Transcript Pediatric emergencies

Pediatric Patients
& Emergencies
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Family Matters
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When a child is ill or injured, you may
have several patients, not just one.
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Children mimic caregiver behavior
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Be calm, professional, and sensitive.
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Anatomic Differences
Less circulating blood
 Lose body heat more easily
 Bones are more flexible
 Less fat surrounding organs
 Could be much internal damage with
little external visible trauma
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Skeletal Differences
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Bones are prone to fracture
with stress.
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Infants have two openings in
the skull called fontanels.
– close by 18 months.
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Airway Differences
– Larger tongue relative
to the mouth
– Less well-developed
rings of cartilage in
the trachea
– Head tilt-chin lift may
occlude the airway.
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Breathing Differences
Infants breathe faster than children
or adults.
 Infants use the diaphragm when
they breathe.
 Sustained, labored breathing may
lead to respiratory failure.
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Circulation Differences
The heart rate increases for illness
and injury
 Very effective vasoconstriction
keeps vital organs nourished
 Pale, extremities, decreased cap
refill are early signs of perfusion
problems
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Approach to Assessment
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level of activity, work of breathing, and skin color
cap refill
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ALS backup or immediate transport?
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Pediatric patients crash harder than adults
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Transport to peds facilities when possible
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Capillary Refill
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Treatment Considerations
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Oxygen - treat same as adult – Use
“blow-by” administration if needed
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Patient position - same as adult
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*Remember* airway and breathing are
focus
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Growth and Development
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Usually grouped into stages
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Infant
Toddler
Preschool
School-age
Adolescent
Infant
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first year of life
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respond physical stimuli
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crying is main means of
expression
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have caregiver hold pt
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Toddler
1 to 3 years of age
 mobile
 may resist separation
 don’t like being
restrained
 can be distracted
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Preschool
3 to 6 years of age
 can understand directions
 can identify painful areas
 fearful of pain
 allow them to handle equipment
 explain what you are going to
do
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School-Age Child
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6 to 12 years of age
begin to think like adults
can be included when taking medical
history
should be familiar with physical exam
allow them to make choices when
possible
The Adolescent
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12 to 18 years of age
concerned about body image
may have strong feelings about being
observed
respect their privacy
they understand pain
explain any procedure
Notes
 never
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lie to a child
Vital Signs
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Respirations
Abnormal respirations are a common
sign of illness or injury
 Less than 3, count rise and fall of
abdomen
 Note effort of breathing/noises
 Note if they are crying
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Respiration Notes
Less than 12 breaths/min
 More than 60 breaths/min,
 ALOC and/or an inadequate tidal
volume
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= ventilation with a BVM device
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Pulse
Infants -brachial
or femoral
 Child- use carotid
 Count at least 1
minute
 Note strength
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Blood Pressure
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Use right size cuff
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Difficult scene? Don’t waste
time
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Under 3? No BP
Skin Signs
important sign
 feel for
temperature
and moisture
 always check
capillary refill
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Pediatric Problems
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Fever
–Common Causes
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Infections
Neoplasm (cancer)
Drug ingestion
Collagen vascular disease
High environmental temperatures
Emergency Care for Fever
Ensure BSI
 Begin passive cooling
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– Remove clothing/coverings
– Damp towels
No ice
 No alcohol
 No cold water baths
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Febrile Seizures
common in children 6 months to 6
years
 most caused by high fever
 hx of infection
 generalized grand mal seizure
 less than 15 minutes
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Treatment
ABC’s
 protect patient
 recovery position
 high flow oxygen
 suction prn
 passive cooling measures
 transport
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Dehydration
Dry lips and gums
 Fewer wet diapers
 Sunken eyes
 Poor skin turgor
 Sleepy or irritable
 Sunken fontanels
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Care for Dehydration
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Assess the ABCs
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Obtain baseline vital signs
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ALS backup may be needed for
IV administration
Airway Obstruction
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Croup
– An infection of the airway below the
level of the vocal cords, caused by a
virus
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Epiglottitis
– Infection of the soft tissue in the area
above the vocal cords
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Foreign body Aspiration
Croup
barking cough
 stridor
 wheezing
 rales
 accessory muscle use
 nasal flaring
 grunting
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Epiglottitis
 severe
dyspnea
 stridor
 inability
to swallow - DROOLING
 fever
 tripod
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position
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Foreign body aspiration
 Partial
Blockage
– coughing
– accessory
muscle use
– nasal flaring
– wheezing
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 Complete
Blockage
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no sound
no cry
stridor
cyanosis
loss of
consciousness
treatment
 ABC’s
 high
flow oxygen
 position of comfort
do not attempt to visualize the throat!
do not put anything into patient’s mouth.
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Asthma
 dyspnea
 wheezing
 accessory
muscle use
 nasal flaring
 respiratory rate - observe
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Treatment
 ABC’s
 high
flow oxygen
 position of comfort
 transport
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What is the most frequent
cause of cardiac arrest in
pediatrics?
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Respiratory arrest!
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want to save a pediatric
patient?
aggressive ventilation & high flow
oxygen
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USC video!
Pediatric respiratory distress
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Meningitis
Inflammation of meninges
 Bacterial or viral
 Permanent brain damage/death
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Signs and Symptoms of
Meningitis
Fever
 ALOC
 Headache
 Seizure
 Stiff neck
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Vomiting
 Photophobia
 Irritability
 Bulging
fontanel
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Neisseria meningitidis
rapid onset
 pinpoint cherry-red spots or larger
purple/black rash
 sepsis, shock, and death
 all suspected cases considered
contagious
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Treatment
BSI
 ABC’s
 protect patient
 high flow oxygen
 passive cooling for fever
 monitor for shock
 Transport
 Call ALS for backup if unstable
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Submersion Injury
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Drowning or near drowning
Second most common cause of
unintentional death
ABC’s
May be in respiratory or cardiac
arrest
C-spine precautions?
Be ready to suction
 Keep warm
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Poisoning
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Poisoning is common in children
Ask specific questions of caregivers
Focus on the ABCs
Give oxygen
Provide transport
Child’s condition could change at any
time
Pediatric Resuscitation Tape
Measure (Aka: Broslow tape)
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Used to
determine
height,
weight, and
proper
equipment.
Interossius IV
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Used if traditional IV sites are difficult
to assess
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Medication delivered into bone marrow
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Painful
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Interossius
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Transporting Infants and
Children
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Children require padding under the torso
Newborns should be in special incubators
Do not hold child during the actual transport
Drive with due care
Do not allow your emotions to take control
Sudden Infant Death
Syndrome
SIDS - “crib death”
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SIDS
 Definition
- unexplained death of
an apparently healthy infant.
 7500+ cases per year in U.S.
 Leading cause of death in infants
<1 year old
 more cases in winter months
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Sudden Infant Death
Syndrome (SIDS)
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Several known risk factors:
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Mother younger than 20 years old
Mother smoked during pregnancy
Low birth weight
Putting babies to sleep on stomach
Siblings of SIDS babies
Tasks at Scene
Assess and manage patient
 Communicate with and
support the family
 Assess the scene
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Assessment and
Management
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Diagnosis of exclusion
Can be other causes of condition
Regardless of cause, TX is same
Infant may have signs of postmortem
changes
It is ok to work up an obviously dead
baby
If no postmortem changes, begin CPR
immediately
Communication and Support
of Family
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The death of child is very stressful for the
family
Parents guilt is overwhelming
Provide support in whatever ways you can
IT IS NOT YOUR PLACE TO JUDGE
Use the infant’s name
Allow family time with the infant
Scene Assessment
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Inspect the environment, noting:
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Signs of illness, including medications
General condition of the house
Family interaction
Site where infant was discovered
Support Groups
 Know
your local phone numbers
for referrals
 Arrange
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for proper debriefing
Child Abuse
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Any improper or excessive action that
injures or harms a child or infant
physical, sexual, emotional abuse and
neglect
More than 2 million cases reported
annually
Be aware of signs of child abuse and
report it to authorities
Questions Regarding
Signs of Abuse (1 of 4)
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Is the injury typical?
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Is reported method of injury consistent with
injuries?
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Is the caregiver behaving appropriately?
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Is there evidence of drinking or drug abuse?
Questions Regarding
Signs of Abuse (2 of 4)
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Delay in seeking care?
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Good relationship between child
and caregiver?
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Multiple injuries at various stages of
healing?
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Any unusual marks or bruises?
Questions Regarding
Signs of Abuse (3 of 4)
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Are there several types of injuries?
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Any burns on the hands or feet
involving a glove distribution?
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Unexplained decreased level of
consciousness?
Questions Regarding
Signs of Abuse (4 of 4)
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Is the child clean and an
appropriate weight?
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Any rectal or vaginal bleeding?
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What does the home look like?
Other Indicators
Withdrawn, fearful or hostile child
 Refusal to discuss MOI
 History of “accidents”
 Conflicting stories
 Caregiver lack of concern
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Emergency Medical Care
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ABCs
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Transport if you suspect child
abuse
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Do not make accusations
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EMT-Bs must report all
suspected cases of child abuse
Sexual Abuse
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Children of any age or either gender
can be victims
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Limit examination
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Do not allow child to wash, urinate, or
defecate
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Document carefully
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Transport
EMS Response to
Pediatric Emergencies
You may experience a wide range
of emotions
 You may feel anxious
 Practice helps
 After difficult incidents, a
debriefing may be helpful
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stop
questions?
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