TAEM10: Pediatric Emergency


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TAEM10: Pediatric Emergency

  1. 1. Nursing Care of Pediatric Emergency AranYa Thaitae Queen Sirikit National Institute of Child Health
  2. 2. Pediatric emergency <ul><li>Respiratory emergency </li></ul><ul><li>Fever group </li></ul><ul><li>Anaphylaxis </li></ul><ul><li>GI emergency </li></ul><ul><li>Neurological emergency </li></ul><ul><li>Surgical emergency </li></ul><ul><li>Accident </li></ul><ul><li>Eye emergency </li></ul><ul><li>ENT emergency </li></ul>
  3. 3. Top 5 diseases at ER of QSNICH
  4. 4. Respiratory assessment <ul><li>Physical assessment </li></ul><ul><li>2 . Oxygen therapy </li></ul>
  5. 5. <ul><li>Physical assessment </li></ul>
  6. 6. Physical assessment <ul><li>Observation </li></ul><ul><li>- Dyspnea : grunting, flaring, </li></ul><ul><li>retraction </li></ul><ul><li>- Cyanosis </li></ul><ul><li>- Tachypnea, bradypnea </li></ul><ul><li>- Chest movement </li></ul>
  7. 7. Normal respiratory rate < 60 < 50 < 40 < 30 2 months 2 – 12 months 1 – 5 years 6 – 8 years Respiratory rate Age
  8. 8. Physical assessment <ul><li>Ausculation </li></ul><ul><li>- Aspiratory </li></ul><ul><li>- Expiratory </li></ul><ul><li>3. Pulse oxymetry </li></ul><ul><li>- perfusion </li></ul><ul><li>- motion </li></ul><ul><li>4. Arterial blood gas analysis </li></ul>
  9. 9. Nursing Care in Respiratory emergency <ul><li>Airway management </li></ul><ul><li>1.1 Open airway using; </li></ul><ul><li>- head till-chin lift </li></ul><ul><li>- jaw thrust maneuver </li></ul><ul><li>1.2 Clear airway : suction </li></ul>
  10. 10. Indication of suction <ul><li>More frequent or congested sounding cough </li></ul><ul><li>Coarse audible secretions </li></ul><ul><li>Visible secretions </li></ul><ul><li>Increased pressures or decreased tidal volumes on the ventilator </li></ul><ul><li>Indication by the patient that suctioning is necessary </li></ul>
  11. 11. Indication of suction <ul><li>6. Suspected aspiration of gastric or upper airway secretions </li></ul><ul><li>7. Otherwise unexplained increase in shortness of breath. </li></ul><ul><li>8. Decreased oxygen saturations thought to be related to mucus plugging where oxygen saturations are monitored. </li></ul>
  12. 12. Table of ET Tube & suction 5 – 6 6 – 8 8 8 8 10 10 10 12 12 12 8 9 – 10 10 11 12 14 15 16 17 18 19 2.5,3.0 uc 3.0,3.5 uc 3.5,4.0 uc 4.0,4.5 uc 4.5,5.0 uc 5.0,5.5 uc 5.5 uc 6.0 c or uc 6.5 c or uc 7.0 c 7.0,8.0 c Premature infant Term infant 6 months 1 year 2 years 4 years 6 years 8 years 10 years 12 years Adolescent Suction NO. Distance ET tube Patient age
  13. 13. Complication of suction <ul><li>Hypoxia </li></ul><ul><li>Tissue hypoxia </li></ul><ul><li>Atelectasis </li></ul><ul><li>Hypotension </li></ul><ul><li>Airway constriction </li></ul>
  14. 14. Nursing Care <ul><li>Airway management </li></ul><ul><li>1.3 Oropharyngeal airway </li></ul>
  15. 15. Method of insertion oropharyngeal airway <ul><li>depress the tongue with a tongue blade and slide the airway in .    </li></ul><ul><li>Insert  the  airway upside  down  into  the victim’s mouth </li></ul><ul><li>Rotate it 180 °  as it slides into the pharynx </li></ul>
  16. 16. Oxygen therapy
  17. 17. Oxygen therapy <ul><li>Oxygen may be classified as an element, a gas, and a drug . Oxygen therapy is the administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxemia ( not enough oxygen in the blood). </li></ul><ul><li>Oxygen therapy is beneficial in all types of hypoxia, cyanosis, asphyxia, hypotonia. </li></ul>
  18. 18. Oxygen therapy <ul><li>Some of the conditions oxygen therapy </li></ul><ul><li>is used to treat include : </li></ul><ul><li>Hypoxemia </li></ul><ul><li>S evere respiratory distress (e.g., acute asthma or pneumonia ) </li></ul><ul><li>Severe trauma </li></ul><ul><li>S hronic obstructive pulmonary disease (COPD, including chronic bronchitis , emphysema , and chronic asthma) </li></ul>
  19. 19. Oxygen therapy <ul><li>pulmonary hypertension </li></ul><ul><li>cor pulmonale </li></ul><ul><li>acute myocardial infarction ( heart attack ) </li></ul><ul><li>short-term therapy, such as post-anesthesia recovery </li></ul><ul><li>Oxygen may also be used to treat chronic lung disease patients during exercise . </li></ul>
  20. 20. Oxygen therapy <ul><li>Too much O2 can cause respiratory arrest </li></ul><ul><li>A COPD patient in severe distress O2 is limited to two liters a minute by nasal catheter and given O2 under pressure with regulation of O2 and CO2. </li></ul>
  21. 21. Type of oxygen therapy <ul><li>2 systems </li></ul><ul><li>Low flow system </li></ul><ul><li>High flow system </li></ul>
  22. 22. Low flow system <ul><li>Nasal cannula </li></ul><ul><li>Nasopharyngeal catheter </li></ul><ul><li>Simple mask </li></ul><ul><li>Partial rebreathing mask </li></ul><ul><li>Non rebreathing mask </li></ul>
  23. 23. Low flow system <ul><li>Nassal cannula </li></ul><ul><li>Simple mask </li></ul>
  24. 24. Low flow system <ul><li>partial rebreathing </li></ul><ul><li>mask </li></ul><ul><li>Non- rebreathing mask </li></ul>
  25. 25. High flow system <ul><li>Venturi masks (mask without bag) </li></ul><ul><li>Oxygen hood </li></ul><ul><li>tracheostomy collars </li></ul><ul><li>Oxygen T- Piece </li></ul><ul><li>T ent f ace </li></ul><ul><li>Oxygen tent </li></ul>
  26. 26. High flow system Venturi mask                           
  27. 27. Low flow system <ul><li>Oxygen hood </li></ul><ul><li>tracheostomy </li></ul><ul><li>collar </li></ul>
  28. 28. High flow system <ul><li>Oxygen t- piece </li></ul><ul><li>Tent face </li></ul>
  29. 29. High flow system <ul><li>Oxygen tent </li></ul>
  30. 30. Complications from oxygen therapy <ul><li>Respiratory depression </li></ul><ul><li>Oxygen toxicity </li></ul><ul><li>Absorption atelectasis are the most serious complications with overuse of oxygen . </li></ul><ul><li>Perforation of the nasal septum as a result of using a nasal cannula </li></ul><ul><li>Bacterial contamination of nebulizer and humidification systems </li></ul>
  31. 31. Nursing in Oxygen Therapy <ul><li>Check order for flow rate and oxygen concentrations required </li></ul><ul><li>Place the mask over patient’s nose, mouth and chin </li></ul><ul><li>Check that the </li></ul><ul><li>- Oxygen is flow freely </li></ul><ul><li>- Patient is comfortable with freedom movement </li></ul>
  32. 32. Nursing in Oxygen Therapy <ul><li>Observe patient for signs of discomfort </li></ul><ul><li>Monitor and record vital signs </li></ul><ul><li>Monitor Sa0 2 </li></ul><ul><li>Check the patient’s face for signs of pressure mouth and nose for dryness </li></ul>
  33. 33. Nurses’ role <ul><li>Nurses are responsible for </li></ul><ul><li>Assessing patients </li></ul><ul><li>Ensuring that oxygen therapy is initiated as prescribed </li></ul><ul><li>Monitoring oxygen delivery systems </li></ul><ul><li>Recommending changes in therapy </li></ul>
  34. 34. Question
  35. 35. THANK YOU