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Paediatric Emergencies

Paediatric Emergencies



Presentation on paediatric emergency for pre-hospital care providers.

Presentation on paediatric emergency for pre-hospital care providers.



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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 Paediatric Emergencies Presentation Transcript

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