Ch 34 - Pediatric Emergencies

Wong-Baker FACES Pain Rating 0

No hurt (Wong-Baker FACES Pain Rating)

Blood Pressure Range for Neonates: 1 day to 4 days

60-76 Systolic Blood Pressure Range

Blood Pressure Range for Neonates: 4 days to 1 month

67-84 Systolic Blood Pressure Range

Blood Pressure Range for Infants: 1 month to 3 months

73-94 Systolic Blood Pressure Range

Blood Pressure Range for Infants: 3 months to 6 months

78-103 Systolic Blood Pressure Range

Blood Pressure Range for Infants: 6 months to 1 year

82-105 Systolic Blood Pressure Range

Blood Pressure Range for Children: 1 year to 2 years

85-104 Systolic Blood Pressure Range

Responsive Pulse Rate for Newborn to 3 months

85-205 beats/min

Blood Pressure Range for Children: 2 years to 7 years

88-106 Systolic Blood Pressure Range

Blood Pressure Range for Children: 7 years to 15 years

96-115 Systolic Blood Pressure Range

toddler

A child age 1 to 3 years.

epiglottitis

A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction.

school age

Children between ages 6-12 years.

Responsive Pulse Rate for >10 years

60-100 beats/min

Responsive Pulse Rate for 2 years to 10 years

60-140 beats/min

Responsive Pulse Rate for 3 months to 2 years

100-190 beats/min

Blood Pressure Range for Adolescents: 15 years to 18 years

110-131 Systolic Blood Pressure Range

Respiratory Rate for Adolescents 13-18 years

12-16 breaths/min

Respiratory Rate for School-Ages 6-12 years

18-30 breaths/min

Respiratory Rate for Preschool-Ages 4-5 years

22-34 breaths/min

Respiratory Rate for Toddlers 1 to 3 years

24-40 breaths/min

Respiratory Rate for Infants 1 month to 1 year

30-60 breaths/min

shaken baby syndrome

A syndrome seen in abused infants and children; the patient has been subjected to violent, whiplash-type shaking injuries inflicted by the abusing individual that may cause coma, seizures, and increased intracranial pressure due to tearing of the cerebral veins with consequent bleeding into the brain.

length-based resuscitation tape

A tape used to estimate an infant or child's weight on the basis of length; appropriate drug doses and equipment sizes are listed on the tape.

Neisseria meningitides

A form of bacterial meningitis characterized by rapid onset of symptoms, often leading to shock and death.

child abuse

A general term applying to all forms of abuse and neglect of children.

generalized tonic-clonic seizure

A seizure that features rhythmic back-and-forth motion of an extremity and body stiffness.

pediatrics

A specialized medical practice devoted to the care of the young.

pediatric assessment triangle (PAT)

A structured assessment tool used to rapidly form a general impression of the infant or child without touching him or her; consists of assessing appearance, work of breathing, and circulation to the skin.

A (Child Abuse Assessment Mnemonic)

Affect

Pediatric ABC's

Airway, Breathing, Circulation, Disability, Exposure

A (AEIOU TIPS)

Alcohol

AEIOU TIPS

Alcohol, Epilepsy/endocrine/electrolytes, Insulin, Opiates and other drugs, Uremia (kidney failure), Trauma/temperature, Infection, Poisoning/psychogenic causes, Shock/stroke/seizure/syncope/space-occupying lesion/subarachnoid hemorrhage. Mnemonic to assess causes of altered mental status.

Common sources of poisoning in children

Alcohol, aspirin and acetaminophen, cosmetics, household cleaning products, houseplants, iron, prescription medications, illicit (street) drugs (such as crack, cocaine, or PCP), vitamins

grunting

An "uh" sound heard during exhalation; reflects the child's attempt to keep the alveoli open; a sign of increased work of breathing.

whooping cough

An airborne bacterial infection that affects mostly children younger than 6 years, in which the patient is feverish and exhibits a "whoop" sound on inspiration after a coughing attack; highly contagious through droplet infection. Also called pertussis.

pertussis

An airborne bacterial infection that affects mostly children younger than 6 years, in which the patient is feverish and exhibits a "whoop" sound on inspiration after a coughing attack; highly contagious through droplet infection. Also called whooping cough.

apparent life-threatening event (ALTE)

An event that causes unresponsiveness, cyanosis, and apnea in an infant, who then resumes breathing with stimulation.

work of breathing

An indicator of oxygenation and ventilation; reflects the child's attempt to compensate for hypoxia.

meningitis

An inflammation of the meningeal coverings of the brain and spinal cord; it is usually caused by a virus or bacterium.

croup

An inflammatory disease of the upper respiratory system that may cause a partial airway obstruction and is characterized by a barking cough; usually seen in children.

tripod position

An upright position in which the patient leans forward onto outstretched arms with the head and chin thrust slightly forward.

sniffing position

An upright position in which the patient's head and chin are thrust slightly forward to keep the airway open; the optimum position for the uninjured child who requires airway management.

ALTE

Apparent Life-Threatening Event. An event that causes unresponsiveness, cyanosis, and apnea in an infant, who then resumes breathing with stimulation.

fontanelles

Areas where the neonate's or infant's skull has not fused together; usually disappear at approximately 18 months of age.

B (Child Abuse Assessment Mnemonic)

Bruises of varying ages

Consolability (TICLS)

Can the child be consoled or comforted by the parent or care giver or by the EMT? Or is the child's crying or agitation unrelieved by gentle reassurance?

adolescents

Children between ages 12 to 18 years.

preschool age

Children between ages 3-6 years.

C (Child Abuse Assessment Mnemonic)

Consistency of the injury with the child's developmental age

sudden infant death syndrome (SIDS)

Death of an infant or young child that remains unexplained after a complete autopsy.

D (Child Abuse Assessment Mnemonic)

Delay in seeking care

Provocation/palliation (Pediatric OPQRST)

Does anything make the pain or discomfort better or worse? In what position is the patient the most comfortable?

Look or gaze (TICLS)

Does the child fix his or her gaze on a face, or is there a "nobody home," glass-eyed stare?

E (Child Abuse Assessment Mnemonic)

Environmental clues

E (AEIOU TIPS)

Epilepsy, endocrine, electrolytes

Medications (Pediatric SAMPLE)

Exact names and doses of ongoing drugs (including over-the-counter, prescribed, herbal, and recreational drugs). Timing and amount of last dose. Time and dose of analgesics and antipyretics.

H (Child Abuse Assessment Mnemonic)

History inconsistent with injury

Interactiveness (TICLS)

How alert is the child? How readily does a person, object, or sound distract the child or draw the child's attention? Will the child reach for, grasp, and play with a toy or examination instrument, like a penlight or tongue blade? Or is the child uninterested in playing or interacting with the parent or caregiver or with the EMT?

Onset (Pediatric OPQRST)

How long has the patient been experiencing this event? What was the patient doing when the symptoms began?

Wong-Baker FACES Pain Rating 6

Hurts even more (Wong-Baker FACES Pain Rating)

Wong-Baker FACES Pain Rating 2

Hurts little bit (Wong-Baker FACES Pain Rating)

Wong-Baker FACES Pain Rating 4

Hurts little more (Wong-Baker FACES Pain Rating)

Wong-Baker FACES Pain Rating 8

Hurts whole lot (Wong-Baker FACES Pain Rating)

Wong-Baker FACES Pain Rating 10

Hurts worst (Wong-Baker FACES Pain Rating)

I (Child Abuse Assessment Mnemonic)

Inappropriate parental concerns

tachypnea

Increased respiratory rate.

I (AEIOU T-I-PS)

Infection

bronchiolitis

Inflammation of the bronchioles that usually occurs in children younger than 2 years and is often caused by the respiratory syncytial virus.

tracheitis

Inflammation of the trachea.

I (AE-I-OU TIPS)

Insulin

Tone (TICLS)

Is the child moving or resisting examination vigorously? Does the child have a good muscle tone? Or is the child limp, listless, or flaccid?

Speech or cry (TICLS)

Is the child's cry strong and spontaneous or weak or high-pitched? Is the content of speech age-appropriate or confused and garbled?

Events leading up to the illness or injury (Pediatric SAMPLE)

Key events leading up to the current incident; Fever history.

Allergies (Pediatric SAMPLE)

Known drug reactions or other allergies.

L (Child Abuse Assessment Mnemonic)

Lack of supervision

Unresponsive (AVPU Scale)

No response to any stimulus

Severity (Pediatric OPQRST)

Observe nonverbal cues (such as wincing or posture). Ask the pediatric patient to rate his or her symptoms using the Wong-Baker FACES pain scale.

Signs and symptoms (Pediatric SAMPLE)

Onset and nature of symptoms of pain or fever. Age-appropriate signs of distress.

OPQRST

Onset, Provocation/palliation, Quality, Region/radiation, Severity, Timing

O (AEIOU TIPS)

Opiates or other drugs

Responsive to Pain (AVPU Scale)

Patient does not respond to verbal stimuli but moves or cries out in response to pain (eg, pinched ear lobe)

Awake and Alert (AVPU Scale)

Patient is awake; the eyes visually track people and objects

Responsiveness to Verbal Stimuli (AVPU Scale)

Patient opens the eyes or moans, speaks, or moves in response to your voice

PAT

Pediatric Assessment Triangle. A structured assessment tool used to rapidly form a general impression of the infant or child without touching him or her; consists of assessing appearance, work of breathing, and circulation to the skin.

P (AEIOU TIPS)

Poisoning, psychogenic causes

central pulses

Pulses that are closest to the core (central) part of the body where vital organs are located; include the carotid, femoral, and apical pulses.

neglect

Refusal or failure on the part of the parent or caregiver to provide life necessities.

S (AEIOU TIPS)

Shock, stroke, seizure, syncope, space-occupying lesion, subarachnoid hemorrhage

SAMPLE

Signs and symptoms, Allergies, Medications, Pertinent past medical history, Last oral intake, Events leading up to the illness or injury

bradypnea

Slow respiratory rate; ominous sign in a child that indicates impending respiratory arrest.

SIDS

Sudden Infant Death Syndrome. Death of an infant or young child that remains unexplained after a complete autopsy.

S (Child Abuse Assessment Mnemonic)

Suspicious circumstances

nares

The external openings of the nostrils. A single nostril opening is called a naris.

infancy

The first year of life.

Timing (Pediatric OPQRST)

When did the symptoms begin? Have the symptoms been constant or do they come and go?

Pertinent past medical history (Pediatric SAMPLE)

Timing of the child's last food or drink, including bottle or breastfeeding.

blanch

To turn white.

TICLS

Tone, Interactiveness, Consolability, Look or gaze, Speech or cry

T (AEIOU TIPS)

Trauma, temperature

U (Child Abuse Assessment Mnemonic)

Unusual injury patterns

U (AEIOU TIPS)

Uremia (kidney failure)

Quality (Pediatric OPQRST)

What does the pain feel like? "Dull," "sharp," or "cramping" are common descriptions. Does it come in waves?

Region/radiation (Pediatric OPQRST)

Where does the patient feel the symptoms?

Common causes of seizures

child abuse, electrolyte imbalance, fever, hypoglycemia (low blood glucose level), infection, ingestion, lack of oxygen, medications, poisoning, seizure disorder, recreational drug use, head trauma

abnormal breathing sounds

crackles, stridor, wheezing, grunting, absent breath sounds (silent chest)