Transcript Document

Oklahoma
Prehospital Pediatric
Supplement
Developed by the Oklahoma EMSC Resource Center for the:
“Infants and Children Module of the
1994 EMT-Basic Curriculum”
PART 1: INTRODUCTORY
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Introduction
• OSDH-EMS approved
– PAC’s course to include in EMT-B 1998’s NSC in
1993
– USDOT-NHTSA: EMT-B 1994’s NSC in 1995
– EMSC Pediatric Supplement (Revision of PAC’s)
to include in EMT-B 1994’s NSC in 1996
• Mandatory inclusion into EMT-B courses
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PART 1: Introductory
This section covers the following informational areas.
- Emergency Medical Services for Children
- Injury Prevention Methodology
- Anatomy and Physiology
- Approaching Children
- Vital Signs Assessment
- Assessment Tools
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Objectives
• Define Emergency Medical Services for
Children (EMSC).
– Objective: 6-1.0
• Discuss how an integrated EMSC system
can affect patient outcome.
– Objective: 6-1.0 A
• Identify methods/mechanisms of injury
prevention for Infants and Children.
– Objective: 6-1.0 B
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Objectives (Continued)
• Identify two (2) anatomic and physiologic
differences between children and adults
regarding skin and body surface.
– Objective: 6-1.2 A
• Identify four (4) areas to consider when
taking the child’s history.
– Objective: 6-1.3 A
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Objectives (Continued)
• Describe important factors in taking and
interpreting vital signs. Objective: 6-1.3 B
–
–
–
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Pulse
Respirations
Blood Pressure
Temperature
• Identify a minimum of four (4) significant
differences between the adult and pediatric
airway which affect ventilation.
– Objective: 6-1.3 C
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Emergency Medical Services
for Children (EMSC)
OBJECTIVE: 6-1.0
• Definition
– A program designed to reduce child and youth
mortality and morbidity due to severe illness or
trauma.
• History
– 1984 Legislation
• National Management
– MCHB
– NHTSA
• Oklahoma Management
– OUHSC
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EMSC (Continued)
• National Resource Centers
– National EMSC-NRC
– National EMSC Resource Alliance (NERA)
• Oklahoma Resource Center
– Oklahoma EMSC Resource Center
• Oklahoma Education and Training
– Pediatric Specialty Courses
•
•
•
•
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PALS
PEPP
PPC
ENPC
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EMSC (Continued)
– Prehospital Curricula
• Pediatric ’94 NSC Supplement
• Injury Prevention
• Bystander Care
– Emergency 1st Care for Childcare Providers
– Childcare Health and Safety Courses
– Other Areas
• Pediatric Resource Library
– Education
– Assessment and Management Tools
– Information Center
• Instructional Outcome Statistics and Improvement
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EMSC (Continued)
OBJECTIVE 6-1.0 A
• Integrated EMSC Systems
–
–
–
–
–
–
–
–
–
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Prevention
Prehospital
E D’s
I C U’s
Rehab
Community
Psychological
Trauma Systems
State Agencies
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EMSC (Continued)
• Patient Outcome Affect
– Prevention
– Reduction
•
•
•
•
Emergencies
Disability
Death
Negative Impact
– Family
– Community
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Injury Prevention
OBJECTIVE 6-1.0 B
• Methodology and Mechanisms
– C P R and 1st Aid
• Training
• Certification
• Requirement
– Bicycle Safety
– Community Injury Prevention Programs
• Data Analysis
• Common Injury Specific Education
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Anatomy and Physiology (A&P)
OBJECTIVE 6-1.2 A
• Skin and Body Surface Area (BSA)
– Infants and Young Children
• Head = 20% BSA
• BSA Larger in Proportion to Body Mass
– Changes by Body Part through Childhood
– Assumes Adult as Adolescent
• Thin Skin and Less Subcutaneous Fat
• Prone to Hypothermia and Deeper Burns than Adult
• Resuscitation and Drug Therapy Reduced in
Hyperthermia
– Newborn Temperature Regulation Not Well
Developed
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A & P (Continued)
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Pediatric Approach
OBJECTIVE 6-1.3 A
• Obtaining a History
– Primary Caregiver
• Information
• Reassures and Calms
– Elements Similar to Adult
– Additional Elements
• Birth Weight
• Problems with Pregnancy
• Current Estimated Weight
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Pediatric Approach (Continued)
• Cooperation Enhancement
– Permit “Transition Phase”
– Level of Child
• Calm and Friendly Mannerism
– Cooperation of Child
– Uncooperative Child
• A-B-C’s Appropriate?
• Condition Known?
• Don’t Waste Time!
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Pediatric Approach (Continued)
• General Examination Guidelines
– Remain and Display Calmness
– Assessment
•
•
•
•
•
Life-Threatening = Head to Toe
Non-Life-Threatening = Toe to Head
Non-Traumatic = In Caregivers Lap/Arms
Use Assessment Tools
Take Opportune Advantages
– Color and Moistness of Mucous Membranes
– Presence of Tears
– Inspiratory Breath Sounds
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Pediatric Assessment Triangle
(PAT)
APPEARANCE
WORK OF BREATHING
CIRCULATION
TO
SKIN
PAT does not exclude an initial or focused assessment, but by precluding
it complements them giving opportunity for immediate interventions to be
established.
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Pediatric Trauma Score (PTS)
COMPONENTS
+2
+1
-1
WEIGHT
>20 kg
(>44 lbs)
10-20 kg
(22-44 lbs)
<10 kg
(<22 lbs)
PATENT
MAINTAINABLE
NON –
MAINTAINABLE
SYSTOLIC BP
(AUSCULTATED)
>90 mmHg
50-90 mmHg
<50 mmHg
(PALPATED PULSE)
RADIAL
CAROTID
NONE
MENTAL STATUS
Awake
VERBAL OR PAIN
UNRESPONSIVE
FRACTURES
NONE
CLOSED OR
SUSPECTED
WOUNDS
NONE
MINOR
MULTIPLE
OPEN OR
CLOSED
MAJOR
AIRWAY
BURNS OR
PENETRATING
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Other Assessment Tools
GLASGOW COMA SCALE (GCS)
EYES
MOTOR
VERBAL
4 SPONTANEOUS
6 OBEYS COMMANDS
5 ORIENTED/BABBLES
3 SPEECH
5 LOCALIZED PAIN
4 CONFUSED/CRYING
2 PAIN
4 WITHDRAWS TO PAIN
3 CRY TO PAIN
1 NONE
3 DECORTICATE/FLEXION
2 INCOMPREHENSIBLE
2 DECEREBRATE/EXTENSION
1 NONE
1 NONE
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AGE
kg
H-R
R-R
SYS-BP
DIAS-BP
TIDAL VOLUME
N-B
3
120-160
30-60
74-100
50-70
30-45 mL
1m
4
120-160
30-60
74-100
50-70
40-60 mL
2m
5
120-160
30-60
74-100
50-70
50-75 mL
3m
6
120-160
30-60
74-100
50-70
60-90 mL
6m
7
120-160
30-60
74-100
50-70
70-105 mL
8m
8
110-150
30-60
74-100
50-70
80-120 mL
10 m
9
110-150
30-60
74-100
50-70
90-135 mL
1y
10
90-140
20-40
82
54
100-150 mL
1 y
11
90-140
20-40
82
54
110-165 mL
2y
12
90-140
20-40
84
56
120-180 mL
2y
13
90-140
20-40
84
56
130-195 mL
3y
14
90-140
20-40
86
58
140-210 mL
3y
15
90-140
20-40
86
58
150-225 mL
4y
16
80-120
20-40
88
60
160-240 mL
4y
17
80-120
20-40
88
60
170-255 mL
5y
18
60-120
16-30
90
60
180-270 mL
5y
19
60-120
16-30
90
60
190-285 mL
6y
20
60-120
16-30
92
62
200-300 mL
7y
22
60-120
16-30
94
62
220-330 mL
7y
24
60-120
16-30
94
62
240-360 mL
8y
26
60-120
16-30
96
64
260-390 mL
9y
28
60-120
16-30
98
66
280-420 mL
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Vital Signs
OBJECTIVE 6-1.3 B
• PULSE
– CENTRAL
• Carotid
• Femoral
– PERIPHERAL
•
•
•
•
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Radial
Brachial
Popliteal
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Vital Signs (Continued)
– Monitor Pulse
• 30 seconds minimum
• Rate and Quality
• Central and Peripheral
– Tachycardia (Fast) and Triggers
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•
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Compensatory Mechanism
Shock
Anxiety
Fever
Pain
Medical Illness
Traumatic Injury
Environmental Insult
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Vital Signs (Continued)
– Bradycardia (Slow) and Triggers
•
•
•
•
•
•
End Stages Shock
Hypothermia
Hypoxia/Hypoxemia
Cardiac Pathology
Congenital Anomalies
Certain Medications
– Rates Decrease through Childhood to
Adolescence
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Vital Signs (Continued)
• RESPIRATION
– OBSERVATION
• Begins with P-A-T
• Prior to and During Exam
• For Following
–
–
–
–
Tachypnea (Fast) or Bradypnea (Slow)
Hyperpnea (Deep) or Hypopnea (Shallow)
Apnea (Absent)
Use of Accessory Muscles
» Intercostal, Subcostal, Subclavicular, or Diaphragmatic
– Noises
» Wheezing (Inspiratory and/or Expiratory), Grunting
(Expiratory), Rhonchi (Upper Airway Rattling), Rales (Lower
Airway Crackles)
– Nasal Flaring
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Vital Signs (Continued)
– Tachypnea (Fast) and Triggers
•
•
•
•
•
•
•
•
Compensatory Mechanism
Shock
Anxiety
Fever
Pain
Medical Illness
Traumatic Injury
Environmental Insult
– Monitor
• 30 seconds minimum
• Rate, Depth, and Quality
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Vital Signs (Continued)
• BLOOD PRESSURE
– Compensatory Mechanism Sustains
Normotension (Normal BP) Longer in Pediatrics
– Hypotension (Low BP) Confirms Decompensated
Shock
– Peripheral Pulse Presence
• Infants (Birth to 12 months) = Minimum Systolic
Pressure of 60 mmHg
• Children (1 year to 8 years) = Minimum Systolic
Pressure of 70 + (2 x Age in Years)
– Normal Diastolic = 2/3 Systolic
– Appropriate Size BP Cuff Mandatory
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Vital Signs (Continued)
• TEMPERATURE
– Protective Mechanism
• Environmental (Heat and Cold) Regulator
• Microbial Protection
– Assessment
• Rectally (Most Accurate): Normal = 36º C (96.8 º F)
• Axillary or Tympanic: Normal = 36.5º C (97.6 º F)
• Orally: Normal = 37º C (98.6 º F)
– Fever: Most common cause of seizure in infants
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Vital Signs (Continued)
• PULSE OXIMETRY
– Placement
• Proximal to Central Circulation
• Earlobe = Recommended Site
– Administer O2 if SAO2 < 95%
– CO binds with Hemoglobin 200 times faster than
O2
• Pulse Ox of NO VALUE in such case
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Airway: Pediatric vs Adult
OBJECTIVE 6-1.3 C
• Airway Differences
– Pediatric
• Head
– Prominent Occiput
• Tongue
– Larger
– More Anterior
• Epiglottis
– “U” Shaped
– Floppier
– Protrudes more in Laryngopharynx
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Airway (Continued)
– Pediatric (Continued)
• Trachea
– Shorter
» Infant: 4-5 cm
» Child: 8 cm
– More Flexible
– Rings Less Well Developed
• Smallest Airway Diameter = Cricoid Ring
• Larynx
– More Anterior
– More Cephalad
– Cords Shorter and Concave
• Lungs: (Tidal Volume Dependent on Diaphragmatic Movement)
– Adult Opposite that Mentioned
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Summary: Section 1
•
•
•
•
•
•
EMSC: Defined and Integrated
Pediatric Injury Prevention Methodology
Pediatric A&P vs Adult
Approach to Obtaining Medical History
Assessing and Interpreting Vital Signs
Pediatric vs Adult Airway
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