chapter 34 Pediatric Emergencies

what are the signs of increased work of breathing in a pediatric patient, and what do they mean

1. Abnormal airway noise: grunting or wheezing 2. Accessory muscle use: contractions of the muscles above the clavicles - supreclavicular 3. Retractions: drawing in of the muscles between the ribs - intercostal retractions- or of the sternum - substernal retractions - during inspiration 4. Head bobbing: the head lifts and tilts back during inspiration, then moves forward during expiration 5. Nasal flaring: the nares - the external openings of the nose - widen; usually seen during inspiration 6. Tachypnea: increased respiratory rate 7. Tripod position: in older children, this position will maximize the effectiveness of the airway

when assessing for circulation, what are the specific areas to focus on, and what questions should you ask yourself?

1. Pulse: assess both the rate and quality of the pulse. A weak, "thready" pulse is a sign that there is a problem. The appropriate rate depends on the patient's age; generally, except in the case of a newborn, anything over 160 beats per minute suggests shock 2. Skin signs: Assess the temperature and moisture of the hands and feet. How does this compare with the temperature of the skin on the trunk of the body? Is the skin dry and warm or cold and clammy? 3. Capillary refill time: Squeeze a finger or toe for several seconds until the skin blanches and then release it. Does the fingertip return to its normal color within 2 seconds, or is it delayed? 4. Color: Assess the patient's skin color. It is pink, pale, ashen, or blue? 5. Changes: Changes in pulse rate, color, skin signs, and capillary refill time are all important clues suggesting shock.

signs of shock in children include the following

1. altered mental status 2. poor capillary refill 3. tachycardia

list 3 questions you might ask if you suspected a poisoning emergency

1. are there any changes in behavior or level of consciousness? 2. what is the substance involved? 3. was there any choking or coughing after the exposure?

list 3 things you can do when treating pediatric patients with seizures

1. clear the mouth with suction 2. provide 100% oxygen 3. consider placing the patient in the recovery position

list 3 common causes of shock in pediatric patients

1. disease of the heart 2. severe infection 3. dehydration

when obtaining information from the family regarding the pediatric patient's history, what are appropriate inquiries

1. does the child have any rashes? 2. what has been the child's recent activity level? 3. has there been any vomiting or diarrhea?

list 3 common causes of altered mental status in pediatric patients

1. drug and alcohol ingestion 2. seizure 3. hypoglycemia

list 3 signs associated with pneumonia in pediatric patients

1. grunting 2. nasal flaring 3. hypothermia

pupillary response in pediatric patients may be abnormal in the presence of the following

1. hypoxia 2. brain injury 3. drugs

tachycardia in pediatric patients may be an indication of

1. hypoxia 2. fever 3. pain

list 3 common causes of a fever in pediatric patients

1. infection 2. status epilipticus 3. drug ingestion

list 3 signs of increased work of breathing in pediatric patients

1. nasal flaring 2. grunting 3. retractions

incidents involving the death of a child pose extra stress on E.M.S. workers. List 3 signs of posttraumatic stress

1. nightmares 2. difficulty sleeping 3. loss of appetite

name 3 infections that can cause an airway obstruction in pediatric patients

1. pneumonia 2. croup 3. epiglottitis

list 3 common exposures when dealing with pediatric burns

1. scalding water in a bathtub 2. hot items on a stove 3. cleaning solvents

when you are performing a scene assessment at an incident involving S.I.D.S., you should focus your attention on

1. signs of illness, including medication, humidifiers, and thermometers 2. the general condition of the house 3. the site where the infant was discovered

list 3 thing s that are seen in children 12 to 18 months old

1. speak four to six words 2. know the major body parts 3. can open doors

list 3 facts regarding the pediatric airway

1. the glottis opening is higher and positioned more anterior 2. the neck appears to be nonexistent 3. the lungs are smaller

state 3 facts regarding pediatric asthma

1. the wheezing may be so loud that you can hear it without a stethoscope 2. the patient may be in the tripod position 3. A bronchodilator via a metered-dose inhaler may be helpful

list 3 signs of severe dehydration in pediatric patients

1. very dry lips and gums 2. sunken eyes 3. sleepiness

head and neck injuries are common after high speed collisions in the following contact sports

1. wrestling 2. football 3. lacrosse

list 2 facts about examining the head of a pediatric patient

1. you should look for bruising, swelling, and hematomas 2. significant blood loss can come form the scalp 3. the head is larger in proportion to the rest of the body

adolescents

12 to 18 years of age

when assessing capillary refill in pediatric patients, the color should return after

2 seconds

making eye contact, recognizing caregivers, and following a bright light with their eyes are initially noticed in what age group

2 to 6 months

bronchiolitis usually occurs during the first

2 years of life

preschool age

3 to 6 years of age

saying their first work, sitting without support, and teething are initially noticed in what age group

6 to 12 months

what tool is used to determine the appropriate blood pressure for a pediatric patient between 1 and 10 years of age

70 + 2 x child's age in years = systolic blood pressure

you are called to a residence for a 2 year old child with difficulty breathing. The little girl has stridor and expiratory wheezes, as well as intercostal retractions. She is vey upset by your arrival and clings to her mother. Her breathing worsens with agitation. Her mother tells you that she is currently taking medication for an upper respiratory infection and has spend much of her life in and out of hospitals with respiratory problems. How would you best manage this patient?

Allow the child to remain in the mother's arms to decrease her anxiety. Offer oxygen via a nonrebreathng mask with the mother holding it. If she will not tolerate the nonrebreathing mask, us blow by oxygen with her mother holding it. Allow the mother to ride in the patient compartment of the ambulance to comfort the child. Provide rapid transport in a position of comfort with as much oxygen as she will tolerate. Continually assess the patient for signs of altered mental status and decreasing tidal volume; be prepared to assist ventilations. Obtain further history en route.

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

P.A.T.

what does each letter in the mnemonic T.I.C.L.S. mean

T = Tone I = Interactiveness C = Consolability L = Look or gaze S = Speech or cry

you are dispatched to the residence of a toddler who has a history of fever and who is now unresponsive. You arrive to find a 13 year old babysitter who tells you that she is not sure what is wrong with the 2 year old bay. She tells you that he started "shaking all over" and she didn't know what to do. He is currently responsive to painful stimuli and warm to the touch. How would you best manage this patient?

Young children typically experience febrile seizures when their temperature rises rapidly. As with any call, you should assess airway, breathing, and circulation of this 2 year old patient. Ensure that his airway is patent; assist him with breathing using a bag-valve mask and airway adjunct, as necessary; apply high flow oxygen; and remove excessive clothing. The child's level of consciousness should improve. If the child's level of consciousness doesn't improve or if the child experiences additional seizure activity, then this is a very serious sign that should be relayed to the receiving emergency department

a pediatric patient involved in a drowning emergency may present with

abdominal distention

children between 12 to 18 years of age

adolescents

children not only have a higher metabolic rate but also a higher oxygen demand, which is twice that of an

adult

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

alte

a pediatric patient with hives, wheezing, increased work of breathing, and hypoperfusion is likely suffering from

anaphylaxis

p pediatric patient with a fever, pain on palpation of the right lower quadrant, and rebound tenderness is likely to be suffering from

appendicitis

infants and young children should be kept warm during a transport or when the patient is exposed to

assess or reassess an injury

exposure to cold air, infection, and emotional stress are all triggers of

asthma

car seats are designed to be either forward facing or rear facing, they cannot be mounted sideways on a

bench seat

a generalized tonic-clonic seizure features rhythmic back and forth motion of an extremity and

body stiffness

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

bradypnea

anxiety, agitation, and crying may increase the effort or work of

breathing

pertussis

caused by a bacterium that is spread through respiratory droplets

drowning is the second most common cause of unintentional death among

children in the United States

hemophilia is a congenital condition in which the patient lacks one or more of the normal

clotting factors of blood

an infant's heart can beat as many as 160 times or more per minute if the body needs to

compensate for injury or illness

young children can compensate for fluid losses by

decreasing blood flow to the extremities

some of the risks that adolescents take can ultimately facilitate

development and judgment

breathing requires the use of the chest muscle and

diaphragm

E.M.T.s in all states must report all cases of suspected abuse, even if the emergency department

fails to do so

neglect

failure to provide life necessities

infancy

first year of life

located on the front or anterior and back or posterior portions of the head are soft spots, the

fontanelles

how many triage categories are there in the JumpSTART system?

four

list 3 known risk factors for S.I.D.S.

gestational diabetes

an "uh" sound heard during exhalation reflecting the child's attempt to keep the alveoli open

grunting

you are dispatched to the residence of a 3 year old child with a history of lung problems. The child, a very small boy, is cyanotic and lethargic. He is pain responsive. He has copious mucous secretions in his airway. The grandmother, who was sitting with the child, is hysterical. How would you best manage this patient?

immediately open and suction the airway. Assess breathing and apply high flow oxygen via nonrebreathing mask or bag valve mask. Assess the patient further en route during rapid transport. Obtain the history for the grandmother en route. Reassess the patient's airway and vital signs en route as well.

toddler

infant to 3 years of age

a rectal temperature is the most accurate for

infant to toddlers

shaken baby syndrome is seen in abused

infants and children

one common problem following burn injuries in children is

infection

do not examine the genitalia of a young child unless there is evidence of bleeding or there is an

injury that must be treated

pediatrics

medical practice devoted to care of the young

children who have had head trauma are at the greatest risk for contracting

meningitis

the external openings of the nostrils

nares

refusal or failure on the part of the caregiver to provide life necessities

neglect

at around 8 to 10 years of age, children no longer require padding underneath the torso to create a

neutral position

sniffing positions

optimal neutral head position for uninjured airway management

a fracture of the femur is rare and is a major source of blood loss in the

pediatric population

sprains are uncommon in the

pediatric population

a specialized medical practice devoted to the care of the young

pediatrics

in pediatric patients, chest injuries are usually the result of blunt trauma, rather than

penetrating trauma

appendicitis is common in pediatric patients and if left untreated can lead to

peritonitis or shock

an acute infectious disease characterized by a catarrhal stage, followed by a paroxysmal cough that ends in a whooping inspiration. Also called whooping cough

pertussis

activated charcoal is indicated for pediatric patients who have ingested a

poison

toddlers have a hard time describing or localizing pain because they do not have the verbal ability to be

precise

toilet training is typically mastered at what age level

preschool age

neglect is refusal or failure on the part of the caregiver to

provide life necessities

the pediatric assessment triangle is a structured assessment tool that allows you to

rapidly form a general impression of the pediatric patient's condition without touching him or her

an oropharyngeal airway should be used for pediatric patients who are unconscious and in possible

respiratory failure

young children experience muscle fatigue much more quickly than older children, which can lead to

respiratory failure

when you assess a pediatric patient, it is best to place both hands on the patient's chest to feel the

rise and fall of the chest wall

adolescence is a time for experimentation and

risk-taking behaviors

children between 6 to 12 years of age

school age

all children with abdominal injuries should be monitored for signs and symptoms of

shock

grunting

sign of increased work of breathing

list the indications for immediate transport of a pediatric patient

significant M.O.I. - same M.O.I.s as adults with the addition of A: any fall from height equal to or greater than a pediatric patient's height, especially with a headfirst landing. B- bicycle crash- when not wearing a helmet 1. a history compatible with a serious illness 2. a physical abnormality noted during the primary assessment 3. a potentially serious anatomic abnormality 4. significant pain 5. abnormal level of consciousness, altered mental status, or signs and or symptoms of shock

always position the airway in a neutral

sniffing position

a prolonged asthma attack that is unrelieved ma progress to a condition known as

status asthmaticus

a prolonged asthma attack that is unrelieved may progress into

status asthmaticus

a child in respiratory distress or possible respiratory failure needs

supplemental oxygen

increased respiratory rate

tachypnea

breath sounds in the pediatric population are more easily heard because

their chest walls are thinner

it's 0530, and you are dispatched to the home of a 6 month old girl who is not breathing. You arrive to find a crying, young mother holding a lifeless baby. The infant is not breathing, is cold t the touch, and appears to have dependent lividity. How would you best manage this patient?

this infant is deceased, possibly as a result of SIDS. After you have quickly assessed the infant and made this detrermination, you must communicate the condition of the baby to the mother and family. This may be difficult, and they will possibly request resuscitation attempts regardless of your findings. This becomes a judgment call, which can be clarified by utilizing online medical direction and or standing orders. you should survey the scene and document andy history of recent illness, congenital conditions, and so forth. Be supportive of family members and assist them as appropriate. Calls involving infants and children can be traumatic experiences for emergency medical providers as well. Request debriefing as necessary and follow local protocols

the period following infancy until 3 years of age

toddler

blanching

turning white

chest compressions are recommended to relieve a severe airway obstruction in an

unconscious pediatric patient

epiglottitis is an infection of the soft tissue in the area above the

vocal cords

inserting a nosopharyngeal airway in a responsive patient may cause a spasm of the larynx and result in

vomiting

signs and symptoms of a lower airway obstruction in pediatric patients include

wheezing