TAEM10: Pediatric Emergency

Nursing Care of Pediatric Emergency AranYa Thaitae Queen Sirikit National Institute of Child Health

Pediatric emergency
Respiratory emergency
Fever group
Anaphylaxis
GI emergency
Neurological emergency
Surgical emergency
Accident
Eye emergency
ENT emergency

Top 5 diseases at ER of QSNICH

Respiratory assessment
Physical assessment
2 . Oxygen therapy

Physical assessment

Physical assessment
Observation
- Dyspnea : grunting, flaring,
retraction
- Cyanosis
- Tachypnea, bradypnea
- Chest movement

Normal respiratory rate < 60 < 50 < 40 < 30 2 months 2 – 12 months 1 – 5 years 6 – 8 years Respiratory rate Age

Physical assessment
Ausculation
- Aspiratory
- Expiratory
3. Pulse oxymetry
- perfusion
- motion
4. Arterial blood gas analysis

Nursing Care in Respiratory emergency
Airway management
1.1 Open airway using;
- head till-chin lift
- jaw thrust maneuver
1.2 Clear airway : suction

Indication of suction
More frequent or congested sounding cough
Coarse audible secretions
Visible secretions
Increased pressures or decreased tidal volumes on the ventilator
Indication by the patient that suctioning is necessary

Indication of suction
6. Suspected aspiration of gastric or upper airway secretions
7. Otherwise unexplained increase in shortness of breath.
8. Decreased oxygen saturations thought to be related to mucus plugging where oxygen saturations are monitored.

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

Complication of suction
Hypoxia
Tissue hypoxia
Atelectasis
Hypotension
Airway constriction

Nursing Care
Airway management
1.3 Oropharyngeal airway

Method of insertion oropharyngeal airway
depress the tongue with a tongue blade and slide the airway in .
Insert the airway upside down into the victim’s mouth
Rotate it 180 ° as it slides into the pharynx

Oxygen therapy

Oxygen therapy
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).
Oxygen therapy is beneficial in all types of hypoxia, cyanosis, asphyxia, hypotonia.

Oxygen therapy
Some of the conditions oxygen therapy
is used to treat include :
Hypoxemia
S evere respiratory distress (e.g., acute asthma or pneumonia )
Severe trauma
S hronic obstructive pulmonary disease (COPD, including chronic bronchitis , emphysema , and chronic asthma)

Oxygen therapy
pulmonary hypertension
cor pulmonale
acute myocardial infarction ( heart attack )
short-term therapy, such as post-anesthesia recovery
Oxygen may also be used to treat chronic lung disease patients during exercise .

Oxygen therapy
Too much O2 can cause respiratory arrest
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.

Type of oxygen therapy
2 systems
Low flow system
High flow system

Low flow system
Nasal cannula
Nasopharyngeal catheter
Simple mask
Partial rebreathing mask
Non rebreathing mask

Low flow system
Nassal cannula
Simple mask

Low flow system
partial rebreathing
mask
Non- rebreathing mask

High flow system
Venturi masks (mask without bag)
Oxygen hood
tracheostomy collars
Oxygen T- Piece
T ent f ace
Oxygen tent

High flow system Venturi mask

Low flow system
Oxygen hood
tracheostomy
collar

High flow system
Oxygen t- piece
Tent face

High flow system
Oxygen tent

Complications from oxygen therapy
Respiratory depression
Oxygen toxicity
Absorption atelectasis are the most serious complications with overuse of oxygen .
Perforation of the nasal septum as a result of using a nasal cannula
Bacterial contamination of nebulizer and humidification systems

Nursing in Oxygen Therapy
Check order for flow rate and oxygen concentrations required
Place the mask over patient’s nose, mouth and chin
Check that the
- Oxygen is flow freely
- Patient is comfortable with freedom movement

Nursing in Oxygen Therapy
Observe patient for signs of discomfort
Monitor and record vital signs
Monitor Sa0 2
Check the patient’s face for signs of pressure mouth and nose for dryness

Nurses’ role
Nurses are responsible for
Assessing patients
Ensuring that oxygen therapy is initiated as prescribed
Monitoring oxygen delivery systems
Recommending changes in therapy

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TAEM10: Pediatric Emergency

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