Pediatric

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  • Pediatric

    1. 1. Pediatric Patients & Emergencies pediatrics
    2. 2. Family Matters When a child is ill or injured, you may have several patients, not just one. Children mimic caregiver behavior Be calm, professional, and sensitive. pediatrics
    3. 3. Anatomic Differences Less circulating blood Lose body heat more easily Bones are more flexible Less fat surrounding organs Could be much internal damage with little external visible trauma pediatrics
    4. 4. Skeletal Differences Bones are prone to fracture with stress. Infants have two openings in the skull called fontanels. – close by 18 months. pediatrics
    5. 5. Airway Differences – Larger tongue relative to the mouth – Less well-developed rings of cartilage in the trachea – Head tilt-chin lift may occlude the airway. pediatrics
    6. 6. Breathing Differences Infants breathe faster than children or adults. Infants use the diaphragm when they breathe. Sustained, labored breathing may lead to respiratory failure. pediatrics
    7. 7. Circulation Differences The heart rate increases for illness and injury Very effective vasoconstriction keeps vital organs nourished Pale, extremities, decreased cap refill are early signs of perfusion problems pediatrics
    8. 8. Approach to Assessment level of activity, work of breathing, and skin color cap refill ALS backup or immediate transport? Pediatric patients crash harder than adults Transport to peds facilities when possible pediatrics
    9. 9. Capillary Refill pediatrics
    10. 10. Treatment Considerations Oxygen - treat same as adult – Use “blow-by” administration if needed Patient position - same as adult *Remember* airway and breathing are focus pediatrics
    11. 11. Growth and Development Usually grouped into stages – – – – – pediatrics Infant Toddler Preschool School-age Adolescent
    12. 12. Infant first year of life respond physical stimuli crying is main means of expression have caregiver hold pt pediatrics
    13. 13. Toddler 1 to 3 years of age mobile may resist separation don’t like being restrained can be distracted pediatrics
    14. 14. Preschool 3 to 6 years of age can understand directions can identify painful areas fearful of pain allow them to handle equipment explain what you are going to do pediatrics
    15. 15. School-Age Child 6 to 12 years of age begin to think like adults can be included when taking medical history should be familiar with physical exam allow them to make choices when possible pediatrics
    16. 16. The Adolescent 12 to 18 years of age concerned about body image may have strong feelings about being observed respect their privacy they understand pain explain any procedure pediatrics
    17. 17. Notes never lie to a child pediatrics
    18. 18. Vital Signs pediatrics
    19. 19. Respirations Abnormal respirations are a common sign of illness or injury Less than 3, count rise and fall of abdomen Note effort of breathing/noises Note if they are crying pediatrics
    20. 20. Respiration Notes Less than 12 breaths/min More than 60 breaths/min, ALOC and/or an inadequate tidal volume = ventilation with a BVM device pediatrics
    21. 21. Pulse Infants -brachial or femoral Child- use carotid Count at least 1 minute Note strength pediatrics
    22. 22. Blood Pressure Use right size cuff Difficult scene? Don’t waste time Under 3? No BP pediatrics
    23. 23. Skin Signs important sign feel for temperature and moisture always check capillary refill pediatrics
    24. 24. Pediatric Problems pediatrics
    25. 25. Fever – Common Causes Infections Neoplasm (cancer) Drug ingestion Collagen vascular disease High environmental temperatures pediatrics
    26. 26. Emergency Care for Fever Ensure BSI Begin passive cooling – Remove clothing/coverings – Damp towels No ice No alcohol No cold water baths pediatrics
    27. 27. Febrile Seizures common in children 6 months to 6 years most caused by high fever hx of infection generalized grand mal seizure less than 15 minutes pediatrics
    28. 28. Treatment ABC’s protect patient recovery position high flow oxygen suction prn passive cooling measures transport pediatrics
    29. 29. Dehydration Dry lips and gums Fewer wet diapers Sunken eyes Poor skin turgor Sleepy or irritable Sunken fontanels pediatrics
    30. 30. Care for Dehydration Assess the ABCs Obtain baseline vital signs ALS backup may be needed for IV administration pediatrics
    31. 31. Airway Obstruction Croup – An infection of the airway below the level of the vocal cords, caused by a virus Epiglottitis – Infection of the soft tissue in the area above the vocal cords Foreign body Aspiration pediatrics
    32. 32. Croup barking cough stridor wheezing rales accessory muscle use nasal flaring grunting pediatrics
    33. 33. Epiglottitis severe dyspnea stridor inability to swallow - DROOLING fever tripod position pediatrics
    34. 34. pediatrics
    35. 35. pediatrics
    36. 36. Foreign body aspiration Partial Blockage – coughing – accessory muscle use – nasal flaring – wheezing pediatrics Complete Blockage - no sound no cry stridor cyanosis loss of consciousness
    37. 37. treatment ABC’s high flow oxygen position of comfort do not attempt to visualize the throat! do not put anything into patient’s mouth. pediatrics
    38. 38. Asthma dyspnea wheezing accessory muscle use nasal flaring respiratory rate - observe pediatrics
    39. 39. Treatment ABC’s high flow oxygen position of comfort transport pediatrics
    40. 40. What is the most frequent cause of cardiac arrest in pediatrics? pediatrics
    41. 41. Respiratory arrest! pediatrics
    42. 42. want to save a pediatric patient? aggressive ventilation & high flow oxygen pediatrics
    43. 43. USC video! Pediatric respiratory distress pediatrics
    44. 44. Meningitis Inflammation of meninges Bacterial or viral Permanent brain damage/death pediatrics
    45. 45. Signs and Symptoms of Meningitis Fever ALOC Headache Seizure Stiff neck pediatrics Vomiting Photophobia Irritability Bulging fontanel
    46. 46. Neisseria meningitidis rapid onset pinpoint cherry-red spots or larger purple/black rash sepsis, shock, and death all suspected cases considered contagious pediatrics
    47. 47. Treatment BSI ABC’s protect patient high flow oxygen passive cooling for fever monitor for shock Transport Call ALS for backup if unstable pediatrics
    48. 48. Submersion Injury Drowning or near drowning Second most common cause of unintentional death ABC’s May be in respiratory or cardiac arrest C-spine precautions? Be ready to suction Keep warm pediatrics
    49. 49. Poisoning Poisoning is common in children Ask specific questions of caregivers Focus on the ABCs Give oxygen Provide transport Child’s condition could change at any time pediatrics
    50. 50. Pediatric Resuscitation Tape Measure (Aka: Broslow tape) Used to determine height, weight, and proper equipment. pediatrics
    51. 51. Interossius IV Used if traditional IV sites are difficult to assess Medication delivered into bone marrow Painful pediatrics
    52. 52. Interossius pediatrics
    53. 53. pediatrics
    54. 54. Transporting Infants and Children Children require padding under the torso Newborns should be in special incubators Do not hold child during the actual transport Drive with due care Do not allow your emotions to take control pediatrics
    55. 55. Sudden Infant Death Syndrome SIDS - “crib death” pediatrics
    56. 56. SIDS Definition - unexplained death of an apparently healthy infant. 7500+ cases per year in U.S. Leading cause of death in infants <1 year old more cases in winter months pediatrics
    57. 57. Sudden Infant Death Syndrome (SIDS) Several known risk factors: – – – – – pediatrics Mother younger than 20 years old Mother smoked during pregnancy Low birth weight Putting babies to sleep on stomach Siblings of SIDS babies
    58. 58. Tasks at Scene Assess and manage patient Communicate with and support the family Assess the scene pediatrics
    59. 59. Assessment and Management Diagnosis of exclusion Can be other causes of condition Regardless of cause, TX is same Infant may have signs of postmortem changes It is ok to work up an obviously dead baby If no postmortem changes, begin CPR immediately pediatrics
    60. 60. Communication and Support of Family The death of child is very stressful for the family Parents guilt is overwhelming Provide support in whatever ways you can IT IS NOT YOUR PLACE TO JUDGE Use the infant’s name Allow family time with the infant pediatrics
    61. 61. Scene Assessment Inspect the environment, noting: – – – – pediatrics Signs of illness, including medications General condition of the house Family interaction Site where infant was discovered
    62. 62. Support Groups Know your local phone numbers for referrals Arrange for proper debriefing pediatrics
    63. 63. Child Abuse Any improper or excessive action that injures or harms a child or infant physical, sexual, emotional abuse and neglect More than 2 million cases reported annually Be aware of signs of child abuse and report it to authorities pediatrics
    64. 64. Questions Regarding Signs of Abuse (1 of 4) Is the injury typical? Is reported method of injury consistent with injuries? Is the caregiver behaving appropriately? Is there evidence of drinking or drug abuse? pediatrics
    65. 65. Questions Regarding Signs of Abuse (2 of 4) Delay in seeking care? Good relationship between child and caregiver? Multiple injuries at various stages of healing? Any unusual marks or bruises? pediatrics
    66. 66. Questions Regarding Signs of Abuse (3 of 4) Are there several types of injuries? Any burns on the hands or feet involving a glove distribution? Unexplained decreased level of consciousness? pediatrics
    67. 67. Questions Regarding Signs of Abuse (4 of 4) Is the child clean and an appropriate weight? Any rectal or vaginal bleeding? What does the home look like? pediatrics
    68. 68. Other Indicators Withdrawn, fearful or hostile child Refusal to discuss MOI History of “accidents” Conflicting stories Caregiver lack of concern pediatrics
    69. 69. pediatrics
    70. 70. pediatrics
    71. 71. pediatrics
    72. 72. pediatrics
    73. 73. pediatrics
    74. 74. pediatrics
    75. 75. pediatrics
    76. 76. Emergency Medical Care ABCs Transport if you suspect child abuse Do not make accusations EMT-Bs must report all suspected cases of child abuse pediatrics
    77. 77. Sexual Abuse Children of any age or either gender can be victims Limit examination Do not allow child to wash, urinate, or defecate Document carefully Transport pediatrics
    78. 78. EMS Response to Pediatric Emergencies You may experience a wide range of emotions You may feel anxious Practice helps After difficult incidents, a debriefing may be helpful pediatrics
    79. 79. stop questions? pediatrics

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