Lec 3/6 Peds Assessment and Trauma 1651-1661

toddlers

What age group does the following note describe? 1654 - 1-2 years - struggle between independence and dependence on caregiver - Not capable of logical reasoning - Illnesses may cause respiratory distress, vomiting and diarrhea with dehydration, febrile seizures, sepsis, and meningitis. - Toddlers who are learning to walk are prone to falls. - Physical injuries: poisoning from accidental ingestions, physical/sexual abuse, drowning, and motor vehicle crashes.

preschooler

What age group does the following note describe? 1655 - 3-5 years - can understand plain language - Advances in gross and fine motor and verbal skills. - Illnesses and injuries include those mentioned for toddlers. - Experience injuries from thermal burns, pedestrian accidents, submersion incidents, or drowning. - often curious

adolescents

What age group does the following note describe? 1656 - 13-18 years - most illnesses are caused by viral infections -Final changes in growth and development occur. -Paramedics may encounter behavioral emergencies associated with alcohol and/or drugs, eating disorders, depression, suicide and suicide gestures, sexually transmitted diseases, pregnancy, and sexual assault.

school age

What age group does the following note describe? 1656 - 6-12 years - Display an increased ability to concentrate and learn quickly and onset of puberty. - Most illnesses are caused by viral infection. - Injuries are common because of increased physical activity (ie, bicycle crashes, falls, and sport-related injuries.)

falls, motor vehicle crashes, pedestrian-motor vehicle collisions, drowning/submersion, penetrating injuries, burns, child abuse

What are common injuries that highlight the value of injury prevention programs? 1691

blunt and penetrating trauma

What are major causes of injury and death in children? 1691

asymmetrical pupils, abnormal posturing

What are signs of cerebral herniation? - brain begins to push through the foramen magnem due to increased intracranial pressure - 1692

coagulopathy from dilution of clotting factors, hypothermia, an increase in BO that can accelerate bleeding and acidosis

What are some potential complications of to much fluid? 1694

system approach, education, data collection, quality improvement, injury prevention, access, prehospital care, emergency care, definitive care, rehabilitation, finance, continual health care from birth to young adulthood

What are the 12 basic components of the EMSC? 1652

appearance ( mental status, muscle tone), Circulation ( skin signs, skin color ), Work of breathing ( respiratory rate, respiratory effort )

What are the parts of the pediatric assessment triangle? 1659

falls

What are the single most common cause of nonfatal injuries in children from birth to 9 years, ranks second in children 10 years and older. 1691

scene size-up, primary survey, vital functions, transition phase, focus history, secondary assessment, reassessment

What are the steps of a pediatric assessment? 1659

modified GCS scale or AVPU

What can be used to determine a child's LOC and assess for signs of inadequate oxygenation? 1660

unintentional injuries

What causes about one third of the deaths in children aged 1-19 years? 1656

prehospital emergency care applied research network

What does PECARN stand for? 1652

hypotension

What is a late sign of shock in pediatrics? 1657

7-10

What is a normal APGAR for a 1 minute old neonate?

cricothyroidotomy

What is rarely indicated for an upper airway obstruction? 1693

about 35

What is the average glucose for a neonate?

20mL/kg

What is the general pediatric fluid bolus amount? 1694

motor vehicle crashes

What is the leading cause of death in children aged 1 to 4 years and older than 15 years? 1691

head injury

What is the most common cause of death in pediatric trauma patients? 1691

cricoid ring

What is the narrowest section of a child's airway? 1656

drowning/submersion

What is the second-leading cause of death in children from 1 to 14 years of age? 1691

airway control, immobilization techniques, fluid management, pain relief

What parts of trauma management requires special consideration for pediatrics? 1693

25

What percent of a newborn's body weight does the head account for? 1656

10-15

What percent of pediatric trauma admissions are from stab wounds or firearm injuries? 1691

pulmonary contusion

What significant chest injury is common in pediatric chest truama? 1658

pneumothorax

What significant lung injury is common in pediatric barotrauma/trauma to the thoracic cavity? 1658

diffuse

What type of head injuries are common in children? 1692 - focal injuries are rare

fever, nausea, vomiting, diarrhea, frequency of urination

When assessing a pediatric patient who is ill, it is important to note the presence or absence of what? 1661

tone (movement vigorous or limp), interactiveness (is child alert), consolabity (can child be comforted), look/gaze (does child look at the caregiver or paramedic), speech/cry (is there a strong voice or cry)

When assessing a pediatric's appearance, the TICLS mneumonic should be used. What does TICLS stand for? 1659

distal and proxmial ends of long bones

Where are epiphyseal plates located? 1658

pneumonia

an acute inflammation of the lungs, often caused by inhaled pneumococci of the species Streptococcus pneumoniae.

pertussis

an acute, infectious disease characterized by a cough ending in a whooping inspiration; whooping cough AKA whooping cough

epiphyseal plate

cartilaginous area at the ends of long bones where lengthwise growth takes place in the immature skeleton

epiglottitis

inflammation of the epiglottis; a severe form of the condition that affects primarily children characterized by fever, sore throat, stridor, croupy cough, drooling, resp distress, erythematous epiglottis

backboard

______ are extrication devices meant to assist in emergency personnel in moving patients. As a stand-alone device, a backboard does not provide adequate immobilization of the spine and is not considered a treatment of spinal injury. 1693

croup

a childhood infection of the upper airways that causes a distinctive "seal-like" barking cough. It is usually caused by a virus (MC parainfluenza) but rarely can be bacterial AKA laryngotrachebronchitis

febrile seizure

a seizure that results from fever MC occurs in children between 6 months -5 years

shunt

a tube or device surgically implanted in the body to redirect body fluid from one cavity or vessel to another.

apearance, pulse, grimace, activity, respirations

What does APGAR stand for?

size (weight), airway, CNS, systolic BP, skeletal injury, open wound

What does the pediatric trauma score look at? 1694

preschool age ( 3 to 5 years )

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 80-120 Asleep:65-100 Respirations: 20-28 BP: Systolic: 89-112, Diastolic: 46-72, MAP: 58-69 Temperature: 98.6, 37

toddler (1 to 2 years)

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 98-140 Asleep: 80-120 Respirations: 22-37 BP: Systolic: 86-106, Diastolic: 42-63 MAP: 49-62 Temperature: 96.8-99.6, 36-37.5

fentanyl, ketamine, ketalorac, morphine, in absence of hemorrhage: nitrous oxide

Pain relief should be a priority when providing care for pediatrics. What are some common drugs used for pain relief in peds? 1694

abdominal organ injury risk

Pediatrics lack of chest muscle, this can lead to what? 1658

infants

Developmental Stages and Approach Strategies for Pediatric Patients 1653 47-1 Major Fears: separation and strangers Characteristics of Thinking: Approach Strategies: provide consistent caregivers, reduce parent's anxiety, minimize separation from parents

pediatric glasgow coma scale

EYE OPENING Spontaneously 4 To Speech 3 Painful Stimuli 2 No Response 1 VERBAL Coos 5 Irritable Cry 4 Cries to Pain 3 Moans to Pain 2 No Response 1 MOTOR Normal 6 Localize Pain 5 Withdraws to Pain 4 Abnormal Flexion 3 Abnormal Extension 2 No Response (Flaccid) 1

pediatric trauma

1691 - Trauma is major causes of injury and death in children. - Result of falls, motor vehicle crashes, pedestrian-motor vehicle collisions, drowning/submersion incidents, penetrating injuries, burns, and abuse.

pediatric trauma score

Grades six characteristics commonly seen in pediatric trauma patients: size, airway, CNS, systolic blood pressure, skeletal injury, and open wound. Has a significant inverse linear relationship with patient mortality. oSize oAirway oConsciousness oSystolic BP oFracture oCutaneous injury

cervical collar

A _______ _______ is applied when substantial mechanism of nonpenetrating injury is present. 1693 - ALOC is indicator for C Collar

bacterial tracheitis

A bacterial infection of the upper airway and subglottic trachea; it is characterized by expiratory wheezes, respiratory distress, inflammation, and obstruction at the level of the bronchioles.

hydrocephalus

A pathological condition characterized by an abnormal accumulation of cerebrospinal fluid, usually under increased pressure, within the cranial vault and subsequent dilation of the ventricles

emetic center

An area located in the reticular formation of the brainstem; thought to be the control center for vomiting.

bronchiolitis

An inflammatory bronchial reaction in young children and infants -- causes congestion in the small airways of the lung

pediatric trauma score

An injury severity index that grades six components commonly seen in pediatric trauma patients: size (weight), airway, central nervous system, systolic blood pressure, open wound, and skeletal injury.

preschoolers

Developmental Stages and Approach Strategies for Pediatric Patients 1653 47-1 Major Fears: bodily injury and mutilation, loss of control, the unknown/dark, being left alone Characteristics of Thinking: highly literal interpretation of words, unable to engage in abstract thinking, primitive about the body Approach Strategies: keep explanations simple and concise choose words carefully, emphasize that a procedure will help the child be healthier, be honest

adolescents

Developmental Stages and Approach Strategies for Pediatric Patients 1653 47-1 Major Fears: loss of control, altered body image, separation from peer group Characteristics of Thinking: able to think abstractly, tendency toward hyperresponsiveness to pain, little understanding of the structure and workings of the body Approach Strategies: when appropriate, allow this group to be part of the decision-making about their care, give info sensitively, express how important their compliance and cooperation are to their treatment, be honest about consequences, use or teach coping mechanisms such as relaxation, deep breathing, self-comforting talk

school-aged children

Developmental Stages and Approach Strategies for Pediatric Patients 1653 47-1 Major Fears: loss of control, bodily injury and mutilation, failure to live up to expectations of others, death Characteristics of Thinking: vague or false ides about physical illness and body structure and function, able to listen attentively without always comprehending, reluctant to ask questions about something they think that are expected to know, increased awareness of significant illness Approach Strategies: ask children to explain what they understand, provide as many choices as possible to increase the child's sense of control, reassure the child that he or she has done nothing wrong, expect to answer about long term consequences

toddlers (1-2 years)

Developmental Stages and Approach Strategies for Pediatric Patients 1653 47-1 Major Fears: separation and loss of control Characteristics of Thinking: primitive, unable to recognize views of others little concept of body integrity Approach Strategies: keep explanations simple, choose words carefully let toddler play with equipment, minimize separation from parents

becoming active participants in school community, parent education programs

How can a paramedic play a key role in health care and injury prevention in pediatrics? 1651

9-18 months

How long does that anterior fontanel remain unfused/open? 1656

comparing strength and quality of entral and peripheral pulses, BP in pts over 3 years/all pts seriously ill

How should circulation be assessed? 1660

color, temperature, moisture, turgor, capillary refill

How should the skin be assessed? 1660

in the seat if possible

If a child is restrained in a car seat with harness, the child should be extricated .... 1693

immobilization

In pediatrics, all strains and sprains are considered possible fractures and treated with what? 1658

upright, not crying

In what position are fontanels best assessed? 1656

primary survey

In what step of the pediatric assessment is the pediatric assessment triangle used? 1659

1985

In what year was the Emergency Medical Services for Children (EMSC) Demonstration Program developed? 1651

1991

In what year was the Emergency Medical Services for Children: A Report to the Nation published? 1652 - published by the national center for education in maternal and child health

Brief Resolved Unexplained Event (BRUE)

Infant <1 year *Sudden, brief (lasting less than 1 minute), and now-resolved, episode-no underlying etiology* is found, and infant returns to baseline. Includes 1 or more: 1. cyanosis or pallor 2. absent, decreased, or irregular breathing 3. marked change in tone (hyper- or hypotonia) 4. altered level of responsiveness.

300

More than ___ US children aged 0-19 years sustain burns requiring medical care each day. 1691

Infant (1 month to 1 year)

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 100-180 Asleep: 90-160 Respirations: 30-53 BP: Systolic: 72-104, Diastolic: 37-56, MAP: 50-62 Temperature: 96.8-99.6, 36-37.5

newborn/neonate (0to 1 month)

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 100-205 Asleep: 90-160 Respirations: 30-60 BP: Systolic: 67-84, Diastolic: 35-53, MAP: 45-60 Temperature: 98-100, 37-38

Middle adult ( 41-60 years )

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 60-100 Respirations: 12-20 BP: Systolic: 90-140 Temperature: 98.6, 37

early adult (19-40 years)

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 60-100 Respirations: 12-20 BP: Systolic: 90-140 Temperature: 98.6, 37

older adult ( 61 +)

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 60-100 Respirations: 12-20 BP: Systolic: 90-140 Temperature: 98.6, 37

adolescent ( 13-18years)

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 60-100 Asleep: 50-90 Respirations: 12-20 BP: Systolic: 110-131, Diastolic: 64-83, MAP: 73-84 Temperature: 98.6, 37

school age (6 to 12 years)

Normal Vital Signs at Various Ages Table 47-1 1654 Pulse: Awake: 75-118 Asleep: 58-90 Respirations: 18-25 BP: Systolic: 97-120, Diastolic: 57-80, MAP:66-79 Temperature: 98.6, 37

cushing's triad

Signs of increased intracranial pressure: 1. hypertension 2. bradycardia 3. irregular respirations ( Cheyne-stokes )

omega, 45

The epiglottis in infants is _______-shaped, and extends into the airway at a ___ degree angle. 1656

head and neck injury

The following are important notes about pediatric traumatic injury. 1691 - The larger relative mass of the head and lack of neck muscle strength provide increased momentum in acceleration-deceleration injuries. - Head injury is most common cause of death in pediatric trauma. - Significant blood loss can occur through scalp lacerations and bleeding should be controlled immediately.

extremity injury

The following are important notes about pediatric traumatic injury. 1692 - More common in children than adults. - Growth plate injuries are common. - Compartment syndrome is an emergency. - Femur fractures result from falls or other unintentional injuries; however, child abuse should be considered.

burns

The following are important notes about pediatric traumatic injury. 1692 - Thermal, chemical, or electrical. - Management - airway, intubation if required, suspect musculoskeletal injuries. - smaller than norm tube may be necessary due to anticipated airway swelling - suspect musculoskeletal injury in electrical burns

abdominal injury

The following are important notes about what pediatric traumatic injury? 1692 - Musculature is minimal and poorly protects the viscera. - Organs most commonly injured are the liver, kidneys, and spleen. - Onset of symptoms may be rapid or gradual. Palpation should be performed in one quadrant at a time.

chest injury

The following are important notes about what pediatric traumatic injury? 1692 - Result of blunt trauma younger than 14 years. - Because of flexibility of the chest wall, severe intrathoracic injury can be present without signs of external injury. - Tension pneumothorax is an immediate threat to life.

nervous system

The following are important notes about what section of pediatric anatomy and physiologic changes/pathologies? 1657 - Spinal cord injury in children os rare, occurring only in 1-2% of blunt injuries -Develops throughout childhood and developing neural tissue is fragile. -Greater cerebrospinal fluid space around the neural tissue in children, which buffers blunt forces. -Spinal column also is more pliable. -Direct trauma to the head can lead to brain injuries that are devastating in young children.

cardiovascular system

The following are important notes about what section of pediatric anatomy and physiologic changes/pathologies? 1657 -Cardiac output is rate-dependent in infants and small children. The faster the heart rate, the greater the cardiac output. -Absolute blood volume is smaller. -Ability to use vasoconstriction to decrease size of the vessels allows them to maintain BP longer than adults. -The assessment of shock must be based on clinical signs of tissue perfusion, including level of consciousness, skin color, oxygen saturation, and capillary refill. - Special Considerations with Management: cardiovascular reserve is vigorous but limited. Loss of small absolute volumes of fluid and blood can cause shock. A child may be in shock despite normal blood pressure, and bradycardia is often a response to hypoxia

respiratory system

The following are important notes about what section of pediatric anatomy and physiologic changes/pathologies? 1657 - Tidal volume is proportionally smaller than that of adults. - Have smaller functional residual capacity and smaller oxygen reserves. - Hypoxia can develop rapidly in infants and young children. - Muscles are the main support for the chest wall and can tire easily during respiratory distress. - Respiratory distress can be caused by many conditions that affect the upper and lower airways, including upper and lower foreign body airway obstruction, upper airway disease, and lower airway disease. - Most cases of cardiac arrest in children occur because of respiratory insufficiency. - Severity of respiratory compromise classified as respiratory distress, respiratory failure, and respiratory arrest.

respiratory distress

The following are signs of what? 1657 A change in mental status from normal to irritable or anxious Tachypnea Retractions Nasal flaring Poor muscle tone Tachycardia Head bobbing Grunting Cyanosis that improves with supplemental oxygen Increased RR No distal air movement Increased work of breathing Tachycardia/ rapid decreasing brady

respiratory failure

The following are signs of what? 1657 Irritability deteriorating to lethargy Marked tachypnea deteriorating to bradypnea Marked retractions deteriorating to agonal respirations Marked tachycardia deteriorating to bradycardia Central cyanosis

traumatic brain injury

The following notes the management of what kind of pediatric trauma? 1692 - Early recognition and aggressive management can reduce mortality and morbidity. - Management - high-concentration oxygen, intubation and ventilation at normal breathing rate, and hyperventilate only with signs of increased ICP. - hyperventilation: should be milf with a goal of 30-35 mHg ETCO2 - lidocaine can be used to decrease intracranial pressure under medical direction

nose

The paramedic also should remember that infants breathe mainly through the ____ during the first month of life. 1657

sudden unexpected infant death (SUID)

The sudden and unexpected death of an infant due to natural and unnatural causes. Unnatural causes can include suffocation, drowning, electrocution, hyperthermia, hypothermia, carbon monoxide poising, and homicide

8

Until what age is the head disproportionally large compared to the body? 1656

liver, kidneys, spleen

What abdominal organs are most commonly injured in pediatric abdominal trauma? 1692

infant

What age group does the following note describe? 1652 - 1 to 12 months old - hold head up, crawl, babble - large amount of development happens here - Cannot communicate verbally, so respect a caregiver's perception that something is wrong. Common illnesses affect the respiratory, gastrointestinal, and central nervous systems. They manifest as respiratory distress, nausea, committing, and diarrhea with dehydration, and seizures. - The older infant may experience bronchiolitis, croup, foreign body airway obstruction, and physical injury from sexual abuse, neglect, falls, and motor vehicle crashes. - SIDS happens here

newborn/neonate

What age group does the following note describe? 1652 - Under 1 month old - Most require no intervention at birth and begin extrauterine life without incident. - Illnesses that may be encountered include: respiratory problems, cardiac problems, jaundice, vomiting, ewer, sepsis, meningitis, and complication from prematurity

asthma

respiratory disorder characterized by reoccurring episodes of paroxysmal dyspnea, coughing, and wheezing caused by constriction of the bronchi and viscous mucoid bronchial secretions

child abuse

the physical, sexual, or emotional maltreatment of a child

sudden infant death syndrome (SIDS)

the unexpected and sudden death of an apparently normal and healthy infant that occurs during sleep and has no cause found even after a full investigation