EMT - Chapter 32: Pediatric Emergencies
Pediatric Load-and-go if:
"A significant MOI— MOIs as adults, with the addition of: Any fall from a height equal to or greater than a pediatric patient's
ABCDE
"Airway, Breathing, Circulation, Disability, Exposure."
AEIOU-TIPPS
"Alcohol, Epilepsy, Insulin, Opiates or other drugs, Uremia, Trauma/temperature, Infection, Psychogenic, Poison, Shock/stroke/space-occupying lesions/subarachnoid hemorrahage."
ALTE
"Apparent life-threatening event. An event that causes unresponsiveness, cyanosis, and apnea in an infant, who then resumes breathing with stimulation. "
Neisseria meningitidis
"Bacterium that causes rapid onset on meningitis symptoms, often leading to shock and death. Signs are cherry red spots or large purple black rash."
BLS-CPR
"Blood pressure, Level of Consciousness, Skin color/temp/moisture - Capillary refill; pulse rate/rythym/strength; Respiratory rate/effort/pattern."
Febrile seizures
"Characterized by generalized tonicclonic seizure activity. Last less than 15 minutes, with short postictal phase or none at all. May be sign of meningitis."
Common causes of seizure in children:
"Child abuse, Electrolyte imbalance, Fever, Hypoglycemia, Infection, Ingestion, Lack of O2, Medications, Poisoning, Seizure disorder, Recreational drug use, Head trauma, Idiopathic."
Common causes of fever in children:
"Infection, such as pneumonia, meningitis, or urinary tract infection. Status epilepticus. Neoplasm (cancer). Drug ingestion (aspirin). Arthritis and systemic lupus erythematosus (rash across nose. High environmental temperature."
Meningitis
"Inflammation of the meniges caused by bacteria, viruses, fungi or parasites."
What is the best way to auscultate breath sounds in a pediatric patient?
"On both sides, at the level of the armpit."
PAT
"Pediatric Assesment Triangle. A structured assessment tool that allows you 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. "
Bronchiolitis
"Specific viral illness of newborns and toddlers, often caused by respiratory syncytial virus (RSV) that causes inflammation of the bronchioles. RSV is highly contagious and spread through droplets when the pediatric patient coughs or sneezes. "
Signs of shock in children are as follows:
"Tachycardia, Poor capillary refill (> 2 seconds), Mental status changes."
Pediatric Assesment Triangle
"The PAT consists of three elements: appearance (muscle tone and mental status),work of breathing, and circulation to the skin. "
JumpSTART system
"There are four triage categories in the JumpSTART system, designated by colors corresponding to different levels of urgency for treatment. Decision points include: able to walk (except in infants); presence of spontaneous breathing; respirations of less than 15 or of greater than 45 breaths/min; palpable peripheral pulse; and appropriate response to painful stimuli on the AVPU scale. "
TICLS
"Tone, Interactiveness, Consolability, Look or gaze, and Speech or cry."
What are characteristics of an adolescent?
-Are able to think abstractly & can participate in decision making -This is when puberty hits; adult bodies with child emotion -Able to discriminate b/w right/wrong, their own values incorporated -Is a time of experimentation and risk taking behaviors
What are characteristics of 6-12 Months?
-Begin to babble and say their first words -Sit w/out support, crawl, and begin to walk -Prone to picking up anything and placing it in the mouth
What are characteristics of 2-6 Months?
-Begin to smile and make eye contact, and recognize caregivers -About 70% of infants will sleep through the night by 6 months -Have strong sucking reflex, active extremity movement, and a vigorous cry
What are characteristics of 12-18 Months?
-Begin to walk and explore their environment -They are able to open doors, drawers, boxes, and bottles -Begin to imitate the behaviors of older children and parents
What are characteristics of 18-24 Months?
-Beginning vocab of 10-15 words ending with up to 100 words -They begin to understand cause and effect -Running and climbing also improve rapidly -At this stage they cling to parents or caregivers
What are different oxygen deliveries?
-Blow-by - 6 L/min - more than 21% O2 concentration -Nasal cannula - 1-6 L/min - 24%-44% -Nonrebreater - 10-15 L /min - up 90% -Bag-mask device - 15 L/min - 100%
What are characteristics of 0-2 Months?
-Respond to physical stimuli -Sleep for up to 16 hours a day -Crying is one of the main avenues of expression -Basic needs: Being warm, dry, and fed
What are characteristics of Preschool-age?
-They are able to use simple language quite effectively -They are learning which behaviors are appropriate -Toilet training is mastered at this stage
What are the characteristics of a school-age child?
-They think in concrete terms & respond sensibly to direct questions -School is important & concerns with popularity and peer pressure -Children with chronic illness can become self-conscious -They begin to understand death is final, which may increase anxiety
What are the most common causes of shock in pediatric patients?
-Traumatic injury with blood loss -Dehydration from diarrhea & vomiting -Sever infection (sepsis) -Neurologic injury (neurogenic shock) -A severe allergic reaction -Diseases of the heart -Collapsed lung (Pneumo) -Blood or fluid around the heart (tamponade)
The anatomy of a pediatric airway and other important structures differs from that of an adult's in the following ways:
1) A larger, rounder occiput, or back of the head, which requires more careful positioning of the airway. 2) A proportionately larger tongue relative to the size of the mouth 3) and a more anterior location in the mouth. 4) The child's tongue is also larger relative to the small mandible and can easily block the airway. 5) A long, floppy, U-shaped epiglottis in infants and toddlers is larger than an adult's, relative to the size of the airway that extends at a 45° angle into the airway. 6)Less well-developed rings of cartilage in the trachea that may easily collapse if the neck is flexed or hyperextended. 7) A narrowing funnel-shaped (wide to narrow) upper airway compared to that of a cylinder-shaped (same width) lower airway.
How do you assess a toddler?
1)Allow them to hold any special object that brings them comfort 2)Difficult describing localized pain, b/c verbal is not precise 3)You may be able to distract them at this age 4)Begin you assessment at the feet up
How do you assess an infant?
1)Begin by observing from a distance 2)Let the parent or caregiver hold the baby 3)Plan to do anything painful at the end of the assessment
How do you assess a school-age child?
1)Like an adult, you can begin from head to feet with the exam 2)Whenever possible, give the child choices 3)They understand the difference between physical/emotional pain
How do you assess and adolescent?
1)Respect their privacy at all times 2)Their risk taking behavior may result in trauma, dangerous sexual practices, and teen pregnancy 3)Have a clear understanding of pain, explain procedures in advance
How do you assess a preschool-age child?
1)Tell the child what you are going to do before you do it 2)Never lie to child, difficult to regain trust 3)Begin you assessment from feet to head 4)Use bandages to cover the site of injection, b/c they're worried about keeping body in one piece/modesty
Infant pulse rate?
100-160bpm.
Adolescent (12 to 18 yrs) respiratory rate is:
12-20 breaths/min.
Older than 18 years respiratory rate is:
12-20 breaths/min.
School age(6 to 12 yrs) respiratory rate is:
15-20 breaths/min.
Which of the following is the MOST appropriate dose of activated charcoal for a 20-kg child?
20 g
Preschool (3 to 6yrs) respiratory rate is:
20-25 breaths/min.
Toddler (1 to 3 yrs) respiratory rate is:
20-30 breaths/min.
The normal respiratory rate for infants is:
25-50 breaths per minute
Infant (1mo to 1 yr) respiratory rate is:
25-50 breaths/min.
Newborn (0-1 month) respiratory rate is:
30 to 60 breaths/min.
Adolescent pulse rate?
60-100bpm.
School-age pulse rate?
70-120bpm.
Pre-school pulse rate?
80-140bpm.
Toddler pulse rate?
90-150bpm.
Pediatric resuscitation tape measure
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.
CHILD ABUSE
C)Consistency of the injury with the child's developmental stage. H)History inconsistent with injury. I)Inappropriate parental concern. L) Lack of supervision. D) Delay in seeking care. A) Affect. B) Bruises of varying stages. U) Unusual injury patterns. S) Suspicious circumstances. E) Environmental clues.
Signs & symptoms of upper airway obstruction include:
Decreased or absent breath sounds and stridor
Croup
Infection of the airway below the level of the vocal cords. Usually caused by a virus.
Epoglotitis (Supraglottitis)
Infection of the soft tissue in the area above the vocal cords.
Children have a higher metabolic rate and higher oxygen demand, because of what?
It is related to the actual size of the lungs and volume exchanged. Smaller lungs mean smaller reserves.
What is the weight limit to utilize transport in a car seat?
Pediatrict patients weighing less than 40 lb should be transported in a car seat
START
Simple triage and rapid treatment
APGAR
Summarizes the health of a newborn. A=Appearance P=Pulse G=Grimace A=Activity R=Respirations
Signs & symptoms of lower airway obstruction include:
Wheezing and/or crackles
If the heart rate is slow (less than 60 beats/min) or absent then you must?
You must begin CPR immediately. Without aggressive airway management, bradycardia may quickly progress to cardiopulmonary arrest.
