2. Family Matters
When a child is ill or injured, you may
have several patients, not just one.
Children mimic caregiver behavior
Be calm, professional, and sensitive.
pediatrics
3. Anatomic Differences
Less circulating blood
Lose body heat more easily
Bones are more flexible
Less fat surrounding organs
Could be much internal damage with
little external visible trauma
pediatrics
4. Skeletal Differences
Bones are prone to fracture
with stress.
Infants have two openings in
the skull called fontanels.
– close by 18 months.
pediatrics
5. Airway Differences
– Larger tongue relative
to the mouth
– Less well-developed
rings of cartilage in
the trachea
– Head tilt-chin lift may
occlude the airway.
pediatrics
6. Breathing Differences
Infants breathe faster than children
or adults.
Infants use the diaphragm when
they breathe.
Sustained, labored breathing may
lead to respiratory failure.
pediatrics
7. Circulation Differences
The heart rate increases for illness
and injury
Very effective vasoconstriction
keeps vital organs nourished
Pale, extremities, decreased cap
refill are early signs of perfusion
problems
pediatrics
8. Approach to Assessment
level of activity, work of breathing, and skin color
cap refill
ALS backup or immediate transport?
Pediatric patients crash harder than adults
Transport to peds facilities when possible
pediatrics
10. Treatment Considerations
Oxygen - treat same as adult – Use
“blow-by” administration if needed
Patient position - same as adult
*Remember* airway and breathing are
focus
pediatrics
12. Infant
first year of life
respond physical stimuli
crying is main means of
expression
have caregiver hold pt
pediatrics
13. Toddler
1 to 3 years of age
mobile
may resist separation
don’t like being
restrained
can be distracted
pediatrics
14. Preschool
3 to 6 years of age
can understand directions
can identify painful areas
fearful of pain
allow them to handle equipment
explain what you are going to
do
pediatrics
15. School-Age Child
6 to 12 years of age
begin to think like adults
can be included when taking medical
history
should be familiar with physical exam
allow them to make choices when
possible
pediatrics
16. The Adolescent
12 to 18 years of age
concerned about body image
may have strong feelings about being
observed
respect their privacy
they understand pain
explain any procedure
pediatrics
19. Respirations
Abnormal respirations are a common
sign of illness or injury
Less than 3, count rise and fall of
abdomen
Note effort of breathing/noises
Note if they are crying
pediatrics
20. Respiration Notes
Less than 12 breaths/min
More than 60 breaths/min,
ALOC and/or an inadequate tidal
volume
= ventilation with a BVM device
pediatrics
26. Emergency Care for Fever
Ensure BSI
Begin passive cooling
– Remove clothing/coverings
– Damp towels
No ice
No alcohol
No cold water baths
pediatrics
27. Febrile Seizures
common in children 6 months to 6
years
most caused by high fever
hx of infection
generalized grand mal seizure
less than 15 minutes
pediatrics
29. Dehydration
Dry lips and gums
Fewer wet diapers
Sunken eyes
Poor skin turgor
Sleepy or irritable
Sunken fontanels
pediatrics
30. Care for Dehydration
Assess the ABCs
Obtain baseline vital signs
ALS backup may be needed for
IV administration
pediatrics
31. Airway Obstruction
Croup
– An infection of the airway below the
level of the vocal cords, caused by a
virus
Epiglottitis
– Infection of the soft tissue in the area
above the vocal cords
Foreign body Aspiration
pediatrics
36. Foreign body aspiration
Partial
Blockage
– coughing
– accessory
muscle use
– nasal flaring
– wheezing
pediatrics
Complete
Blockage
-
no sound
no cry
stridor
cyanosis
loss of
consciousness
48. Submersion Injury
Drowning or near drowning
Second most common cause of
unintentional death
ABC’s
May be in respiratory or cardiac
arrest
C-spine precautions?
Be ready to suction
Keep warm
pediatrics
49. Poisoning
Poisoning is common in children
Ask specific questions of caregivers
Focus on the ABCs
Give oxygen
Provide transport
Child’s condition could change at any
time
pediatrics
54. Transporting Infants and
Children
Children require padding under the torso
Newborns should be in special incubators
Do not hold child during the actual transport
Drive with due care
Do not allow your emotions to take control
pediatrics
56. SIDS
Definition - unexplained death of
an apparently healthy infant.
7500+ cases per year in U.S.
Leading cause of death in infants
<1 year old
more cases in winter months
pediatrics
57. Sudden Infant Death
Syndrome (SIDS)
Several known risk factors:
–
–
–
–
–
pediatrics
Mother younger than 20 years old
Mother smoked during pregnancy
Low birth weight
Putting babies to sleep on stomach
Siblings of SIDS babies
58. Tasks at Scene
Assess and manage patient
Communicate with and
support the family
Assess the scene
pediatrics
59. Assessment and
Management
Diagnosis of exclusion
Can be other causes of condition
Regardless of cause, TX is same
Infant may have signs of postmortem
changes
It is ok to work up an obviously dead
baby
If no postmortem changes, begin CPR
immediately
pediatrics
60. Communication and Support
of Family
The death of child is very stressful for the
family
Parents guilt is overwhelming
Provide support in whatever ways you can
IT IS NOT YOUR PLACE TO JUDGE
Use the infant’s name
Allow family time with the infant
pediatrics
61. Scene Assessment
Inspect the environment, noting:
–
–
–
–
pediatrics
Signs of illness, including medications
General condition of the house
Family interaction
Site where infant was discovered
62. Support Groups
Know your local phone numbers
for referrals
Arrange for proper debriefing
pediatrics
63. Child Abuse
Any improper or excessive action that
injures or harms a child or infant
physical, sexual, emotional abuse and
neglect
More than 2 million cases reported
annually
Be aware of signs of child abuse and
report it to authorities
pediatrics
64. Questions Regarding
Signs of Abuse (1 of 4)
Is the injury typical?
Is reported method of injury consistent with
injuries?
Is the caregiver behaving appropriately?
Is there evidence of drinking or drug abuse?
pediatrics
65. Questions Regarding
Signs of Abuse (2 of 4)
Delay in seeking care?
Good relationship between child
and caregiver?
Multiple injuries at various stages of
healing?
Any unusual marks or bruises?
pediatrics
66. Questions Regarding
Signs of Abuse (3 of 4)
Are there several types of injuries?
Any burns on the hands or feet
involving a glove distribution?
Unexplained decreased level of
consciousness?
pediatrics
67. Questions Regarding
Signs of Abuse (4 of 4)
Is the child clean and an
appropriate weight?
Any rectal or vaginal bleeding?
What does the home look like?
pediatrics
68. Other Indicators
Withdrawn, fearful or hostile child
Refusal to discuss MOI
History of “accidents”
Conflicting stories
Caregiver lack of concern
pediatrics
76. Emergency Medical Care
ABCs
Transport if you suspect child
abuse
Do not make accusations
EMT-Bs must report all
suspected cases of child abuse
pediatrics
77. Sexual Abuse
Children of any age or either gender
can be victims
Limit examination
Do not allow child to wash, urinate, or
defecate
Document carefully
Transport
pediatrics
78. EMS Response to
Pediatric Emergencies
You may experience a wide range
of emotions
You may feel anxious
Practice helps
After difficult incidents, a
debriefing may be helpful
pediatrics
