Chapter

Twenty-Five
Infants and
Children
Chapter

CORE CONCEPTS

Twenty-Five
Pediatric respiratory
emergencies

Other pediatric medical
emergencies
Pediatric traum...
Newborns and Infants: Birth to 1 Year
Newborns and Infants
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 ups...
Toddler: 1 to 3 Years
Toddlers
Dislike

Being touched
Separation from parents
Removal of clothing
(remove, examine, replace)

Feeling of oxygen ...
Toddlers
Think illness/injury is punishment.
Afraid of needles, pain.
Examine trunk first, head last.
Preschool: 3 to 6 Years
Preschoolers
Dislike

Being touched
Separation from parents
Removal of clothing
(remove, examine, replace)

Feeling of oxy...
Preschoolers
Think illness/injury is punishment.
Afraid of blood, pain,
permanent injury.
Modest.
Have magical thoughts.
School Age: 6 to 12 Years
School-Age Child
Afraid of blood and pain.
Afraid of permanent injury
and disfigurement.
Modest.
Adolescent: 12 to 18 Years
Adolescent
Afraid of permanent injury
and disfigurement.
Modest.
Treat as an adult.
Examine in private if possible
(away f...
Airway Differences between
Adults and Children
Airway Differences between
Adults and Children
Small airways are more easily
blocked.
Child's tongue is larger.
Infants ar...
Airway Differences between
Adults and Children
Put child’s head in neutral position,
not hyperextended.
Children can compe...
Opening the airway Use head-tilt,
chin-lift procedure without hyperextension.
Suctioning
Ensure small enough catheter.
Do not insert too deeply.
Suction as briefly as possible.
Treating Mild Airway
Obstruction
Place in position of comfort
(parent’s lap okay).
Administer high-concentration
oxygen.
T...
Severe Airway
Obstruction
No crying or speech
Initial difficulty breathing that
worsens
Cough becomes weak and ineffective...
Clearing Foreign Body
Obstructions
INFANTS

CHILDREN

Back blows and Abdominal
chest thrusts
thrusts
Remove visible foreig...
Oral Airways
Use correct size.
Use tongue depressor to hold down tongue.
Insert right side up (not upside down).
Nasal Airways
Use proper size.
Insertion technique is same
as for adult.
Nonrebreather Mask
Blow-By Technique
Hold tubing 2 inches from face,
OR
Insert tubing into paper
cup. Do not use
styrofoam cup.
Artificial Ventilation
Use proper size mask and bag.
If trauma is involved, use jaw
thrust (not head tilt).
If unable to m...
Mouth-to-Mask Ventilation
Artificial Ventilation
Bag-Mask Device:

• Squeeze bag slowly/evenly until chest rises.
• From birth to puberty (about 12 ...
Assessment: General Impression
Observe:

• Mental status
• Breathing
• Color

Observe:

• Quality of cry or speech
• Emoti...
Assessment: General Impression

Observe:

• Interaction with environment
and parents
Normal behavior for age?
• Playing or...
Approach to Evaluation
As soon as you see patient, check:
• Mechanism of injury
• Surroundings
• Healthy or sick appearanc...
Approach to Evaluation
Assess respirations:

• Chest expansion and symmetry
• Effort of breathing
• Nasal flaring
• Retrac...
Approach to Evaluation
Assess respirations:
• Crowing or noisy respirations
• Stridor
• Grunting
• Respiratory rate

Asses...
Approach to Evaluation
When you reach child,
continue breathing assessment
using stethoscope:
• Breath sounds present or a...
Approach to Evaluation
Assess circulation:
• Brachial or femoral pulse
• Peripheral pulses
• Capillary refill
• Blood pres...
Detailed Physical Exam
Generally start at trunk and
evaluate head last.
Alter order of steps to fit situation.
Avoid makin...
PEDIATRIC
RESPIRATORY
EMERGENCIES
Patient ASSESSMENT

Partial Airway Obstruction
Signs and Symptoms

Stridorous, crowing, or noisy
respirations
Retractions ...
Patient CARE

Partial Airway Obstruction
Emergency Care Steps

Allow position of comfort
(parent’s lap okay).

Do not lay ...
Patient ASSESSMENT

Complete Airway Obstruction
Signs and Symptoms

No crying or speech
Initial breathing difficulty that ...
Patient CARE

Complete Airway Obstruction
Emergency Care Steps

Clear airway with infant/child
foreign body procedures.
At...
Respiratory Emergencies
Upper airway obstruction
• Stridor on inspiration

Lower airway disease
• Wheezing and respiratory...
PRECEPTOR PEARL
Tell new EMT-Bs that pediatric care experts
emphasize that the priority of children in
respiratory distres...
Patient ASSESSMENT

Early Respiratory Distress
Signs and Symptoms

Nasal flaring
Retractions
• Between ribs (intercostal)
...
Patient ASSESSMENT

Early Respiratory Distress
Signs and Symptoms

Stridor
Retractions of neck,
abdominal muscles
Audible ...
Patient ASSESSMENT

Early Respiratory Distress
Signs and Symptoms

Respiratory rate > 60/minute
Cyanosis
Decreased muscle ...
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
Unconscio...
Signs of Respiratory Distress
Patient CARE

Respiratory Emergencies
Emergency Care Steps

Administer high-concentration oxygen.
Ventilate if respiratory...
PEDIATRIC
TRAUMA
Trauma
In the United States, injuries kill
more children and infants than
any other cause of death.
Blunt Trauma
(Most Common Type of Injury)

Motor vehicle crashes
• Unrestrained passenger head and
neck injuries
• Restrai...
Blunt Trauma
Motor vehicle crashes
• Struck while riding bicycle
(head, spine, abdominal injuries)

• Pedestrian struck by...
Blunt Trauma
Falls from height

• Head and neck injuries

Diving into shallow water
• Head and neck injuries

Burns
Sports...
Blunt Trauma
Specific Types of Injuries

Head
• Airway maintenance is critical.
• Head injury is common.
• Can result in r...
Blunt Trauma
Specific Types of Injuries

Chest

• Children’s ribs are less rigid than
adults’ ribs.
• Result in injury to ...
Blunt Trauma
Specific Types of Injuries

Abdomen

• More commonly injured in children
than adults.
• May be subtle and dif...
Blunt Trauma
Specific Types of Injuries

Extremities

• Managed the same as adults
Trauma
Other Considerations

Pneumatic Antishock Garment
• Use only if:

Child fits in garment.
• Trauma occurs with hypop...
Trauma
Other Considerations

Burns

• Cover with sterile dressing
(sterile sheet works well).
• Follow local protocol with...
Patient CARE

Trauma
Emergency Care Steps

Establish and maintain airway with
jaw thrust.
Suction and ventilate as needed....
Shock (Hypoperfusion)
Causes

Uncommon
Causes

Diarrhea, vomiting, dehydration
Trauma and blood loss
Infection
Abdominal i...
PRECEPTOR PEARL
Tell new EMT-Bs that one way
to remember how little blood
children have is to envision that an
infant’s to...
Patient ASSESSMENT

Shock (Hypoperfusion)
Signs and Symptoms

Rapid breathing
Pale, cool, clammy skin
Weak/absent peripher...
Patient ASSESSMENT

Shock (Hypoperfusion)
Signs and Symptoms

Decreased urine output

Inspect diaper/ask parents when last...
Signs of Shock (Hypoperfusion)
Patient CARE

Shock (Hypoperfusion)
Emergency Care Steps

Assure airway and give
high-concentration oxygen.
Ventilate as n...
Patient CARE

Near Drowning (submersion)
Emergency Care Steps

Ventilation is top priority.
Consider possibilities of trau...
KEY TERMS

Abuse

Improper or excessive action so as to
injure or cause harm

Neglect
Giving insufficient attention or res...
Physical abuse and neglect are
forms of child abuse EMT-B
is most likely to suspect.
EMT-B must be aware of
condition in o...
PRECEPTOR PEARL
Tell new EMT-Bs that the ED physician is
required to report cases of child abuse.
Therefore, they should c...
Patient ASSESSMENT

Abuse
Signs and Symptoms

Multiple bruises in different stages
of healing
Injury inconsistent with
mec...
Patient ASSESSMENT

Abuse
Signs and Symptoms

Fresh burns
Apparent lack of enough concern
in parents
Conflicting stories
C...
Patient ASSESSMENT

Neglect
Signs and Symptoms

Lack of adult supervision
Apparent malnourishment
Unsafe living environmen...
Handling Abuse and Neglect
Head injuries are most lethal
(shaken baby syndrome).
Do not accuse anyone in the field.

(Cont...
Handling Abuse and Neglect
Required reporting

• Follow state laws and local regulations.
• Document objective information...
PEDIATRIC
MEDICAL
EMERGENCIES
Seizures
Rarely life-threatening in
children, but EMT-B should
take seriously.
May be brief or prolonged.
May cause injuri...
Seizures
Causes

Fever
Infection
Poisoning
Hypoglycemia
Trauma
Hypoxia
Idiopathic
(unknown cause)
Patient ASSESSMENT

Child after Seizure
Signs and Symptoms

Has child had seizures before?
If yes, was this typical seizur...
Patient CARE

Seizures
Emergency Care Steps

Establish airway.
Position on left side if no spine trauma.
Have suction read...
Altered Mental Status
Causes

Hypoglycemia
Poisoning
Postseizure
Infection
Head trauma
Hypoxia
Shock
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 di...
Patient CARE

Poisoning: Unresponsive Patient
Emergency Care Steps

Rule out trauma.
Establish airway.
Administer oxygen; ...
Fever
Many things can cause fever.
Meningitis is one of worst. May
appear as fever with rash.
Transport.
Be prepared for s...
Sudden Infant Death
Syndrome (SIDS)
Sudden death occurs without
identifiable cause in infant
< 1 year old.
Cause is not we...
Patient CARE

SIDS
Emergency Care Steps

Try to resuscitate unless rigor
mortis is present.
Avoid comments that blame pare...
INFANTS AND
CHILDREN WITH
SPECIAL NEEDS
Children with Special Needs
Premature babies with lung disease
Heart disease
Neurologic disease
Chronic disease or altered...
Technologically Dependent
Children (“High-Tech Kids”)
Tracheostomy tube
Central intravenous lines
Gastrostomy tubes
Shunts
Tracheostomy Tube
Complications

Obstruction
Bleeding
Air leak
Dislodged tube
Infection
Patient CARE

Tracheostomy Tube
Emergency Care Steps

Maintain open airway.
Suction.
Maintain position of comfort.
Transpo...
Home Artificial Ventilation
Parents are usually very
familiar with equipment.
Patient CARE

Home Artificial Ventilation
Emergency Care Steps

Assure airway.
Artificially ventilate with
high-concentrat...
Central Intravenous Lines
IVs that are very long
• Tip in vein near heart

Complications
• Cracked line
• Infection
• Clot...
Patient CARE

Central Intravenous Lines
Emergency Care Steps

If bleeding, apply pressure.
Transport.
KEY TERMS
Shunt
Tube running from brain to abdomen
to drain excess cerebrospinal fluid

Gastrostomy Tube
Tube placed direc...
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 o...
REVIEW QUESTIONS
1. Describe two characteristics of a
typical child in each of the five
age groups.
2. Describe the manage...
Upcoming SlideShare
Loading in …5
×

Ch25eec3 110623155931-phpapp01

521 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
521
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
37
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Ch25eec3 110623155931-phpapp01

  1. 1. Chapter Twenty-Five Infants and Children
  2. 2. Chapter CORE CONCEPTS Twenty-Five Pediatric respiratory emergencies Other pediatric medical emergencies Pediatric trauma
  3. 3. Newborns and Infants: Birth to 1 Year
  4. 4. Newborns and Infants Very little anxiety from exposure to strangers. Dislike separation from parents. (Continued)
  5. 5. Newborns and Infants Dislike feeling of oxygen mask on face. Need warmth: • Warm hands and stethoscope (Continued)
  6. 6. 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.
  7. 7. Toddler: 1 to 3 Years
  8. 8. Toddlers Dislike Being touched Separation from parents Removal of clothing (remove, examine, replace) Feeling of oxygen mask on face (Continued)
  9. 9. Toddlers Think illness/injury is punishment. Afraid of needles, pain. Examine trunk first, head last.
  10. 10. Preschool: 3 to 6 Years
  11. 11. Preschoolers Dislike Being touched Separation from parents Removal of clothing (remove, examine, replace) Feeling of oxygen mask on face (Continued)
  12. 12. Preschoolers Think illness/injury is punishment. Afraid of blood, pain, permanent injury. Modest. Have magical thoughts.
  13. 13. School Age: 6 to 12 Years
  14. 14. School-Age Child Afraid of blood and pain. Afraid of permanent injury and disfigurement. Modest.
  15. 15. Adolescent: 12 to 18 Years
  16. 16. Adolescent Afraid of permanent injury and disfigurement. Modest. Treat as an adult. Examine in private if possible (away from adults).
  17. 17. Airway Differences between Adults and Children
  18. 18. 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)
  19. 19. 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.
  20. 20. Opening the airway Use head-tilt, chin-lift procedure without hyperextension.
  21. 21. Suctioning Ensure small enough catheter. Do not insert too deeply. Suction as briefly as possible.
  22. 22. Treating Mild Airway Obstruction Place in position of comfort (parent’s lap okay). Administer high-concentration oxygen. Transport without agitating.
  23. 23. Severe Airway Obstruction No crying or speech Initial difficulty breathing that worsens Cough becomes weak and ineffective Altered mental status, unconsciousness
  24. 24. Clearing Foreign Body Obstructions INFANTS CHILDREN Back blows and Abdominal chest thrusts thrusts Remove visible foreign body. Attempt artificial ventilation with BVM.
  25. 25. Oral Airways Use correct size. Use tongue depressor to hold down tongue. Insert right side up (not upside down).
  26. 26. Nasal Airways Use proper size. Insertion technique is same as for adult.
  27. 27. Nonrebreather Mask
  28. 28. Blow-By Technique Hold tubing 2 inches from face, OR Insert tubing into paper cup. Do not use styrofoam cup.
  29. 29. Artificial Ventilation 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)
  30. 30. Mouth-to-Mask Ventilation
  31. 31. Artificial 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.
  32. 32. Assessment: General Impression Observe: • Mental status • Breathing • Color Observe: • Quality of cry or speech • Emotional state • Response to your presence • Tone and body position (Continued)
  33. 33. 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? •
  34. 34. Approach to Evaluation As soon as you see patient, check: • Mechanism of injury • Surroundings • Healthy or sick appearance (Continued)
  35. 35. Approach to Evaluation Assess respirations: • Chest expansion and symmetry • Effort of breathing • Nasal flaring • Retractions (Continued)
  36. 36. Approach to Evaluation Assess respirations: • Crowing or noisy respirations • Stridor • Grunting • Respiratory rate Assess perfusion: • Skin color (CTC) (Continued)
  37. 37. Approach to Evaluation When you reach child, continue breathing assessment using stethoscope: • Breath sounds present or absent? • Stridor? • Wheezing? (Continued)
  38. 38. Approach to Evaluation Assess circulation: • Brachial or femoral pulse • Peripheral pulses • Capillary refill • Blood pressure (if over age 3) • Skin color, temperature, condition
  39. 39. Detailed Physical Exam Generally start at trunk and evaluate head last. Alter order of steps to fit situation. Avoid making child more anxious.
  40. 40. PEDIATRIC RESPIRATORY EMERGENCIES
  41. 41. Patient ASSESSMENT Partial Airway Obstruction Signs and Symptoms Stridorous, crowing, or noisy respirations Retractions on inspiration Pink mucous membranes and nail beds Alert
  42. 42. 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.)
  43. 43. 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
  44. 44. 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.
  45. 45. Respiratory Emergencies Upper airway obstruction • Stridor on inspiration Lower airway disease • Wheezing and respiratory effort on exhalation OR rapid breathing without stridor
  46. 46. PRECEPTOR PEARL 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!
  47. 47. Patient ASSESSMENT Early Respiratory Distress Signs and Symptoms Nasal flaring Retractions • Between ribs (intercostal) • Above clavicles (supraclavicular) • Below ribs (subcostal) (Continued)
  48. 48. Patient ASSESSMENT Early Respiratory Distress Signs and Symptoms Stridor Retractions of neck, abdominal muscles Audible wheezing Grunting (Continued)
  49. 49. Patient ASSESSMENT Early Respiratory Distress Signs and Symptoms Respiratory rate > 60/minute Cyanosis Decreased muscle tone Excessive use of accessory muscles
  50. 50. Patient ASSESSMENT Respiratory Distress Signs and Symptoms Poor peripheral perfusion Altered mental status Grunting
  51. 51. Patient ASSESSMENT Respiratory Arrest Signs and Symptoms Respiratory rate < 10/minute Little or no muscle tone Unconsciousness Slow/absent heart rate Weak/absent pulse
  52. 52. Signs of Respiratory Distress
  53. 53. 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
  54. 54. PEDIATRIC TRAUMA
  55. 55. Trauma In the United States, injuries kill more children and infants than any other cause of death.
  56. 56. Blunt Trauma (Most Common Type of Injury) Motor vehicle crashes • Unrestrained passenger head and neck injuries • Restrained passenger abdominal and lower spine injuries (Continued)
  57. 57. Blunt Trauma Motor vehicle crashes • Struck while riding bicycle (head, spine, abdominal injuries) • Pedestrian struck by vehicle (abdominal, femur, head injuries) (Continued)
  58. 58. Blunt Trauma Falls from height • Head and neck injuries Diving into shallow water • Head and neck injuries Burns Sports injuries Child abuse
  59. 59. Blunt Trauma Specific Types of Injuries Head • Airway maintenance is critical. • Head injury is common. • Can result in respiratory arrest. • Nausea and vomiting are common. (Continued)
  60. 60. Blunt Trauma Specific Types of Injuries Chest • Children’s ribs are less rigid than adults’ ribs. • Result in injury to internal organs without external wounds. (Continued)
  61. 61. Blunt Trauma Specific Types of Injuries 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)
  62. 62. Blunt Trauma Specific Types of Injuries Extremities • Managed the same as adults
  63. 63. Trauma Other Considerations Pneumatic Antishock Garment • Use only if: Child fits in garment. • Trauma occurs with hypoperfusion and pelvic instability. • • Do not inflate abdominal compartment. (Continued)
  64. 64. Trauma Other Considerations Burns • Cover with sterile dressing (sterile sheet works well). • Follow local protocol with regard to transport to burn center.
  65. 65. 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.
  66. 66. Shock (Hypoperfusion) Causes Uncommon Causes Diarrhea, vomiting, dehydration Trauma and blood loss Infection Abdominal injuries Allergic reactions Poisoning Cardiac problems
  67. 67. PRECEPTOR PEARL 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.
  68. 68. Patient ASSESSMENT Shock (Hypoperfusion) Signs and Symptoms Rapid breathing Pale, cool, clammy skin Weak/absent peripheral pulses Delayed capillary refill (Continued)
  69. 69. 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
  70. 70. Signs of Shock (Hypoperfusion)
  71. 71. 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.
  72. 72. 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.)
  73. 73. KEY TERMS 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
  74. 74. 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.
  75. 75. PRECEPTOR PEARL 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.
  76. 76. Patient ASSESSMENT Abuse Signs and Symptoms Multiple bruises in different stages of healing Injury inconsistent with mechanism described Repeated calls to same address (Continued)
  77. 77. 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
  78. 78. Patient ASSESSMENT Neglect Signs and Symptoms Lack of adult supervision Apparent malnourishment Unsafe living environment Untreated chronic illness
  79. 79. Handling Abuse and Neglect Head injuries are most lethal (shaken baby syndrome). Do not accuse anyone in the field. (Continued)
  80. 80. 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.
  81. 81. PEDIATRIC MEDICAL EMERGENCIES
  82. 82. Seizures Rarely life-threatening in children, but EMT-B should take seriously. May be brief or prolonged. May cause injuries.
  83. 83. Seizures Causes Fever Infection Poisoning Hypoglycemia Trauma Hypoxia Idiopathic (unknown cause)
  84. 84. Patient ASSESSMENT Child after Seizure Signs and Symptoms Has child had seizures before? If yes, was this typical seizure? Was antiseizure medication taken?
  85. 85. 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.
  86. 86. Altered Mental Status Causes Hypoglycemia Poisoning Postseizure Infection Head trauma Hypoxia Shock
  87. 87. Patient CARE Altered Mental Status Emergency Care Steps Establish airway. Ventilate and suction as needed. Transport.
  88. 88. Patient CARE Poisoning: Responsive Patient Emergency Care Steps Contact medical direction. Give activated charcoal as directed. Administer oxygen. Transport and monitor patient.
  89. 89. Patient CARE Poisoning: Unresponsive Patient Emergency Care Steps Rule out trauma. Establish airway. Administer oxygen; ventilate as needed. Contact medical direction. Transport.
  90. 90. Fever Many things can cause fever. Meningitis is one of worst. May appear as fever with rash. Transport. Be prepared for seizures.
  91. 91. 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.
  92. 92. 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.
  93. 93. INFANTS AND CHILDREN WITH SPECIAL NEEDS
  94. 94. Children with Special Needs Premature babies with lung disease Heart disease Neurologic disease Chronic disease or altered function since birth
  95. 95. Technologically Dependent Children (“High-Tech Kids”) Tracheostomy tube Central intravenous lines Gastrostomy tubes Shunts
  96. 96. Tracheostomy Tube Complications Obstruction Bleeding Air leak Dislodged tube Infection
  97. 97. Patient CARE Tracheostomy Tube Emergency Care Steps Maintain open airway. Suction. Maintain position of comfort. Transport.
  98. 98. Home Artificial Ventilation Parents are usually very familiar with equipment.
  99. 99. Patient CARE Home Artificial Ventilation Emergency Care Steps Assure airway. Artificially ventilate with high-concentration oxygen. Transport.
  100. 100. Central Intravenous Lines IVs that are very long • Tip in vein near heart Complications • Cracked line • Infection • Clotting off • Bleeding
  101. 101. Patient CARE Central Intravenous Lines Emergency Care Steps If bleeding, apply pressure. Transport.
  102. 102. KEY TERMS 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
  103. 103. Patient CARE Shunt Emergency Care Steps Assure airway and ventilate as needed. Transport.
  104. 104. 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.
  105. 105. REVIEW QUESTIONS 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

×