Paediatric Emergencies


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  • Recognising differences and implementing appropriate interventions to support these differences can result in increased survivability of the paediatric trauma patient.
  • The size of the trachea is the size of there little finger.
  • Paediatric Emergencies

    1. 1. Paediatric Emergencies. Kane Guthrie St John Ambulance Australia State Retrieval Team.
    2. 2. Objectives <ul><li>To gain an understanding of the differences between children and adults. </li></ul><ul><li>To understand difference’s in management between adults and children. </li></ul><ul><li>To understand different illnesses that affect children. </li></ul>
    3. 5. Introduction to the sick kid!! <ul><li>Sick children present unique challenges to health care professionals. </li></ul><ul><li>Assessment and treatment of sick children are unique because children’s perceptions may be radically different from those of adults. </li></ul>
    4. 6. Adults Vs Kids The Difference <ul><li>Children differ from adults: </li></ul><ul><li>Size </li></ul><ul><li>Developmentally </li></ul><ul><li>Anatomically </li></ul><ul><li>Physiologically. </li></ul>
    5. 7. Adults Vs Kids cont. <ul><li>The child’s airway is smaller than an adults and can obstruct a lot more easily. </li></ul><ul><li>Children have a smaller circulating blood volume than an adult. </li></ul><ul><li>An infants head is larger in proportion to the rest of the body than an adults. (Heat Loss)! </li></ul><ul><li>Solid abdominal organs are relatively larger in children compared with adults, there is an increased risk of direct organ injury following blunt or penetrating forces. </li></ul>
    6. 8. Adults Vs Kids cont. <ul><li>The bones in a growing child are stronger, thicker compared with adult’s decreasing there risk of an open fracture. </li></ul><ul><li>Children have a larger ratio of body surface area to weight, which makes them susceptible to convective and conductive heat loss. </li></ul>
    7. 9. Approach to the Paediatric Patient <ul><li>Gaining Rapport: Builds confidence, and helps with assessing the child. </li></ul><ul><li>Age Appropriate: approach the child at an age appropriate level. </li></ul><ul><li>Development Appropriate: Younger child generally benefit from being examined while their parents are holding them. </li></ul><ul><li>Parental Involvement: in order to provide emotional support, parents should be encouraged to remain close to their child during procedures or examination. </li></ul>
    8. 10. Parental Issues <ul><li>PARENTS KNOW THEIR CHILD BETTER THAN YOU!!! LISTEN TO THEM!!!! </li></ul><ul><li>Parents who often accompany their child are very anxious and concerned about their child's condition. </li></ul><ul><li>Listening to and addressing the parents concern’s in a sympathetic and unhurried fashion is the main therapeutic strategy to reassure the parent’s that a child with a minor illness will be ok. </li></ul><ul><li>Acknowledged the parents concerns and anxieties in an empathetic manner. </li></ul>
    9. 11. Assessment of the Sick Child <ul><li>A: Alertness/activity </li></ul><ul><li>B: Breathing </li></ul><ul><li>C: Circulation </li></ul><ul><li>F luids in </li></ul><ul><li>F luids out </li></ul>
    10. 12. Vital signs <ul><li>It is necessary to interpret the vital signs according to the age of a particular child. </li></ul><ul><li>A good rule to remember is any child with a persistent RR > 60 or a HR > 160 is abnormal. </li></ul>
    11. 13. Vital Signs cont. 90 60-100 16 40 12 years 80 70-110 16 25 8 years 70 80-130 20 15 4 years 65 100-170 30-40 10 1 year 50 100-170 40-60 3.5 Birth BP (systolic) HR (min) RR (min) Weight (kg) Age
    12. 14. Warning Signs in Sick Children! <ul><li>The pale, pasty child. </li></ul><ul><li>The floppy child. </li></ul><ul><li>The child who appears drowsy. </li></ul><ul><li>Alterations in vital signs. </li></ul><ul><li>Early signs of compensated shock. </li></ul><ul><li>The tiring child with respiratory distress. </li></ul><ul><li>The child who looks sicker than the child with the same disease. </li></ul>
    13. 15. Remember The Rule’s. <ul><li>A quite kid is a sick kid. </li></ul><ul><li>Initial impressions are usually far more important than any vital signs. </li></ul>
    14. 16. Paediatric Resuscitation <ul><li>The majority of cardiac arrest in children/infants is caused by hypoxaemia or hypotension or both. </li></ul><ul><li>Causes can be: SIDS, trauma, drowning, septicaemia, asthma, or congenital abnormalities. </li></ul><ul><li>The initial ECG rhythm is usually bradycardia or asystole. </li></ul><ul><li>Remember 30:2 </li></ul>
    15. 17. Shock <ul><li>Shock results from an acute failure of circulatory function. </li></ul><ul><li>Inadequate amounts of nutrients, especially oxygen, are delivered to body tissues and there is inadequate removal of tissue waste products. </li></ul>
    16. 18. Causes of Shock <ul><li>Vomiting &/or Diarrhoea </li></ul><ul><li>Fever/rash (septicaemia) </li></ul><ul><li>Anaphylaxis </li></ul><ul><li>Major trauma (hypovolaemia) </li></ul><ul><li>Sick cell disease </li></ul><ul><li>DKA </li></ul><ul><li>Drug ingestion </li></ul>
    17. 19. Shock <ul><li>The child may present primarily with: </li></ul><ul><li>Pale, mottled skin </li></ul><ul><li>Tachycardia > bradycardia </li></ul><ul><li>Changes in mental status </li></ul><ul><li>Tachypnoea </li></ul><ul><li>Decreased peripheral pulses </li></ul><ul><li>Decreased urine output </li></ul><ul><li>Hypotension </li></ul><ul><li>Hypoglycaemia ( ABC D on’t E ver F orget G lucose). </li></ul>
    18. 20. Shock Management <ul><li>D.R.A.B.C.D.E. </li></ul><ul><li>A.V.P.U. </li></ul><ul><li>O.P.R. (very important) </li></ul><ul><li>Vital signs </li></ul><ul><li>Secondary assessment. </li></ul><ul><li>Ambulance </li></ul>
    19. 21. Trauma <ul><li>Trauma is the prime cause of death and serious injury throughout childhood. </li></ul><ul><li>Children have the ability to compensate for an extended period of time due to small body area, and maintain adequate vital signs </li></ul><ul><li>Continuous monitoring is paramount in ongoing care of the paediatric trauma patient. </li></ul>
    20. 22. Assessing the Trauma Patient. <ul><li>D.R.A.B.C.D.E. </li></ul><ul><li>O.P.R. </li></ul><ul><li>A.V.P.U. </li></ul><ul><li>History: A.M.P.L.E. </li></ul><ul><li>Secondary assessment. </li></ul>
    21. 23. Ongoing care of the trauma patient. <ul><li>1. Early pain relief. </li></ul><ul><li>2. Continuous monitoring. </li></ul><ul><li>3. Support of family members. </li></ul>
    22. 24. Respiratory Emergencies <ul><li>Most children with breathing difficulties will have an upper or lower respiratory tract illness. </li></ul><ul><li>Most respiratory illnesses are self-limiting minor infections, but a few present as potentially life threatening. </li></ul>
    23. 25. Respiratory Assessment <ul><li>Infants are nose breather’s, nasal congestion can severely impair an infant respiratory status. </li></ul><ul><li>Feeding difficulties could mean respiratory problems. </li></ul>
    24. 26. Respiratory Assessment Cont! <ul><li>Recession: Sternal </li></ul><ul><li>Respiratory rate: Hypoventilation suggest exhaustion, hyperventilation suggest compensation. </li></ul><ul><li>Grunting/Stridor: high pitched noisy resp, sign of upper airway obstruction. </li></ul><ul><li>Accessory muscle use: neck or chest muscles </li></ul><ul><li>Flare of the alae nasi: </li></ul><ul><li>Heart rate: brady = exhaustion, tachy = compensating. </li></ul><ul><li>Skin colour: Central or peripheral cyanosis. </li></ul>Mental Status: Confused = ?Hypoxia, hypoglycaemia Wheeze: suggest lower airway pathology.
    25. 27. Partial or complete obstruction: Foreign Body! <ul><li>Foreign body aspiration usually occurs in children less than 3 years old. </li></ul><ul><li>The foreign body can lodge at any place along the airway. </li></ul><ul><li>Hx: </li></ul><ul><li>1. Coughing and choking episode </li></ul><ul><li>2. Cyanosis </li></ul><ul><li>3. Persistent cough after chocking </li></ul><ul><li>episode. </li></ul><ul><li>Manage as per choking guidelines! </li></ul>
    26. 28. Croup <ul><li>Croup is defined as a syndrome with inspiratory stridor, a barking cough, hoarseness and variable degrees of respiratory distress. </li></ul><ul><li>Generally of viral origin (parainfluenza). </li></ul><ul><li>May have mild fever. </li></ul><ul><li>Symptoms generally worse at night. </li></ul><ul><li>Tx: steroids </li></ul>
    27. 29. Epiglottitis <ul><li>Share’s similar feature’s to croup. </li></ul><ul><li>Infection causes swelling of the epiglottis, surrounding tissues, & obstruction of the larynx. </li></ul><ul><li>Presents febrile, soft inspiratory stridor, and respiratory difficulty. </li></ul>
    28. 30. Epiglottis Cont. <ul><li>Typically the child sits immobile, with a slightly raised chin with mouth open, drooling saliva. </li></ul><ul><li>Because the throat is so painful, the child is reluctant to talk or swallow drinks or saliva. </li></ul><ul><li>Attempts to examine the throat can result in total obstruction and death. </li></ul><ul><li>Leave child sitting in position they are comfortable, transport to hospital immediately. </li></ul>
    29. 31. Asthma <ul><li>Asthma is recurrent episodes of cough, wheeze and breathlessness. </li></ul><ul><li>Life threatening asthma is characterised by silent chest, cyanosis, poor respiratory effort, exhaustion and altered mental state. </li></ul><ul><li>PMHX can tells us the clinical significance of a persons asthma. </li></ul><ul><li>Remember the Mag7 </li></ul><ul><li>Use spacer to administer ventolin. </li></ul>
    30. 32. Bronchiolitis <ul><li>A viral infection commonly found in infants younger than 18months. </li></ul><ul><li>An inflammatory process causes edema in the bronchial mucosa with expiratory obstruction and air trapping. </li></ul><ul><li>Dyspnea can last up to 5 days. </li></ul><ul><li>Hx typically includes a cold, cough, coryza (runny nose), before onset of dyspnea. </li></ul>
    31. 33. Cardiovascular Disorders: <ul><li>Heart disease in children is generally caused by congenital abnormalities. </li></ul><ul><li>Children can suffer from heart murmurs, fast and slow heart rates, and structural defects in the hearts anatomy. </li></ul><ul><li>The main priority with management of these children is the ABC. </li></ul>
    32. 34. Head Injuries in Children. <ul><li>Head injury is the most common single cause of trauma death in children aged 1-15 years. </li></ul><ul><li>It accounts for 40% of injuries. </li></ul>
    33. 35. Factors indicating a potentially serious head injury. <ul><li>Hx of substantial trauma such as MVA, Fall from height. </li></ul><ul><li>A Hx of LOC. </li></ul><ul><li>Children who are not fully conscious and responsive. </li></ul><ul><li>Any child with obvious neuro S&S such as headache, convulsion/s, or limb weakness. </li></ul><ul><li>Evidence of penetrating injury. </li></ul>
    34. 36. Assessment of Concussion <ul><li>Concussion is a temporal loss of brain function after a head injury. </li></ul><ul><li>Generally caused by direct blow. </li></ul><ul><li>Assess: </li></ul><ul><li>Confusion: (Unsure of time and/or place) </li></ul><ul><li>Amnesia: (a loss of memory of the injury) </li></ul><ul><li>Loss of consciousness (even briefly) </li></ul>
    35. 37. Myths About Head Injuries <ul><li>Paracetamol can be given to relieve discomfort and will not cause harm. </li></ul><ul><li>Children can sleep post head injury. </li></ul><ul><li>Cold pack can be applied to head injury to minimise swelling or stop bleeding. </li></ul>
    36. 38. Management of Head injury: <ul><li>D.R.A.B.C.D.E </li></ul><ul><li>Remember C spine: </li></ul><ul><li>A.V.P.U. </li></ul><ul><li>O.P.R. </li></ul><ul><li>Secondary assessment </li></ul><ul><li>BSL:? Why? </li></ul>
    37. 39. Burns & Scalds <ul><li>2 main factors determine severity of burns & scalds- these are temperature & the duration of contact. </li></ul><ul><li>Assess: </li></ul><ul><li>Surface area: %BSA. </li></ul><ul><li>Depth: </li></ul><ul><li>Special areas. </li></ul><ul><li>Airway: </li></ul>
    38. 40. Febrile Convulsion <ul><li>Are not epilepsy!! </li></ul><ul><li>Typically occur in children between 6months - 6years. </li></ul><ul><li>Caused by underlying fever can be bacterial or viral related. </li></ul><ul><li>Febrile convulsion is the bodies natural response to fever. Not necessarily how high the fever is but how quick the fever rises, that cause the convulsion. </li></ul>
    39. 41. Febrile Convulsion Management! <ul><li>D.R.A.B.C.D.E. </li></ul><ul><li>O.P.R </li></ul><ul><li>Remove clothing </li></ul><ul><li>Do not over cool child. </li></ul><ul><li>Monitor vitals signs (Temp) </li></ul><ul><li>Paracetamol (check dose!!!) </li></ul>
    40. 42. Gastroenteritis <ul><li>Gastroenteritis (gastro) is a bowel infection that is common in young infants and children. </li></ul><ul><li>Viruses are the most common cause of gastro. (rotavirus) </li></ul><ul><li>Dehydration cause the most serious complications of gastro and fluid replacement is essential in preventing this. </li></ul>
    41. 43. Meningitis <ul><li>Bacterial meningitis is a medical emergency requiring rapid diagnosis and prompt treatment. </li></ul><ul><li>Meningitis is the inflammation of the meninges that surround the brain. </li></ul><ul><li>Septicaemia is infection of the blood. </li></ul><ul><li>Can present with both!!! </li></ul>
    42. 44. Clinical presentation in infants and toddlers. <ul><li>Signs and symptoms of serious infection within this age group are often non specific: </li></ul><ul><li>1. Fever, irritability, vomiting. </li></ul><ul><li>2. Drowsiness </li></ul><ul><li>3. Neck stiffness or a bulging fontanelle. </li></ul><ul><li>Both neck stiffness and bulging fontanelle may be absent, especially during infancy and early in the illness. </li></ul>
    43. 45. Clinical presentation in children over the age of 3. <ul><li>The signs of meningitis are more obvious. </li></ul><ul><li>Fever, severe headache, vomiting, photophobia (light sensitivity). </li></ul><ul><li>Neck stiffness. </li></ul><ul><li>3.Delirium or deteriorating consciousness. </li></ul><ul><li>A rash may be evident in some case’s but is a late sign of the disease. </li></ul>
    44. 46. The Poisoned Child <ul><li>D.R.A.B.C.D.E </li></ul><ul><li>O.P.R </li></ul><ul><li>Do not induce vomiting </li></ul><ul><li>Try to find out what was taken, </li></ul><ul><li>How much was taken </li></ul><ul><li>When was it taken. </li></ul>
    45. 47. Drowning <ul><li>Two major consequences occur from drowning: </li></ul><ul><li>Hypoxia </li></ul><ul><li>Asphyxiation </li></ul><ul><li>Generally related to amount of liquid aspirated into lungs. </li></ul><ul><li>No clinical difference between salt water and fresh water drowning. </li></ul>
    46. 48. Tetanus! <ul><li>Always check with parents if there immunised. </li></ul>
    47. 49. The End!