume 85 ml/kg = 2380 ml
 Class I shock - <15% (<357 ml)
 Class II shock – 15-30% (357 – 714 ml)
 Class III shock – 30-40% (714 - 952 ml)
 Class IV shock - >40% (>952 ml)
Compensated shock in Class I & II
Decompensated shock by Class III
 Falling blood pressure is the key
 Falling blood pressure is also a LATE sign
76
Pediatric Fluid Challenges

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IF a patient needs fluid replacement, the formula is
20 ml per kg for all ages
Monitor the adult as every 200 ml is infused

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Monitor smaller patients as often as necessary
Example: 6 y/o (62# = 28 kg) would get 560 ml

A runaway IV of 1 liter of fluid could fluid overload the
small patients
 EMS must control fluid infusion by careful observation
along with hanging small sized IV bags
 IV bags may need to be changed more often but
child won’t be in failure due to fluid overload
77
Drug Calculation and Preparation
Practice


Work in small groups
Prepare meds used for VF for various age groups as
you would on the call
 Draw up Epinephrine and Amiodarone as you
would on a call






10 pound patient
18 pound patient
36 pound patient
42 pounds
58 pound patient
62 pounds
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Scenario Practice





Read the following scenarios
Describe the pediatric assessment triangle
Determine your general impression
Decide which SOP to follow
Discuss treatment options determined to be
necessary
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Scenario #1


You are called to the scene for an 18 month old
child choking
Upon arrival the child is on the mother’s lap





Child anxious, frightened looking
Coughing, drooling
High pitched stridor heard from doorway
Retractions evident
Appears dusky
80
Scenario #1

Pediatric assessment triangle




General impression?


Appearance?
Work of breathing?
Circulation?
Airway obstruction
SOP to follow

2010 AHA obstructed airway guidelines if obstruction is
complete
 CPR with pause to look into airway prior to ventilations
resuming
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Scenario #1

What assessments would be important in this
case?

History





If sudden onset think FB
If gradual onset consider a medical problem
A positive history should never be ignored
 BUT…
 A negative history may be misleading
Auscultation of breath sounds
Visualization of oral area with out use of probing
instruments
82
Scenario #1
Removal of FB in the ED

Your goal – try not to excite child; allow patient
to dictate best position to maintain open airway –
they often do this instinctively
83
Scenario #2

You are called to the scene for a 5 y/o child
found unresponsive in the backyard



Upon arrival, the child is unconscious, not
breathing and there is no pulse
Parents state that other children were in backyard
playing with patient
What is your first action after scene
survey/scene safety?

Begin CPR while preparing to apply the cardiac
monitor
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Scenario #2

What is the rhythm strip?
NO PULSE!!!
PEA

What is your next intervention?


Resume CPR
Search for treatable causes – H’s and T’s
85
Scenario #2

What is the ratio of chest compressions to
ventilations?




1 man CPR all patients 30:2
2 man CPR in infant and child 15:2
Once advanced airway in place, compressions with
out stopping, ventilations performed once every
6-8 seconds (same for all persons except neonate)
Have you asked/considered why this child
would have arrested? Have you checked the
environment?
86
Scenario #2

What is the treatment for PEA?

A vasopressor is the only drug given
 Use epinephrine 1:10,000 IVP/IO
 Stimulates vasoconstriction to improve
blood flow
 Also stimulates heart which is not needed in
this situation but comes with the use of this
medication
 Dose repeated every 3-5 minutes
 No limit to epinephrine
87
Scenario #2

When do you check pulses during CPR?



Pulses are checked on all patients when first
assessed
If patient remains in VF or asystole, pulses will
never be rechecked
If patient presents with VT or any rhythm that
should produce a pulse, then pulses will be
checked every 2 minutes during 10 second pause
in CPR
88
Scenario #2

Why would this child be in PEA?


Consider the H’s and T’s
Follow-up:




Child was shot in chest with a BB gun
The other children were too frightened to confess
BB was lodged in the heart
The small entrance wound on the chest wall was
overlooked
89
Endotracheal Tubes With/Without
Cuffs


Newer investigations question old practices
Children can be intubated with cuffed ETT



There is little evidence to indicate that cuffed tubes
are more dangerous than uncuffed tubes in
children
The volume in the cuff can be regulated to avoid
undue pressure on the tracheal wall
A cuffed airway device better protects the airway
from aspiration
90
Cuffed versus Uncuffed ETT

Cuffed ETT are appropriate in all patients




Are no more dangerous than uncuffed tubes
More secure airway with cuff in place
Cuffs are adjustable so pressure against wall of
trachea can be controlled and regulated
Uncuffed tubes often too small or too large


Too small and airway is not secured and aspiration
not as well controlled
Too large and there is too much pressure against
91
the wall of the trachea causing tissue damage
Scenario #3






You are called to the scene for a 6 year old
with history of asthma having an asthma attack
Sudden onset of wheezing
Anxious, sitting up leaning forward
Using accessory muscles
Audible wheezing
What’s your impression?

Asthma attack
92
Scenario #3

What else needs to be done for assessment?

Auscultate breath sounds


Obtain pulse oximetry reading


Hear wheezing on the right, clear on the left
SpO2 92%
What is your interpretation of the breath sounds
and pulse ox?



Asthma should produce bilateral wheezing
Consider FB if wheezing is only unilateral
If oxygen sat is low – administer supplemental oxygen
93
Scenario #3


History of asthma confuses the presentation
This is most likely a FBAO; not asthma



Unilateral wheezing
Sudden onset without likely provocation
Be careful of tunnel vision and being
swayed by history
94
Scenario #3



Peanut in bronchus found on exam at hospital
Inspiratory film on left
Expiratory film – trapped air on patient’s left
95
Scenario #3

Progression of disease process of FB

Child aspirates



Will display signs of obstruction immediately or
become asymptomatic
Complications develop due to the lodged FB




Coughs, chokes, gags, wheezes
Adjacent structures can erode
There is formation of granular tissue to wall off the FB
Child may develop a change in health (i.e.: noisy
breathing, snoring, coughing) that wasn’t previously
present
Surgical procedure required to remove the FB
96
Scenario #4





You are called to the scene for a 16 year-old
child ill with fever
Upon arrival the child is pale with flushed
cheeks, listless, no evidence of respiratory
distress
Skin is hot to the touch
They complain of body aches all over
Patient complains of increased pain when neck
is moved
97
Scenario #4

What is your general impression?


Consider bacterial infection
 Bacterial meningitis
What precautions need to be observed?


Consider transmission routes via respiratory
droplets
 First mask yourself with the Hepa filter mask
or N95
 Then mask the patient with a surgical mask
Inform Medical Control of suspicions ASAP
98
Scenario #4

If patient is diagnosed with a contagious
disease, the EMS providers will be notified


Appropriate interventions will be discussed based
on nature of exposure
 If exposure is to meningitis, exposed persons
will be treated prophylactically with oral
antibiotic therapy
Remember to complete the exposure form, if
indicated, based on nature of call
99
100
Bibliography








Bledsoe, B., Porter, R., Cherry, R. Essentials of Paramedic
Care 2nd edition Update. Brady. 2011.
Limmer, D., O’Keefe, M. Emergency Care 12th Edition. Brady.
2012.
Region X SOP’s IDPH Approved January 6, 2012
Walraven, G., Basic Arrhythmias 7th Edition. Brady. 2011.
http://www.meddean.luc.edu/lumen/meded/elective/ent/lecture
2/img065.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231400/
www.spine.org/Documents/NATA_Prehospital_Care.pdf
http://www.cdc.gov/vaccines/vpd-vac
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