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Chapter 31 Pediatric Emergencies

Chapter 31 Pediatric Emergencies. Objectives. There are no 1985 objectives for this chapter. Unique Needs of Children. Not uncommon for the prehospital professional to experience anxiety. The EMT-I must be prepared to deal with parents and caregivers.

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Chapter 31 Pediatric Emergencies

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  1. Chapter 31Pediatric Emergencies

  2. Objectives • There are no 1985 objectives for this chapter.

  3. Unique Needs of Children • Not uncommon for the prehospital professional to experience anxiety. • The EMT-I must be prepared to deal with parents and caregivers. • The EMT-I must develop assessment and management strategies.

  4. Epidemiology (1 of 4) • 10% of EMS calls involve children. • 20,000 pediatric deaths per year. • Trauma is the leading cause of death in children in the U.S. • Falls and abuse are common. • MVAs are the cause for injuries in older children.

  5. Epidemiology (2 of 4) • Other causes • Injuries from suicide or homicide • Burns • Drownings • Sports-related injuries

  6. Epidemiology (3 of 4) • The EMT-I will respond to calls for ill children involving: • Croup • Bronchiolitis • Febrile seizures • These condition are unique to children

  7. Epidemiology (4 of 4) • Children often suffer from the same illnesses as adults. • The key to reducing morbidity and mortality is early and aggressive intervention.

  8. Injury and Illness Prevention (1 of 3) • Children are at higher risk for injury and illness than adults. • Adverse effects of injury/illness are more severe.

  9. Injury and Illness Prevention (2 of 3) • The EMT-I should be actively involved in programs to reduce child injury/illness. • Teach parents about safe living environments. • Electrical covers • Cabinets containing medications and poisons are secure • Car seats • Helmets for bikes and skateboards

  10. Injury and Illness Prevention (3 of 3) • Education on drugs and alcohol • Education regarding recognition of certain illnesses and when it is appropriate to seek medical attention • Community CPR training

  11. Growth and Development • Infancy • Toddler years • Preschool age • School age • Adolescence

  12. Infant • First year of life. • They respond mainly to physical stimuli. • Crying is their main avenue of expression. • They may prefer to be with caregiver. • If possible, have caregiver hold the infant as you start your examination.

  13. Toddler (1 of 2) • 1 to 3 years of age. • At this time they learn to walk. • Injuries are more frequent. • Stranger anxiety may develop. • May resist being separated from primary caregiver.

  14. Toddler (2 of 2) • May dislike being restrained. • Make as many observations as you can before you touch the child. • Easily distracted.

  15. Preschool • 3 to 6 years of age. • They can use simple language effectively. • They can understand directions. • They can identify painful areas when questioned. • They can understand what you are going to do using simple descriptions. • They can be distracted by using toys.

  16. School-Age Child • 6 to 12 years of age. • They begin to think like adults. • They can be included with the parent when taking medical history. • They may be familiar with physical exam. • They may be able to make choices.

  17. The Adolescent • 12 to 18 years of age. • They are very concerned about body image. • They may have strong feelings about being observed. • Respect an adolescent’s privacy. • They understand pain. • Explain any procedure that you are doing.

  18. Anatomy and Physiology • The next section discusses pediatric anatomy and physiology, including differences in: • Head • Airway • Chest and lungs • Abdomen • Extremities • Skin • Respiratory system • Cardiovascular system • Nervous system • Metabolic differences

  19. The Head (1 of 2) • Proportionately larger than adults’ • More prone to head trauma. • Care must be taken in positioning the child’s airway. • Injured child younger than 3 years – place thin pad under head to maintain neutral position. • Ill child younger than 3 years– place folded sheet under head to obtain sniffing position.

  20. The Head (2 of 2) • Anterior fontanelles are open during infancy. • Fontanelles are areas where the infant’s skull bones have not fused together. • Bulging suggests increased intracranial pressure. • Sunken suggests dehydration.

  21. The Airway (1 of 6) • Anatomic differences • Heart is higher and lungs are smaller. • The opening to the trachea is higher.

  22. The Airway (2 of 6) • Anatomic differences (cont.) • Larger tongue relative to the mouth • Less well-developed rings of cartilage in the trachea • Head tilt-chin lift may occlude the airway

  23. The Airway (3 of 6) • A child’s airway differs from an adult’s in five ways: • Larger head • Larger tongue • Floppy U-shaped epiglottis • Higher larynx • Narrower airway at all levels

  24. The Airway (4 of 6) • Is easily obstructed by secretions, blood, and swelling. • Trachea is easily collapsible. • Trachea tugging. • Intercostal muscles are not well developed. • Diaphragm dictates volume. • Belly breathers

  25. The Airway (5 of 6) • Gastric distention is a more common and significant complication in pediatric patients. • Infants are obligate nosebreathers until the age of approximately 4-6 months. • If their nasal passages are blocked by secretions, they may not have the intuition to open their mouths to breath.

  26. The Airway (6 of 6) • It is important for the EMT-I to remember: • Keep the nares clear in infants younger than 6 months. • Avoid hyperextension of the child’s neck; this may result in reverse hyperflexion and kinking of the trachea. • Keep airway clear of all secretions. • Use care when managing the child’s airway.

  27. Chest and Lungs (1 of 3) • The tissues of the lungs are more fragile in children. • Significant compression to the chest may injure vital organs without obvious signs of external injury. • Rib fractures occur less frequently than in adults.

  28. Chest and Lungs (2 of 3) • Barotraumas (pressure trauma) are the result of injury or overzealous ventilation. • The respiratory muscles are more immature in children and fatigue more quickly. • The chest wall is thin. • Breath sounds are easily transmitted to all areas of the chest.

  29. Chest and Lungs (3 of 3) • The mediastinum is more pliable in children. • The EMT-I may see a more pronounced mediastinal shift as the result of a tension pneumothorax.

  30. The Abdomen • Abdominal musculature is immature. • It offers less protection to solid, vascular organs such as the spleen and liver. • The abdominal organs are nearer to one another in children. • Pediatric patients are at higher risk for splenic and hepatic injuries than adults; multiple organ injuries are more common.

  31. The Extremities • Bones are softer and more porous in children. • Incomplete fractures are common. • Injury to the epiphyseal plate during development can cause abnormalities in normal bone growth and development.

  32. Skin and Body Surface Area • Children have thinner and more elastic skin than adults. • They have a larger body surface area (BSA)/weight ratio and less subcutaneous tissue. • These factors contribute to: • Increased risk of injury following exposure to temperature extremes • Increased risk of hypothermia and dehydration • Increased severity of burns

  33. Respiratory System (1 of 4) • Proportionally, tidal volume in children is similar to adolescents and adults. • Their metabolic oxygen demand is doubled. • Their functional capacity is smaller, resulting in smaller oxygen reserves.

  34. Respiratory System (2 of 4) • An infant needs to breathe faster than an older child. • Their lungs will grow and develop better abilities to handle oxygen exchange as the child ages. • A respiratory rate of 40 to 60 breaths/min is normal for a newborn. • Teenagers are expected to have rates closer to the adult range.

  35. Respiratory System (3 of 4) • Infants have little use of chest muscles; they use their diaphragms. • Anything that puts pressure on the abdomen of a young child can block the movement of the diaphragm and cause respiratory compromise. • Young children also experience muscle fatigue much more quickly than older children. • Long, labored breathing may lead to respiratory failure.

  36. Respiratory System (4 of 4) • During respiratory distress, infants and children are more susceptible to hypoxia because of: • Decreased oxygen reserves • Easily fatigued respiratory muscles

  37. Cardiovascular System (1 of 5) • An infant’s heart rate can become as high as 200 beats or more per minute if the body needs to compensate for injury or illness. • Increasing the heart rate is the body’s primary method of compensating for decreased oxygenation.

  38. Cardiovascular System (2 of 5) • It is important to know the normal heart rates for children.

  39. Cardiovascular System (3 of 5) • Children have limited cardiac reserves. • They have a larger circulating volume compared with adults. • Because of these factors, injured children can maintain their blood pressure for longer periods than adults.

  40. Cardiovascular System (4 of 5) • A larger volume of blood loss must occur in the child before hypotension develops. • Hypotension is an ominous sign and often indicates impending cardiopulmonary arrest. • The ability of children to constrict their blood vessels enables them to keep the vital organs well perfused. • Pale skin is an early sign that the child may be compensating for decreased perfusion. • Constriction of the vessels can be so profound that blood flow to the extremities can be diminished.

  41. Cardiovascular System (5 of 5) • Signs of vasoconstriction include: • Weak distal pulses in the extremities (eg, radial) • Delayed capillary refill • Cool hands or feet

  42. Nervous System • Continually develops throughout childhood. • Neural tissue is very fragile and easily damaged until fully developed. • Brain and spinal cord are less well protected by the developing skull and vertebrae. • As a result, it takes less force to cause brain and spinal injuries. • Brain injuries are more devastating when they occur in children. • Injury to the spinal cord may occur without injury to the spinal column itself.

  43. Metabolic Differences • Children have limited stores of glycogen and glucose, which are rapidly depleted as a result of injury or illness. • Significant hypovolemia and electrolyte derangements are more common in children as a result of vomiting and diarrhea.

  44. Pediatric Assessment • General considerations • Scene size-up • Initial assessment • Pediatric vital signs • Respirations

  45. General Considerations • Young children are not able to provide the EMT-I with information needed to make treatment decisions and cannot tell you where they hurt. • Remember that when children are injured, you have several patients to treat.

  46. Patient Assessment Process • Scene Size-up • Initial Assessment • Focused History and Physical Exam • Detailed Physical Exam • Ongoing Assessment

  47. Scene Size-Up • Take BSI precautions. • Assess scene safety. • Determine mechanism of injury/nature of illness. • Determine number of patients. • Request additional assistance. • Consider c-spine immobilization.

  48. Initial Assessment • Is accomplished by simple observation on first entering the scene or room. • The objective is to identify and treat immediate or potential life threats. • Begins by forming a general impression of the child’s condition and of the environment. • Note degree of interaction between child and parent or caregiver. • Determine if child is acting normally.

  49. Pediatric Assessment Triangle (PAT) (1 of 4) • A structured assessment tool that allows the EMT-I to rapidly form a general impression • The PAT consists of three elements: • Appearance (muscle tone and mental status) • Work of breathing • Circulation to the skin

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