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Infants and Children
 

Infants and Children

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    Infants and Children Infants and Children Presentation Transcript

    • Chapter Infants and Children Twenty-Five
    • Chapter
      • Pediatric respiratory emergencies
      • Other pediatric medical emergencies
      • Pediatric trauma
      Twenty-Five CORE CONCEPTS
    • Newborns and Infants: Birth to 1 Year
      • Very little anxiety from
      exposure to strangers.
      • Dislike separation from
      parents. (Continued) Newborns and Infants
      • Dislike feeling of oxygen mask
      on face.
      • Need warmth:
      • Warm hands and stethoscope
      (Continued) Newborns and Infants
      • Obtain respiratory rate from
      a distance.
      • If listening to lungs, do it early
      (before child becomes upset) .
      • Examine head last to
      build confidence. Newborns and Infants
    • Toddler: 1 to 3 Years
      • Dislike
      • Being touched
      • Separation from parents
      • Removal of clothing
      (remove, examine, replace)
      • Feeling of oxygen mask on face
      (Continued) Toddlers
      • Think illness/injury is punishment.
      • Afraid of needles, pain.
      • Examine trunk first, head last.
      Toddlers
    • Preschool: 3 to 6 Years
      • Dislike
      • Being touched
      • Separation from parents
      • Removal of clothing
      (remove, examine, replace)
      • Feeling of oxygen mask on face
      (Continued) Preschoolers
      • Think illness/injury is punishment.
      • Afraid of blood, pain,
      permanent injury.
      • Modest.
      • Have magical thoughts.
      Preschoolers
    • School Age: 6 to 12 Years
      • Afraid of blood and pain.
      • Afraid of permanent injury
      and disfigurement.
      • Modest.
      School-Age Child
    • Adolescent: 12 to 18 Years
      • Afraid of permanent injury
      and disfigurement.
      • Modest.
      • Treat as an adult.
      • Examine in private if possible
      (away from adults) . Adolescent
    • Airway Differences between Adults and Children
      • Small airways are more easily blocked.
      • Child's tongue is larger.
      • Infants are nose breathers.
      • Suctioning nasopharynx improves
      • breathing significantly.
      (Continued) Airway Differences between Adults and Children
      • Put child’s head in neutral position,
      not hyperextended.
      • Children can compensate (breathe
      faster/harder) for a while, then get worse rapidly. Airway Differences between Adults and Children
    • Opening the airway Use head-tilt, chin-lift procedure without hyperextension.
      • Ensure small enough catheter.
      • Do not insert too deeply.
      • Suction as briefly as possible.
      Suctioning
    • Treating Mild Airway Obstruction
      • Place in position of comfort (parent’s lap okay).
      • Administer high-concentration oxygen.
      • Transport without agitating.
    • Severe Airway Obstruction
      • No crying or speech
      • Initial difficulty breathing that worsens
      • Cough becomes weak and ineffective
      • Altered mental status, unconsciousness
    • INFANTS Back blows and chest thrusts CHILDREN Abdominal thrusts Remove visible foreign body. Clearing Foreign Body Obstructions Attempt artificial ventilation with BVM.
      • Use correct size.
      • Use tongue depressor to hold down tongue.
      • Insert right side up ( not upside down ) .
      Oral Airways
      • Use proper size.
      • Insertion technique is same
      as for adult. Nasal Airways
    • Nonrebreather Mask
      • Hold tubing 2 inches from face,
      OR
      • Insert tubing into paper cup. Do not use styrofoam cup.
      Blow-By Technique
      • Use proper size mask and bag.
      • If trauma is involved, use jaw
      thrust (not head tilt).
      • If unable to maintain mask seal
      with one hand, use two. (Continued) Artificial Ventilation
    • Mouth-to-Mask Ventilation
      • Bag-Mask Device:
      • Squeeze bag slowly/evenly until chest rises.
      • From birth to puberty (about 12 years old), ventilate 12–20 times a minute, each lasting 1 second.
      • If the patient has reached puberty, ventilate 10–12 times a minute, each lasting 1 second.
      • Use oxygen reservoir to provide 100% oxygen.
      Artificial Ventilation
      • Mental status
      • Breathing
      • Color
      • Observe:
      • Observe:
      • Quality of cry or speech
      • Emotional state
      • Response to your presence
      • Tone and body position
      (Continued) Assessment: General Impression
      • Observe:
      • Interaction with environment
      and parents
      • Normal behavior for age?
      • Playing or moving around?
      • Attentive?
      • Eye contact?
      • Recognize and respond to parents?
      Assessment: General Impression
      • As soon as you see patient, check:
      • Mechanism of injury
      • Surroundings
      • Healthy or sick appearance
      (Continued) Approach to Evaluation
      • Assess respirations:
      • Chest expansion and symmetry
      • Effort of breathing
      • Nasal flaring
      • Retractions
      (Continued) Approach to Evaluation
      • Assess respirations:
      • Crowing or noisy respirations
      • Stridor
      • Grunting
      • Respiratory rate
      • Assess perfusion:
      • Skin color (CTC)
      (Continued) Approach to Evaluation
      • When you reach child,
      • Breath sounds present or absent?
      • Stridor?
      • Wheezing?
      continue breathing assessment using stethoscope: (Continued) Approach to Evaluation
      • Assess circulation:
      • Brachial or femoral pulse
      • Peripheral pulses
      • Capillary refill
      • Blood pressure (if over age 3)
      • Skin color, temperature, condition
      Approach to Evaluation
      • Generally start at trunk and
      evaluate head last.
      • Alter order of steps to fit situation.
      • Avoid making child more anxious.
      Detailed Physical Exam
    • P EDIATRIC RESPIRATORY EMERGENCIES
    • Patient ASSESSMENT Partial Airway Obstruction Signs and Symptoms
      • Stridorous, crowing, or noisy
      respirations
      • Retractions on inspiration
      • Pink mucous membranes and nail beds
      • Alert
    • Patient CARE Partial Airway Obstruction Emergency Care Steps
      • Allow position of comfort
      (parent’s lap okay) .
      • Do not lay child flat.
      • Offer high-concentration oxygen.
      • Transport without agitating.
      (Do not assess blood pressure.)
    • Patient ASSESSMENT Complete Airway Obstruction Signs and Symptoms
      • No crying or speech
      • Initial breathing difficulty that worsens
      • Cough becomes weak and ineffective
      • Altered mental status, unconsciousness
    • Patient CARE Complete Airway Obstruction Emergency Care Steps
      • Clear airway with infant/child
      foreign body procedures.
      • Attempt artificial ventilation with
      BVM. Assure good seal between mask and face.
      • Upper airway obstruction
      • Stridor on inspiration
      • Lower airway disease
      • Wheezing and respiratory effort on exhalation OR rapid breathing
      • without stridor
      Respiratory Emergencies
    • Tell new EMT-Bs that pediatric care experts emphasize that the priority of children in respiratory distress is “AAA,” not just “ABC.” In other words, if you manage the patient’s airway and oxygenate, circulation improvement will follow! P RECEPTOR P EARL
    • Patient ASSESSMENT Early Respiratory Distress Signs and Symptoms
      • Nasal flaring
      • Retractions
      • Between ribs (intercostal)
      • Above clavicles (supraclavicular)
      • Below ribs (subcostal)
      (Continued)
    • Patient ASSESSMENT Early Respiratory Distress Signs and Symptoms
      • Stridor
      • Retractions of neck, abdominal muscles
      • Audible wheezing
      • Grunting
      (Continued)
    • Patient ASSESSMENT Early Respiratory Distress Signs and Symptoms
      • Respiratory rate > 60/minute
      • Cyanosis
      • Decreased muscle tone
      • Excessive use of accessory muscles
    • Patient ASSESSMENT Respiratory Distress Signs and Symptoms
      • Poor peripheral perfusion
      • Altered mental status
      • Grunting
    • Patient ASSESSMENT Respiratory Arrest Signs and Symptoms
      • Respiratory rate < 10/minute
      • Little or no muscle tone
      • Unconsciousness
      • Slow/absent heart rate
      • Weak/absent pulse
    • Signs of Respiratory Distress
    • Patient CARE Respiratory Emergencies Emergency Care Steps
      • Administer high-concentration oxygen.
      • Ventilate if respiratory distress is severe:
      • Altered mental status
      • Cyanosis not improving with oxygen
      • Poor muscle tone
      • Respiratory failure
      • Respiratory arrest
    • P EDIATRIC TRAUMA
    • Trauma In the United States, injuries kill more children and infants than any other cause of death.
      • Unrestrained passenger head and neck injuries
      • Restrained passenger abdominal and lower spine injuries
      (Continued) Blunt Trauma (Most Common Type of Injury)
      • Motor vehicle crashes
      • Motor vehicle crashes
      • Struck while riding bicycle
      (head, spine, abdominal injuries)
      • Pedestrian struck by vehicle
      (abdominal, femur, head injuries) (Continued) Blunt Trauma
      • Falls from height
      • Head and neck injuries
      • Diving into shallow water
      • Head and neck injuries
      • Burns
      • Sports injuries
      • Child abuse
      Blunt Trauma
      • Head
      • Airway maintenance is critical.
      • Head injury is common.
      • Can result in respiratory arrest.
      • Nausea and vomiting are common.
      (Continued) Blunt Trauma Specific Types of Injurie s
      • Children’s ribs are less rigid than
      adults’ ribs.
      • Result in injury to internal organs
      without external wounds. (Continued) Blunt Trauma Specific Types of Injuries
      • Chest
      • Abdomen
      • More commonly injured in children
      than adults.
      • May be subtle and difficult to detect.
      • Under stress, children swallow air
      (may cause gastric distention, impede breathing) . (Continued) Blunt Trauma Specific Types of Injuries
      • Extremities
      • Managed the same as adults
      Blunt Trauma Specific Types of Injuries
      • Use only if:
      • Child fits in garment.
      • Trauma occurs with hypoperfusion
      • and pelvic instability.
      • Do not inflate abdominal compartment.
      Trauma Other Considerations (Continued)
      • Pneumatic Antishock Garment
      • Burns
      • Cover with sterile dressing
      (sterile sheet works well) .
      • Follow local protocol with regard to
      transport to burn center. Trauma Other Considerations
    • Patient CARE Trauma Emergency Care Steps
      • Establish and maintain airway with
      jaw thrust.
      • Suction and ventilate as needed.
      • Provide high-concentration oxygen.
      • Immobilize spine.
      • Transport.
      • Diarrhea, vomiting, dehydration
      • Trauma and blood loss
      • Infection
      • Abdominal injuries
      Causes
      • Allergic reactions
      • Poisoning
      • Cardiac problems
      Uncommon Causes Shock (Hypoperfusion)
    • Tell new EMT-Bs that one way to remember how little blood children have is to envision that an infant’s total blood volume would fill only a soda can and a school age child’s a six-pack. P RECEPTOR P EARL
    • Patient ASSESSMENT Shock (Hypoperfusion) Signs and Symptoms
      • Rapid breathing
      • Pale, cool, clammy skin
      • Weak/absent peripheral pulses
      • Delayed capillary refill
      (Continued)
    • Patient ASSESSMENT Shock (Hypoperfusion) Signs and Symptoms
      • Decreased urine output
      Inspect diaper/ask parents when last changed.
      • Changes in mental status
      • Lack of tears when crying
    • Signs of Shock (Hypoperfusion)
    • Patient CARE Shock (Hypoperfusion) Emergency Care Steps
      • Assure airway and give
      high-concentration oxygen.
      • Ventilate as needed.
      • Control bleeding.
      • Elevate legs.
      • Keep warm.
      • Transport promptly.
    • Patient CARE Near Drowning (submersion) Emergency Care Steps
      • Ventilation is top priority.
      • Consider possibilities of trauma,
      hypothermia, and drug ingestion (especially alcohol in teenagers) .
      • Transport. (Some patients deteriorate
      minutes/hours later.)
    • Abuse Improper or excessive action so as to injure or cause harm Neglect Giving insufficient attention or respect to someone who has a claim to that attention K EY TERMS
    • Physical abuse and neglect are forms of child abuse EMT-B is most likely to suspect. EMT-B must be aware of condition in order to recognize it.
    • Tell new EMT-Bs that the ED physician is required to report cases of child abuse. Therefore, they should complete the PCR with factual information that they observed about the child’s home environment, the condition of the home, the reaction of the parents or other caretakers, the child’s hygiene, and general interaction of all family members involved, and call it to the attention of the physician. P RECEPTOR P EARL
    • Patient ASSESSMENT Abuse Signs and Symptoms
      • Multiple bruises in different stages
      of healing
      • Injury inconsistent with
      mechanism described
      • Repeated calls to same address
      (Continued)
    • Patient ASSESSMENT Abuse Signs and Symptoms
      • Fresh burns
      • Apparent lack of enough concern in parents
      • Conflicting stories
      • Child’s hesitancy to describe how injury occurred
    • Patient ASSESSMENT Neglect Signs and Symptoms
      • Lack of adult supervision
      • Apparent malnourishment
      • Unsafe living environment
      • Untreated chronic illness
      • Head injuries are most lethal
      (shaken baby syndrome) .
      • Do not accuse anyone in the field.
      (Continued) Handling Abuse and Neglect
      • Required reporting
      • Follow state laws and local regulations.
      • Document objective information: what you SEE and HEAR, not what you merely THINK .
      Handling Abuse and Neglect
    • P EDIATRIC MEDICAL EMERGENCIES
    • Seizures
      • Rarely life-threatening in
      children, but EMT-B should take seriously.
      • May be brief or prolonged.
      • May cause injuries.
      • Fever
      • Infection
      • Poisoning
      • Hypoglycemia
      • Trauma
      • Hypoxia
      • Idiopathic
      Causes (unknown cause) Seizures
    • Patient ASSESSMENT Child after Seizure Signs and Symptoms
      • Has child had seizures before?
      • If yes, was this typical seizure?
      • Was antiseizure medication taken?
    • Patient CARE Seizures Emergency Care Steps
      • Establish airway.
      • Position on left side if no spine trauma.
      • Have suction ready.
      • Give oxygen. Ventilate if respiratory
      distress/arrest.
      • Transport.
      • Hypoglycemia
      • Poisoning
      • Postseizure
      • Infection
      • Head trauma
      • Hypoxia
      • Shock
      Causes Altered Mental Status
    • Patient CARE Altered Mental Status Emergency Care Steps
      • Establish airway.
      • Ventilate and suction as needed.
      • Transport.
    • Patient CARE Poisoning: Responsive Patient Emergency Care Steps
      • Contact medical direction.
      • Give activated charcoal as directed.
      • Administer oxygen.
      • Transport and monitor patient.
    • Patient CARE Poisoning: Unresponsive Patient Emergency Care Steps
      • Rule out trauma.
      • Establish airway.
      • Administer oxygen; ventilate as needed.
      • Contact medical direction.
      • Transport.
    • Fever
      • Many things can cause fever.
      • Meningitis is one of worst. May
      appear as fever with rash.
      • Transport.
      • Be prepared for seizures.
    • Sudden Infant Death Syndrome (SIDS)
      • Sudden death occurs without identifiable cause in infant < 1 year old.
      • Cause is not well understood.
      • Most common time of discovery is early morning.
    • Patient CARE SIDS Emergency Care Steps
      • Try to resuscitate unless rigor
      mortis is present.
      • Avoid comments that blame parents.
      • Expect parents to feel remorse and guilt.
    • I NFANTS AND CHILDREN WITH SPECIAL NEEDS
      • Premature babies with lung disease
      • Heart disease
      • Neurologic disease
      • Chronic disease or altered function
      since birth Children with Special Needs
    • Technologically Dependent Children (“High-Tech Kids”)
      • Tracheostomy tube
      • Central intravenous lines
      • Gastrostomy tubes
      • Shunts
      • Obstruction
      • Bleeding
      • Air leak
      • Dislodged tube
      • Infection
      Tracheostomy Tube Complications
    • Patient CARE Tracheostomy Tube Emergency Care Steps
      • Maintain open airway.
      • Suction.
      • Maintain position of comfort.
      • Transport.
      • Parents are usually very
      familiar with equipment. Home Artificial Ventilation
    • Patient CARE Home Artificial Ventilation Emergency Care Steps
      • Assure airway.
      • Artificially ventilate with
      high-concentration oxygen.
      • Transport.
      • IVs that are very long
      • Tip in vein near heart
      • Complications
      • Cracked line
      • Infection
      • Clotting off
      • Bleeding
      Central Intravenous Lines
    • Patient CARE Central Intravenous Lines Emergency Care Steps
      • If bleeding, apply pressure.
      • Transport.
    • Shunt Tube running from brain to abdomen to drain excess cerebrospinal fluid Gastrostomy Tube Tube placed directly into the stomach for a child who cannot be fed by mouth K EY TERMS
    • Patient CARE Shunt Emergency Care Steps
      • Assure airway and ventilate as needed.
      • Transport.
    • Patient CARE Gastrostomy Tube Emergency Care Steps
      • Assure patent airway.
      • Suction as needed.
      • Provide high-concentration oxygen.
      • Transport patient sitting or lying on
      right side with head elevated.
    • 1. Describe two characteristics of a typical child in each of the five age groups. 2. Describe the management of pediatric respiratory distress. 3. How do children compensate for blood loss compared to an adult? 4. What are some indications of child abuse? R EVIEW QUESTIONS