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Pediatrics: Scene Management - The Missing Piece.
 

Pediatrics: Scene Management - The Missing Piece.

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Pediatric Emergencies are difficult for everyone. Emotions run high for patients, parents, bystanders and yes, even emergency responders. In addition, trying to recall or look-up pediatric-specific ...

Pediatric Emergencies are difficult for everyone. Emotions run high for patients, parents, bystanders and yes, even emergency responders. In addition, trying to recall or look-up pediatric-specific vitals, values and medication doses can be tremendously stressful. Because of this, providers often miss the simple steps that can make an important difference in our care. With an approach of “first-things-first” this program will show how to manage the scene of a pediatric emergency with confidence, care and compassion.

Find more at www.romduckworth.com

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    Pediatrics: Scene Management - The Missing Piece. Pediatrics: Scene Management - The Missing Piece. Presentation Transcript

    • Pediatric Emergencies
      Scene Management:
      The Missing Piece
      ROMDUCK, LLC.
      Rommie L. Duckworth
    • Immediately upon arrival at a peds call…
      There’s no need to be a chicken!
      “When in danger, when in doubt, run in circles, scream and shout.”
    • Romig’s Rule of Vital Sign Comparisons
      “It’s hardly ever good when the rescuer’s pulse or respiratory rate is greater than that of their pediatric patient.”
      -Lou E. Romig MD, FAAP, FACEP
      www.jumpstarttriage.com
    • Pediatric Emergencies
      Scene Management: The Missing Piece
      Arrangement
      Prep and Plan ahead
      Assurance
      Communicate with family and bystanders
      Assessment
      Communicate with patient
      Action
      Lead, follow or get out of the way.
    • Crapronyms
      Crappy Acronyms
      AAAAAAAAAAAAAAAAAAAAAAAAAY!
      (Arrangement) Always assign an assistant ahead.
      (Assurance) Anticipate and answer adult anxiety, agitation and aggressive appearance.
      (Assessment) Arrive assuming an age appropriate assessment.
      (Action) Adapt and allow awesome action, You!
    • Arrangement (because you’re in EMS)
      References
      Broslow Tape
      Pedi-Wheel
      Reference Cards
      Reference Books
      Smart Phone Apps
    • Arrangement (At the start of shift)
      Check your gear
      What Peds equipment?
      How do we carry it?
      Where do we carry it?
      Is it ready to go?
    • Arrangement (before you step out)
      What is our game plan?
      Who is the Clinical Lead?
      With whom are we interfacing?
      What is our Good / Bad plan?
      Everybody take a deep breath.
    • Assurance (they’ll meet you at the door)
      Family and Bystanders
      Expectations?
      “Who are you?”
      What to do
      Be Polite
      Be Caring
      Assign Assistance
      Balance Calm and Concern
    • Assurance (Makes Parents Happy)
      Treat your children well.
      LISTEN to parent and child.
      Ask (and use) their name.
      Keep them comfortable.
      Pain Management
      Emotional Comfort
      Relieve fear and anxiety
    • Assurance (Makes Parents Happy)
      Treat your children well.
      Each and every child is the most…
      Special
      Smart
      Beautiful
      Whatever you can think of
      …child in the world.
    • Assessment:What do we need to know?
      Can you tell if the child is
      Critical or Not Critical just by looking at them?
    • The Pediatric Assessment Triangle
      Critical=
      QUICK
      Not Critical=
      Not QUICK
      Appearance
      Breathing
      Circulation
      Adapted from the AAP’s Pediatric Education for Prehospital Professionals (PEPP) course. www.PEPPsite.com
    • General Appearance
      TTone
      IInteractiveness
      CConsolability
      LLook/gaze
      SSpeech/cry
      Appearance
      Are they with it or out of it?
    • Work Of Breathing
      Be
      WWork
      AAbnormal Sounds
      RRetractions
      EExtreme Nasal Flaring
      Breathing
      Are they fighting for air?
    • Circulation to Skin
      TTemperature - Skin
      TTime - Capillary Refill
      PPulse
      Circulation to the Skin
      Are they compensating?
    • Respiratory Distress
      Critical or Not Critical
      Critical
      Work of Breathing
      Fighting for air?
      Gen. Appearance
      With it or not?
      Appearance
      Breathing
      With it
      Fighting
      Circulation
      Normal
      Circulation to Skin?
    • CNS Problem? Seizure?
      Critical or Not Critical
      Critical
      Work of Breathing
      Fighting for air?
      Gen. Appearance
      With it or not?
      Appearance
      Breathing
      Not with it
      Normal
      Circulation
      Normal
      Circulation to Skin?
    • Respiratory Failure!
      What General Direction does this sign point?
      Work of Breathing
      Fighting for air?
      Gen. Appearance
      With it or not?
      Appearance
      Breathing
      Not with it
      Fighting
      Circulation
      Abnormal
      Circulation to Skin?
    • Not Critical. I dunno.
      Critical or Not Critical
      Not Critical
      Work of Breathing
      Fighting for air?
      Gen. Appearance
      With it or not?
      Appearance
      Breathing
      Normal
      Normal
      Circulation
      Normal
      Circulation to Skin?
    • Not Critical. Cold?
      Critical or Not Critical
      Not Critical
      Work of Breathing
      Fighting for air?
      Gen. Appearance
      With it or not?
      Appearance
      Breathing
      Normal
      Normal
      Circulation
      Normal
      Circulation to Skin?
    • Assessment
      Critical=
      QUICK
      Not Critical=
      Not QUICK
      Appearance
      Breathing
      Circulation
      Any single RED FLAG = SICK
    • Pediatric Training Programs
      • PEPP
      • PALS
      • PEARS
      • APLS
      • EPiC
    • Action: Tips for Tots
    • Infant 1 mo. – 1 yr.
      • Try to keep the child with a caregiver or familiar face.
      • Use reassuring facial expressions and tone.
      • Little stranger anxiety at this age.
      • Will accept undressing but will want to stay warm.
      • Toe to Head Exam.
      • Have parent / caregiver assist with exam.
      • Just LOOK at those chubby cheeks!
    • Toddler 1 yr. – 3 yr.
      • Use family, friends, toys to reassure.
      • May perceive illness as punishment.
      • Learning independence and modesty.
      • They’ll understand more than they can speak.
      • Be selective in undressing.
      • Avoid hog-tying them, but don’t wait
      around forever for cooperation.
    • Pre-School 3 yr. – 6 yr.
      • Greatly fear blood, pain and “disfigurement”.
      • Independent and modest.
      • Explain what’s happening in child’s terms.
      • Curious and talkative.
      • Like to have choices.
    • Pre-School 3 yr. – 6 yr.
      • Can misinterpret words and phrases.
      “The flashlight is dead!”
      • May perceive illness as punishment.
      “Daddy crashed because I didn’t sit still.”
      • Magical thinking.
      “The band-aid makes the boo-boo go away!”
    • School Age 6 yr. – 12 yr.
      • Question the patient directly.
      • Respect, do not “baby” them.
      • Do not embarrass them.
      • Talk directly to your patient.
      • Explain what’s going to happen.
      • Ask about common interests.
      • Movies, School, Sports
    • Adolescent >12y/o
      • Identity and peer relationships are a priority.
      • Body image &“disfigurement” are of great concern.
      • Emotional response can be highly understated or exaggerated.
      • Patient may regress to an earlier emotional stage.
      • Variable development in this
      group can make contact difficult.
    • Adolescent >12y/o
      • Be careful not to be aggressive or condescending.
      • Approach physical assessment as with an adult.
      • Do not try to be “Cool”, “With it” or “Jiggy”.
      • Be cautious when questioning about drugs, sexual history or other sensitive issues.
      • Do NOT lie to the patient.
      • Be reassuring and respectful.
    • Action: Transport (Let’s go!)
      Family & Bystanders
      Get A Ride
      Ride with us
      Front
      Back
      Drive Themselves
    • Action: Transport (Let’s go!)
      Child
      Stretcher
      Car Seat
      Their Own
      Built-In
      Inflatable
      Flexible
    • SUMMARY
      Scene Management: The Missing Piece
      Arrangement
      Prep and Plan ahead
      Assurance
      Communicate with family and bystanders
      Assessment
      Communicate with patient
      Action
      Lead, follow or get out of the way.
    • And Finally…
      • Awesome YOU!
    • Crapronyms!
      AAAAAAAAAAAAAAAAAAAAAAAAAY!
      Arrangement
      Prep and Plan ahead
      Assurance
      Communicate with family and bystanders
      Assessment
      Communicate with patient
      Action
      Lead, follow or get out of the way.
    • For questions, comments, feedback
      and to find additional resources on this and other lecture topics find me at…
      Twitter:@romduck
      Facebook: romduck
      Linked In: romduck
      Google:RommieDuckworth
      www.romduckworth.com