Transcript AEMT Transition - Unit 45

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
45
Pediatrics
Objectives
• Discuss how to approach the pediatric
patient.
• Review the Pediatric Assessment
Triangle and how to implement it with
pediatrics.
• Discuss common pediatric pathologies
and their corresponding management.
Introduction
• Managing pediatrics requires:
– Personal preparation
– EMS system preparation
– Hospital network system preparation
Approach: First Impression
• First impressions matter more to
children.
– They don't have the experiences to
make correct judgments.
– Get down to their level with the
caregiver present.
– Assessment starts as soon as you
arrive.
Approach a young child on the child’s level, with the caregiver present.
Parents and Caretakers
• Parents and caretakers know you are
there to help.
– It doesn't mean they trust you.
– Gaining parent's trust will help in
gaining the child's trust.
Assessment
• Assessment of the pediatric patient
differs from that of the adult patient.
• Rapid changes in anatomy, physiology,
and cognitive ability.
• Vitals change during development.
Assessment (cont’d)
• Pediatric Assessment Triangle
– Modifies traditional ABCs of airwaybreathing-circulation to “appearancebreathing-circulation.”
– Outside APGAR, PAT allows for objective
and reproducible evaluation of sick
pediatrics.
The Pediatric Assessment Triangle (PAT). (Used with permission of the American
Academy of Pediatrics.) Source: General Approach to Pediatric Assessment
Assessment (cont’d)
• Appearance
– Often the first clues to a problem are
found in the appearance.
– TICLS mnemonic can help.
 Tone
 Interactiveness
 Consolability
 Look/Gaze
 Speech/Cry
Assessment (cont’d)
• Breathing
– Ventilation needed for respiration.
– Respiration needed for energy and
cellular activity.
– Pediatric respiratory system is illequipped to handle significant
disturbances.
Assessment (cont’d)
• Circulation
– Relationship of pump, pipes, and fluid.
– When one fails, the other two have to
cover.
– Causes
 Volume loss
 Pump failure
 Low vascular tone
– IV versus IO access.
Case Study
• You are called to the home of a 5-yearold child who reportedly fell off a
climbing gym in his back yard, and now
has abdominal pain. The parents are
gone and the child is in the care of the
babysitter.
Case Study (cont’d)
• Scene Size-Up
– Standard precautions taken.
– Scene is safe, no entry or egress
problems.
– 5-year-old male, about 40-45 pounds.
Case Study (cont’d)
• Scene Size-Up
– Patient found sitting under tree in back
yard.
– MOI is fall from a jungle gym (fall <5
feet).
– Parents on way home, per babysitter.
Case Study (cont’d)
• Primary Assessment Findings
– Patient is responsive.
– Airway is clear.
– Breathing adequate, patient crying,
calms with babysitter.
Case Study (cont’d)
• Primary Assessment Findings
– Carotid pulse 120/min, peripheral pulse
present.
– Peripheral skin warm and slightly
diaphoretic.
– Good muscle tone.
Case Study (cont’d)
• How would you characterize this patient
according to PAT?
• What are the patient's life threats, if
any?
• What care should be administered
immediately?
Case Study (cont’d)
• Medical History
– None per babysitter
• Medications
– None per babysitter
• Allergies
– None per babysitter
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Pupils reactive to light, membranes
hydrated.
– Airway patent, patient breathing at
24/min.
– Central and peripheral pulses present,
90/minute.
– Skin is still warm, not as diaphoretic.
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings (continued)
– Pulse ox 100% with low-flow oxygen.
– Patient markedly calmer, interacting
appropriately.
– Abdomen is tender to lower quadrants,
no bruising, guarding, nor rigidity.
– Parents arrive home and consent to
transport.
Case Study (cont’d)
• Is the child improving or deteriorating?
• Is there any additional treatment or
change in treatment required?
• What is the likely underlying cause for
the emergency?
Case Study (cont’d)
• Care provided:
– Patient immobilized supine, secured for
transport.
– Low-flow oxygen.
– Transported with parent in front of
ambulance.
– Nonemergent transport to the hospital.
Summary
• Pediatric emergencies can be stressful
for the provider, the parent, and the
child.
• Approach to treatment of the pediatric
patient should follow the PAT (Pediatric
Assessment Triangle).
• Interventions should be provided based
upon need, and in concert with the
patient and/or parents if possible.