Recognize the acuity and implement appropriate emergency management Discuss the etiology and natural history of common pediatric emergencies Communicate effectively with patients, families, nursing staff, EMS personnel, ancillary service personnel, referring physicians and consultants.
Asthma Bronchiolitis Pneumonia Croup Foreign Body
Pathophysiology Chronic recurrent lower airway disease with episodic attacks of bronchial constriction Precipitating factors include exercise, psychological stress, respiratory infections, and changes in weather & temperature Occurs commonly during preschool years, but also presents as young as 1 year of age Decrease size of child’s airway due to edema & mucus leads to further compromise
Assessment History When was last attack & how severe was it Fever Medications, treatments administered Physical Exam SOB, shallow, irregular respirations, increased or decreased respiratory rate Pale, mottled, cyanotic, cherry red lips Restless & scared Inspiratory & expiratory wheezing, rhonchi Tripod position
Management Assess & monitor ABC’s Big O’s (Humidified if possible) IV of LR or NS at a TKO rate Assist with prescribed medications Prepare for vomiting Pulse oximeter Intubate if airway management becomes difficult or fails
Basics Respiratory infection of the bronchioles Occurs in early childhood (younger than 1 yr) Caused by viral infection Assessment/History Length of illness or fever has infant been seen by a doctor Taking any medications Any previous asthma attacks or other allergy problems How much fluid has the child been drinking
Signs & Symptoms Acute respiratory distress Tachypnea May have intercostal and suprasternal retractions Cyanosis Fever & dry cough May have wheezes - inspiratory & expiratory Confused & anxious mental status Possible dehydration
Management Assess & maintain airway When appropriate let child pick POC Clear nasal passages if necessary Prepare to assist with ventilations IV LR or NS TKO rate Intubate if airway management becomes difficult or fails
Basics Upper respiratory viral infection Occurs mostly among ages 6 months to 3 years More prevalent in fall and spring Edema develops, narrowing the airway lumen Severe cases may result in complete obstruction
Assessment/History What treatment or meds have been given? How effective? Any difficulty swallowing? Drooling present? Has the child been ill? What symptoms are present & how have they changed?
Physical Exam Tachycardia, tachypnea Skin color - pale, cyanotic, mottled Decrease in activity or LOC Fever Breath sounds - wheezing, diminished breath sounds Stridor, barking cough, hoarse cry or voice
Management Assess & monitor ABC’s High flow humidified O2; blow by if child won’t tolerate mask Limit exam/handling to avoid agitation Be prepared for respiratory arrest, assist ventilations and perform CPR as needed Do not place instruments in mouth or throat Rapid transport
Basics Common among the 1-3 age group who like to put everything in their mouths Running or falling with objects in mouth Inadequate chewing capabilities Common items - gum, hot dogs, grapes and peanuts
Assessment Complete obstruction will present as apnea Partial obstruction may present as labored breathing, retractions, and cyanosis Objects can lodge in the lower or upper airways depending on size Object may act as one-way valve allowing air in, but not out
Management – Complete Obstruction Attempt to clear using BLS techniques Attempt removal with direct laryngoscopy and Magill forceps Cricothyrotomy may be indicated
Management - Partial Obstruction Make child comfortable Administer humidified oxygen Encourage child to cough Have intubation equipment available Transport to hospital for removal with bronchoscope
Physical Assessment/Signs & symptoms Onset very abrupt Sudden jerking of entire body, tenseness, then relaxation LOC or confusion Sudden jerking of one body part Lip smacking, eye blinking, staring Sleeping following seizure
Management If mild or moderate Give fluids orally if there is no abdominal pain, vomiting or diarrhea and is alert Severe High flow O2 IV/IO with NS or LR Fluid bolus of 20 ml/kg IV/IO push Repeat fluid bolus if no improvement
The care of the normalnewborn child, heunderstands a specialevaluation in four moments.
IMMEDIATE ATTENTION•Evaluation of the breathing, cardiac frequency and color,Test de Apgar.•Anthropometry and the first evaluation of age gestational.CARE OF TRANSITION•The first hours of life of the newborn child need of a special supervision of his temperature, vital signs and clinical general condition.
ATTENTION OF THE NCH IN PUERPERIO• Spent the immediate period of transition the NCH remains together with his mother in puerperal.• This period has a great importance from the educational and preventive point of view.PREVIOUS TO BE HIGH OF WITH HIS MOTHEROF THE HOSPITAL• It is necessary to give a last general review• The mother needs to interest and to catch knowledge that will facilitate to him the care of his son.
PAEDIATRIC CONTROLS• There will be realized pediatrics controls of healthy children by major frequency when the child is developingCONTROL OF THE HEALTHY CHILD• In this examination, the doctor checks the growth and development of the baby or of the small child and tries to find problems in time.CONSULTATIONS OR CONTROLS• They serve to receive information about the normal development, nutrition, dream, safety, infectious diseases " and other important topics.
After the birth of the baby, the following consultation must bebetween 2 and 3 days after.
1 MONTH. 2 YEAR 2 MONTH. 3 YEAR 4 MONTH. 4 YEAROf there in forward, the 6 MONTH. 5 YEAR consultations musthappen to the following 9 MONTH. 6 YEAR ages 1 YEAR. 8 YEAR 15 MONTH. 10 YEAR 18 MONTH. 10-21 EVERY YEAR