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  1. 1. Pediatrics for Prehospital Providers Paul B. Davenport BSN,RN,EMT-C
  2. 2. Triage <ul><li>Across the room assessment </li></ul><ul><li>Airway </li></ul><ul><li>Respiratory </li></ul><ul><li>Cardiac </li></ul><ul><li>Disability </li></ul><ul><li>Expose </li></ul><ul><li>Vitals </li></ul>
  3. 3. Pediatric Respiratory Section
  4. 4. Respiratory Distress vs. Failure <ul><li>Increased rate </li></ul><ul><li>Nasal flaring </li></ul><ul><li>Use of accessory muscles </li></ul><ul><li>Grunting </li></ul><ul><li>Decreased L.O.C. </li></ul><ul><li>Persistent cyanosis with supplemental oxygen </li></ul><ul><li>Decreased breath sounds </li></ul>
  5. 5. Croup vs. Epiglottis <ul><li>3 months to 3 years </li></ul><ul><li>Gradual onset </li></ul><ul><li>Low grade fever </li></ul><ul><li>Stridor </li></ul><ul><li>Fall / Winter </li></ul><ul><li>3 years to 7 years </li></ul><ul><li>Acute onset </li></ul><ul><li>High fever </li></ul><ul><li>Hoarse </li></ul><ul><li>Drooling </li></ul><ul><li>All year long </li></ul>
  6. 6. Respiratory-Asthma <ul><li>Obstructive airway disease with hypereactivity of the bronchi and trachea. </li></ul>
  7. 7. Respiratory-RSV <ul><li>0-4 years of age </li></ul><ul><li>December - April </li></ul><ul><li>S/S of respiratory infection, thick secretions, and wheezing </li></ul>
  8. 8. Respiratory Summary <ul><li>What does your patient look like? </li></ul><ul><li>What do you hear? </li></ul><ul><li>PMH </li></ul>
  9. 9. Pediatric Cardiac Section
  10. 10. Cardiac Dysrhythmia Treatment <ul><li>Vital signs, 100% Oxygen </li></ul><ul><li>Stable vs. unstable </li></ul><ul><li>Airway </li></ul><ul><li>Vascular access </li></ul><ul><li>Synchronized cardioversion 0.5 - 1.0 J/kg </li></ul><ul><li>Defibrillation (2J/kg, 4J/kg, 4J/kg) </li></ul><ul><li>Medications </li></ul>
  11. 11. Disability
  12. 12. Disability <ul><li>AVPU </li></ul><ul><li>GCS </li></ul><ul><li>Seizures </li></ul><ul><li>Hypoglycemia </li></ul><ul><li>Drug ingestion </li></ul><ul><li>Dehydration </li></ul>
  13. 13. Pediatric Assessment Expose
  14. 14. Expose <ul><li>Evaluation of respiratory status </li></ul><ul><li>Skin color(central and extremities) </li></ul><ul><li>Rashes </li></ul><ul><li>Trauma </li></ul><ul><li>Burns </li></ul>
  15. 15. Pediatric Assessment Vital Signs
  16. 16. Pediatric Vital Signs <ul><li>L.O.C. </li></ul><ul><li>Respiratory rate & quality </li></ul><ul><li>Heart Rate </li></ul><ul><li>Blood Pressure </li></ul><ul><li>systolic BP= 70 + (2 X age in years) </li></ul><ul><li>Temperature </li></ul><ul><li>IV access </li></ul>
  17. 17. Hypothermia Hyperthermia <ul><li>Core Temp.<95F </li></ul><ul><li>Newborns </li></ul><ul><li>Mild, Moderate, Severe </li></ul><ul><li>Frostbite </li></ul><ul><li>Management </li></ul><ul><li>Core Temp. >101.5F </li></ul><ul><li>Infection </li></ul><ul><li>Poisoning </li></ul><ul><li>Heat stroke </li></ul><ul><li>Seizures </li></ul><ul><li>Effects of hyperthermia </li></ul>
  18. 18. IV Access
  19. 19. IV Access in Pediatrics <ul><li>Attempts at peripheral IV access should not exceed 90 seconds--with decompensated shock/cardiac arrest. </li></ul><ul><li>Children <6 years of age place IO cannula </li></ul><ul><li>Location, location, location </li></ul>
  20. 20. Case Scenarios
  21. 21. Case Studies <ul><li>A woman runs into the station on a hot summer day, holding her 9 month old child in her arms. She states she left her child in the car while she went shopping. When she returned to the car the child was unresponsive. </li></ul>
  22. 22. Case Study #2 <ul><li>Your unit is called to the scene of a 3 year old found outside. Patient was missing since early afternoon. It is now 9 p.m. Temperature outside is 32 degrees F. The patient is cold and unresponsive. </li></ul>
  23. 23. Case Studies 3 <ul><li>You arrive on scene of a 2 month-old infant in cardiac arrest. CPR is in progress. The infant is intubated, however no IV access has been obtained. The monitor is showing VFIB. </li></ul>
  24. 24. Case Studies #4 <ul><li>You are called to the scene of a house-fire. The firefighters pull a 5-year-old from the burning building. He has flame burns to the face, chest, abd., and both thighs. The patient is unresponsive with a weak pulse of 150bpm. </li></ul>
  25. 25. Case Studies #5 <ul><li>You are called to the scene for a 1-year-old, unknown type problem. You arrive and find mother holding the 1-year-old female patient. Mother states that the patient has had a high fever for a week. The patient is lethargic and does not react when you pick her up. Vitals: HR 160 ST, BP 60/P, Resp. 40. </li></ul>

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