29)Infants And Children

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29)Infants And Children

  1. 1. Infants and Children
  2. 2. Developmental Concerns Infants <ul><li>Newborns and infants – (Birth to 1 yr) </li></ul><ul><ul><li>Minimal stranger anxiety </li></ul></ul><ul><ul><li>Do not like to be separated from parents </li></ul></ul><ul><ul><li>Do not tolerate NRBs </li></ul></ul><ul><ul><li>Poor thermoregulators = Need to be kept warm </li></ul></ul><ul><ul><li>Breathing rate best obtained at a distance </li></ul></ul><ul><ul><ul><li>Note -Chest rise –Color –Level of activity </li></ul></ul></ul><ul><ul><li>Examine heart and lungs 1 st – Head last </li></ul></ul><ul><ul><ul><li>Builds confidence </li></ul></ul></ul><ul><ul><ul><li>Allows optimal assessment before child becomes agitated </li></ul></ul></ul>
  3. 3. Developmental Concerns Toddlers <ul><li>Toddlers- (1 yr-3 yrs) </li></ul><ul><ul><li>Do not like to be touched </li></ul></ul><ul><ul><li>Do not like being separated from parents </li></ul></ul><ul><ul><li>Do not like having clothing removed </li></ul></ul><ul><ul><ul><li>Remove – Examine - Replace </li></ul></ul></ul><ul><ul><li>Do not tolerate NRB’s </li></ul></ul><ul><ul><li>Children interpret illness as punishment </li></ul></ul><ul><ul><ul><li>Assure the pt they have not been “bad” </li></ul></ul></ul><ul><ul><li>Afraid of needles </li></ul></ul><ul><ul><li>Fear of pain </li></ul></ul><ul><ul><li>Trunk to head assessment </li></ul></ul><ul><ul><ul><li>Builds confidence </li></ul></ul></ul><ul><ul><ul><li>Done before child becomes agitated </li></ul></ul></ul>
  4. 4. Developmental Concerns Preschool <ul><li>Preschool- (3 yrs-6yrs) </li></ul><ul><ul><li>Do not like to be touched </li></ul></ul><ul><ul><li>Do not like being separated from parents </li></ul></ul><ul><ul><li>Do not like to have clothing removed </li></ul></ul><ul><ul><ul><li>-Remove – Assess - Replace </li></ul></ul></ul><ul><ul><li>Do not tolerate NRB’s </li></ul></ul><ul><ul><li>Assure child they were not “bad” </li></ul></ul><ul><ul><li>Afraid of blood </li></ul></ul><ul><ul><li>Fear of pain </li></ul></ul><ul><ul><li>Fear of permanent injury </li></ul></ul><ul><ul><li>Modest </li></ul></ul>
  5. 5. Developmental Concerns Adolescents <ul><li>School age- (6 yrs- 12 yrs) </li></ul><ul><ul><li>Afraid of blood </li></ul></ul><ul><ul><li>Fear of pain </li></ul></ul><ul><ul><li>Fear of permanent injury </li></ul></ul><ul><ul><li>Modest </li></ul></ul><ul><ul><li>Fear if disfigurement </li></ul></ul><ul><li>Adolescent- (12 yrs-18 yrs) </li></ul><ul><ul><li>Fear of permanent injury </li></ul></ul><ul><ul><li>Modest </li></ul></ul><ul><ul><li>Fear of disfigurement </li></ul></ul><ul><ul><li>Treat as adults </li></ul></ul><ul><ul><li>May desire to be assessed privately </li></ul></ul><ul><ul><ul><li>Away from parents/administrators/friends </li></ul></ul></ul>
  6. 6. Anatomical/Physiological Concerns: Airway <ul><li>Small airways throughout the resp system </li></ul><ul><ul><li>Easily blocked by secretions and swelling </li></ul></ul><ul><li>Tongue is large in relations to small mandible </li></ul><ul><ul><li>Can be significant airway complication in unresponsive child </li></ul></ul><ul><li>Positioning airway is different </li></ul><ul><ul><li>DO NOT hyperextend </li></ul></ul><ul><li>Infants are obligate nose breathers </li></ul><ul><ul><li>Suctioning the nasopharynx can improve respirations </li></ul></ul><ul><li>Children can compensate well for short periods of time </li></ul><ul><ul><li>Increased breathing rate and effort of breathing </li></ul></ul><ul><ul><li>Compensation rapidly followed by decompensation </li></ul></ul><ul><ul><ul><li>Rapid respiratory muscle fatigue </li></ul></ul></ul><ul><ul><ul><li>General fatigue of the infant </li></ul></ul></ul>
  7. 8. Airway Techniques <ul><li>Airway opening </li></ul><ul><ul><li>Head tilt chin lift = no trauma </li></ul></ul><ul><ul><li>Modified jaw thrust = trauma </li></ul></ul><ul><ul><li>Do not hyperextend </li></ul></ul><ul><ul><li>Infants below 1 y/o </li></ul></ul><ul><ul><ul><li>“ sniffing position” </li></ul></ul></ul><ul><ul><li>Small children 1-8 yrs </li></ul></ul><ul><ul><ul><li>Extend but do not hyperextend </li></ul></ul></ul>
  8. 9. Another type of sniffing position…
  9. 10. Suctioning <ul><li>Suctioning </li></ul><ul><ul><li>Blood, vomit, small particulate matter from airway </li></ul></ul><ul><ul><ul><li>Rigid suction catheter </li></ul></ul></ul><ul><ul><ul><li>Insert only as far back as you can see </li></ul></ul></ul><ul><ul><ul><li>Pressure less than 300 mmHg </li></ul></ul></ul><ul><ul><ul><li>Should not exceed 100 mmHg in newborns </li></ul></ul></ul><ul><ul><ul><li>Suction for 15 seconds or less </li></ul></ul></ul><ul><ul><li>Nasopharynx </li></ul></ul><ul><ul><ul><li>Soft suction catheter </li></ul></ul></ul><ul><ul><ul><li>Suction for 15 seconds or less </li></ul></ul></ul><ul><ul><li>If appropriate, hyperventilate the pt before and after suctioning </li></ul></ul><ul><ul><li>If airway is full of secretions that cannot be easily cleared </li></ul></ul><ul><ul><ul><li>Log roll pt onto side </li></ul></ul></ul>
  10. 11. Airway Adjuncts <ul><li>Adjuncts </li></ul><ul><ul><li>Oral airways </li></ul></ul><ul><ul><ul><li>Not for initial artificial ventilation </li></ul></ul></ul><ul><ul><ul><li>Should not have a gag reflex </li></ul></ul></ul><ul><ul><ul><li>Size as normal </li></ul></ul></ul><ul><ul><ul><li>Use tongue depressor </li></ul></ul></ul><ul><ul><ul><ul><li>Insert tongue blade to base of tongue </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Push down against tongue while lifting upwards </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Insert OPA directly in without rotation </li></ul></ul></ul></ul><ul><ul><li>Nasal airways </li></ul></ul><ul><ul><ul><li>Not for initial artificial ventilation </li></ul></ul></ul><ul><ul><ul><li>Size as normal </li></ul></ul></ul><ul><ul><ul><li>Insert as normal </li></ul></ul></ul><ul><ul><ul><li>Contraindicated in trauma </li></ul></ul></ul>
  11. 12. Oxygen Deliver <ul><li>Oxygen Delivery </li></ul><ul><ul><li>Nonrebreathers </li></ul></ul><ul><ul><li>Blow By </li></ul></ul><ul><ul><ul><li>Hold O2 tubing 2” from face </li></ul></ul></ul><ul><ul><ul><li>Insert tubing into a paper cup or stuffed animal </li></ul></ul></ul><ul><li>Artificial Ventilation </li></ul><ul><ul><li>Mask/bag size determined by age/size of pt </li></ul></ul><ul><ul><ul><li>-Neonatal – Pediatric - Child </li></ul></ul></ul><ul><ul><li>Consider trauma </li></ul></ul><ul><ul><ul><li>Modified jaw thrust </li></ul></ul></ul><ul><ul><ul><li>Manual in line stabilization </li></ul></ul></ul><ul><ul><li>Mouth to mask ventilation </li></ul></ul><ul><ul><li>Use of BVM </li></ul></ul><ul><ul><ul><li>Squeeze bag slowly and evenly allowing chest rise </li></ul></ul></ul><ul><ul><ul><li>Rate at 20 breaths per minute </li></ul></ul></ul><ul><ul><ul><li>Provide O2 at 100% using an O2 reservoir </li></ul></ul></ul>
  12. 13. Infants and Children Assessment <ul><li>Pediatric Assessment Triangle </li></ul><ul><li>General impression can be obtained from overall appearance (Well v. sick) </li></ul><ul><ul><li>Mental Status </li></ul></ul><ul><ul><li>Effort of breathing </li></ul></ul><ul><ul><li>Color </li></ul></ul><ul><ul><li>Quality of cry/speech </li></ul></ul><ul><ul><li>Interaction to parents/environment </li></ul></ul><ul><ul><ul><li>Normal behavior based on age </li></ul></ul></ul><ul><ul><ul><li>Playing </li></ul></ul></ul><ul><ul><ul><li>Moving around </li></ul></ul></ul><ul><ul><ul><li>Attentive v non attentive </li></ul></ul></ul><ul><ul><ul><li>Eye contact </li></ul></ul></ul><ul><ul><ul><li>Recognized parents </li></ul></ul></ul><ul><ul><ul><li>Responds to parents calling </li></ul></ul></ul><ul><ul><li>Emotional state </li></ul></ul><ul><ul><li>Response to the EMT </li></ul></ul><ul><ul><li>Tone/body position </li></ul></ul>
  13. 14. Approach to Evaluation <ul><li>Begin from across the room </li></ul><ul><ul><li>MOI </li></ul></ul><ul><ul><li>Scene size up </li></ul></ul><ul><ul><li>General impression </li></ul></ul><ul><ul><li>Respiratory assessment </li></ul></ul><ul><ul><ul><li>Note chest expansion/symmetry </li></ul></ul></ul><ul><ul><ul><li>Effort of breathing </li></ul></ul></ul><ul><ul><ul><li>Nasal flaring </li></ul></ul></ul><ul><ul><ul><li>Stridor, crowing, noisy </li></ul></ul></ul><ul><ul><ul><li>Retractions </li></ul></ul></ul><ul><ul><ul><li>Grunting </li></ul></ul></ul><ul><ul><ul><li>Respiratory rate </li></ul></ul></ul><ul><ul><li>Perfusion assessment </li></ul></ul><ul><ul><ul><li>Skin color </li></ul></ul></ul>
  14. 15. Approach to Evaluation “Hands on” <ul><li>“ Hands on” Approach </li></ul><ul><ul><li>Assess breath sounds </li></ul></ul><ul><ul><ul><li>Present </li></ul></ul></ul><ul><ul><ul><li>Absent </li></ul></ul></ul><ul><ul><ul><li>Stridor or wheezing </li></ul></ul></ul><ul><ul><li>Assess circulation </li></ul></ul><ul><ul><ul><li>Assess brachial or femoral pulse </li></ul></ul></ul><ul><ul><ul><li>Assess peripheral pulse </li></ul></ul></ul><ul><ul><ul><li>Assess capillary refill </li></ul></ul></ul><ul><ul><ul><li>Assess BP in children 3 y/o and older </li></ul></ul></ul><ul><ul><ul><li>Assess skin color, temperature, moisture </li></ul></ul></ul><ul><ul><li>Detailed physical exam </li></ul></ul><ul><ul><ul><li>Trunk to head approach </li></ul></ul></ul><ul><ul><ul><li>Situation and age dependant </li></ul></ul></ul><ul><ul><ul><li>Should help reduce infant/child anxiety </li></ul></ul></ul>
  15. 16. Common Problems Partial Airway Obstruction <ul><li>Partial Airway Obstruction </li></ul><ul><ul><li>Infants who are alert and sitting </li></ul></ul><ul><li>S/S </li></ul><ul><ul><li>Stridor, crowing, noisy </li></ul></ul><ul><ul><li>Retractions on inspiration </li></ul></ul><ul><ul><li>Pink </li></ul></ul><ul><ul><li>Good peripheral perfusion </li></ul></ul><ul><ul><li>Still alert, not unconscious </li></ul></ul><ul><li>Emergency care </li></ul><ul><ul><li>Allow position of comfort </li></ul></ul><ul><ul><ul><li>Assist younger child to sit up </li></ul></ul></ul><ul><ul><ul><li>Do not lay down </li></ul></ul></ul><ul><ul><ul><li>May sit on parents lap </li></ul></ul></ul><ul><ul><li>Offer O2 </li></ul></ul><ul><ul><li>Transport </li></ul></ul><ul><ul><li>Do not agitate child </li></ul></ul><ul><ul><li>Limited exam </li></ul></ul>
  16. 17. Common Problems Complete Airway Obstruction <ul><li>Complete Airway Obstruction </li></ul><ul><ul><li>-Total blockage of airway -OR- </li></ul></ul><ul><ul><li>Partial obstruction with -AMS – Cyanosis </li></ul></ul><ul><li>S/S </li></ul><ul><ul><li>No crying/speaking and cyanosis </li></ul></ul><ul><ul><li>Childs cough becomes ineffective </li></ul></ul><ul><ul><li>Increased resp difficulty with stridor </li></ul></ul><ul><ul><li>Loss of consciousness </li></ul></ul><ul><ul><li>AMS </li></ul></ul><ul><li>Emergent clearing of airway </li></ul><ul><ul><li>Infant procedures </li></ul></ul><ul><ul><li>Child procedures </li></ul></ul><ul><li>Attempt artificial ventilation with BVM and good seal </li></ul>
  17. 18. Airway Obstructions <ul><li>Complete obstructions </li></ul><ul><ul><li>Infants less than 1 y/o </li></ul></ul><ul><ul><ul><li>Back blows/chest thrusts </li></ul></ul></ul><ul><ul><ul><li>Visual foreign body removal </li></ul></ul></ul><ul><ul><li>Children 1 y/o+ </li></ul></ul><ul><ul><ul><li>Abdominal thrusts </li></ul></ul></ul><ul><ul><ul><li>Visual foreign body removal </li></ul></ul></ul>
  18. 19. Upper v Lower Respiratory Presentations <ul><ul><li>Upper Airway Obstruction </li></ul></ul><ul><ul><ul><li>Stridor on inspiration </li></ul></ul></ul><ul><ul><li>Lower Airway Disease </li></ul></ul><ul><ul><ul><li>Wheezing and breathing effort on exhalation </li></ul></ul></ul><ul><ul><ul><li>Rapid breathing without stridor </li></ul></ul></ul><ul><ul><li>Complete Airway Obstruction </li></ul></ul><ul><ul><ul><li>No crying </li></ul></ul></ul><ul><ul><ul><li>No speaking </li></ul></ul></ul><ul><ul><ul><li>Cyanosis </li></ul></ul></ul><ul><ul><ul><li>No coughing </li></ul></ul></ul>
  19. 20. S/S of Resp Compromise <ul><li>S/S of Early Respiratory Distress </li></ul><ul><ul><li>Nasal flaring </li></ul></ul><ul><ul><li>Retractions </li></ul></ul><ul><ul><ul><li>Intercostal, Supraclavicular, Subcostal </li></ul></ul></ul><ul><ul><ul><li>Adnominal, Neck </li></ul></ul></ul><ul><ul><li>Stridor </li></ul></ul><ul><ul><li>Audible wheezing </li></ul></ul><ul><ul><li>Grunting </li></ul></ul><ul><li>S/S of Progressive Respiratory Distress </li></ul><ul><ul><li>Rate above 60 breaths per minute </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Decreased muscle tone </li></ul></ul><ul><ul><li>Severe use of accessory muscles </li></ul></ul><ul><ul><li>Poor peripheral perfusion </li></ul></ul><ul><ul><li>AMS </li></ul></ul><ul><ul><li>Grunting </li></ul></ul><ul><li>S/S of Respiratory Arrest </li></ul><ul><ul><li>Rate less than 10 breaths per minute </li></ul></ul><ul><ul><li>Limp/flaccid muscle tone </li></ul></ul><ul><ul><li>Unconscious </li></ul></ul><ul><ul><li>Slow, absent heart rate </li></ul></ul><ul><ul><li>Weak, absent distal pulses </li></ul></ul>
  20. 21. Treatment of Resp Compromise <ul><li>Emergency Care of Respiratory Compromise </li></ul><ul><ul><li>O2 </li></ul></ul><ul><ul><li>O2 and Assist ventilation is severe distress </li></ul></ul><ul><ul><ul><li>Resp distress and AMS </li></ul></ul></ul><ul><ul><ul><li>Cyanosis with O2 </li></ul></ul></ul><ul><ul><ul><li>Resp distress with poor muscle tone </li></ul></ul></ul><ul><ul><ul><li>Resp failure </li></ul></ul></ul><ul><ul><li>Provide O2 and ventilate with Resp arrest </li></ul></ul>
  21. 22. Common Problems Seizures <ul><ul><li>General comments: </li></ul></ul><ul><ul><ul><li>Rarely life threatening in children with a Hx </li></ul></ul></ul><ul><ul><ul><li>However, consider any seizure to be life threatening </li></ul></ul></ul><ul><ul><ul><li>May be brief or prolonged </li></ul></ul></ul><ul><ul><ul><li>Although they can be brief there could be a more serious underlying problem </li></ul></ul></ul><ul><ul><li>Assessment </li></ul></ul><ul><ul><ul><li>Assess for injuries incurred by seizure activity </li></ul></ul></ul><ul><ul><li>Caused by </li></ul></ul><ul><ul><ul><li>Fevers – Infections – Trauma – Hypoglycemia –Poisoning – Hypoxia – Idiopathic </li></ul></ul></ul><ul><ul><li>Hx of seizures </li></ul></ul><ul><ul><ul><li>Has the child has prior seizures? </li></ul></ul></ul><ul><ul><ul><li>If yes, is this the normal seizure pattern? </li></ul></ul></ul><ul><ul><ul><li>Has the child taken any anti seizure medications? </li></ul></ul></ul>
  22. 23. Treatment of Seizures <ul><li>Assure airway position and patency </li></ul><ul><li>If no C-spine trauma place pt on side </li></ul><ul><li>Have suction ready </li></ul><ul><li>Provide O2 </li></ul><ul><li>Treat S/S of respiratory compromise if found </li></ul><ul><ul><li>Inadequate breathing and AMS may follow a seizure </li></ul></ul><ul><li>Transport </li></ul>
  23. 24. Common Problems Altered Mental Status <ul><ul><li>Caused by </li></ul></ul><ul><ul><ul><li>Hypoglycemia </li></ul></ul></ul><ul><ul><ul><li>Poisoning </li></ul></ul></ul><ul><ul><ul><li>Seizure </li></ul></ul></ul><ul><ul><ul><li>Infection </li></ul></ul></ul><ul><ul><ul><li>Head trauma </li></ul></ul></ul><ul><ul><ul><li>Hypoxia </li></ul></ul></ul><ul><ul><ul><li>Hypoperfusion </li></ul></ul></ul><ul><ul><li>Emergency Care </li></ul></ul><ul><ul><ul><li>Assure patency of airways </li></ul></ul></ul><ul><ul><ul><li>Be prepared to artificially ventilate/suction </li></ul></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul>
  24. 25. Common Problems Poisoning <ul><li>Poisoning </li></ul><ul><ul><li>Common reason for EMS activation </li></ul></ul><ul><ul><li>Identify suspected container through Hx </li></ul></ul><ul><ul><li>Bring container to hospital if possible </li></ul></ul><ul><li>Emergency Care </li></ul><ul><ul><li>Responsive Pt </li></ul></ul><ul><ul><ul><li>Contact med control </li></ul></ul></ul><ul><ul><ul><li>Consider activated charcoal </li></ul></ul></ul><ul><ul><ul><li>O2 </li></ul></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul><ul><ul><ul><li>Monitor pt for AMS/unresponsiveness </li></ul></ul></ul><ul><ul><li>Unresponsive Pt </li></ul></ul><ul><ul><ul><li>Assure patency of airway </li></ul></ul></ul><ul><ul><ul><li>Be prepared to artificially ventilate </li></ul></ul></ul><ul><ul><ul><li>O2 </li></ul></ul></ul><ul><ul><ul><li>Call med control </li></ul></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul><ul><ul><ul><li>Rule out trauma as cause of AMS </li></ul></ul></ul>
  25. 26. Common Problems Fever <ul><li>Fever </li></ul><ul><ul><li>General comments: </li></ul></ul><ul><ul><ul><li>Many causes, rarely life threatening </li></ul></ul></ul><ul><ul><ul><li>Severe case is meningitis </li></ul></ul></ul><ul><ul><ul><li>Fever with a rash is a significant finding </li></ul></ul></ul><ul><ul><ul><li>May precipitate a febrile seizure </li></ul></ul></ul><ul><ul><li>Emergency Care </li></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul><ul><ul><ul><li>Be prepared for a seizure </li></ul></ul></ul>
  26. 27. Common Problems Shock <ul><li>Shock </li></ul><ul><ul><li>General comments: </li></ul></ul><ul><ul><ul><li>Rarely a primary cardiac event </li></ul></ul></ul><ul><ul><li>Common Causes: </li></ul></ul><ul><ul><ul><li>Diarrhea and dehydration </li></ul></ul></ul><ul><ul><ul><li>Trauma </li></ul></ul></ul><ul><ul><ul><li>Vomiting </li></ul></ul></ul><ul><ul><ul><li>Blood loss </li></ul></ul></ul><ul><ul><ul><li>Infection </li></ul></ul></ul><ul><ul><ul><li>Abd injuries </li></ul></ul></ul><ul><ul><li>Less common causes: </li></ul></ul><ul><ul><ul><li>Allergic reactions </li></ul></ul></ul><ul><ul><ul><li>Poisoning </li></ul></ul></ul><ul><ul><ul><li>Cardiac </li></ul></ul></ul><ul><ul><li>S/S </li></ul></ul><ul><ul><ul><li>Rapid resp rate </li></ul></ul></ul><ul><ul><ul><li>Pale, cool, clammy skin </li></ul></ul></ul><ul><ul><ul><li>Weak/absent peripheral pulses </li></ul></ul></ul><ul><ul><ul><li>Delayed capillary refill </li></ul></ul></ul><ul><ul><ul><li>Decreased urine output </li></ul></ul></ul><ul><ul><ul><li>ALOC/AMS </li></ul></ul></ul><ul><ul><ul><li>Absence of tears even when crying </li></ul></ul></ul>
  27. 28. Treatment of Shock <ul><li>Assure airway/O2 </li></ul><ul><li>Be prepared to artificially ventilate </li></ul><ul><li>Manage bleeding if present </li></ul><ul><li>Place pt in shock position </li></ul><ul><li>Keep warm </li></ul><ul><li>IMMEDIATE transport </li></ul><ul><li>Detailed exam en route if time permits </li></ul>
  28. 29. Common Problems Water Related Accidents <ul><li>Near Drowning </li></ul><ul><ul><li>Ventilation is TOP priority </li></ul></ul><ul><ul><li>Consider </li></ul></ul><ul><ul><ul><li>possible trauma </li></ul></ul></ul><ul><ul><ul><li>hypothermia </li></ul></ul></ul><ul><ul><ul><li>possible ingestion (alcohol, etc) </li></ul></ul></ul><ul><ul><li>Protect airway </li></ul></ul><ul><ul><li>Suction if necessary </li></ul></ul><ul><li>Secondary Drowning Syndrome </li></ul><ul><ul><li>Minutes to hours after the event </li></ul></ul><ul><ul><li>Deteriorate after breathing normally </li></ul></ul><ul><ul><li>Therefore, transport ALL near drowning pts </li></ul></ul>
  29. 30. Common Problems SIDS <ul><li>Sudden Infant Death Syndrome (SIDS) </li></ul><ul><ul><li>S/S </li></ul></ul><ul><ul><ul><li>Sudden death of infant within 1 st year </li></ul></ul></ul><ul><ul><ul><li>Causes are many and not well understood </li></ul></ul></ul><ul><ul><ul><li>Most commonly found during early morning </li></ul></ul></ul><ul><ul><li>Emergency Care </li></ul></ul><ul><ul><ul><li>Try to resuscitate unless rigor mortis </li></ul></ul></ul><ul><ul><ul><li>Parents will be in distress </li></ul></ul></ul><ul><ul><ul><li>Avoid comments that may place blame </li></ul></ul></ul>
  30. 31. Infants and Children Trauma <ul><li>Injuries are the #1 COD in infants/children </li></ul><ul><li>Blunt injury is mot common </li></ul><ul><li>Pattern of injury if different from adults </li></ul><ul><ul><li>Motor Vehicle Passengers </li></ul></ul><ul><ul><ul><li>Unrestrained = Head/Neck injuries </li></ul></ul></ul><ul><ul><ul><li>Restrained= Abdomen and spinal injuries </li></ul></ul></ul><ul><ul><li>Struck with riding bicycle </li></ul></ul><ul><ul><ul><li>Head, Spine, Abd injury </li></ul></ul></ul><ul><ul><li>Falls from heights </li></ul></ul><ul><ul><ul><li>Injuries to head/neck </li></ul></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><li>Sport injuries </li></ul></ul><ul><ul><ul><li>Head/neck </li></ul></ul></ul><ul><ul><li>Child abuse </li></ul></ul>
  31. 32. Infants and Children Trauma: Specific Body Regions <ul><li>Head </li></ul><ul><ul><li>Maintain airway via modified jaw thrust </li></ul></ul><ul><ul><li>More likely to sustain head injuries </li></ul></ul><ul><ul><li>S/S of shock with head injury suggest other injuries </li></ul></ul><ul><ul><li>Respiratory arrest is common secondary to head injury </li></ul></ul><ul><ul><li>Common S/S = Nausea/Vomiting </li></ul></ul><ul><ul><li>Major airway complication = Tongue </li></ul></ul><ul><li>Chest </li></ul><ul><ul><li>Soft very pliable ribs </li></ul></ul><ul><ul><li>May have injuries without external signs </li></ul></ul><ul><li>Abdomen </li></ul><ul><ul><li>More common in children than adults </li></ul></ul><ul><ul><li>Often a source of hidden injuries </li></ul></ul><ul><ul><li>ALWAYS consider this in multi-system trauma pt who is deteriorating without external S/S </li></ul></ul><ul><ul><li>Be aware of complications of gastric distention </li></ul></ul><ul><li>Extremities </li></ul><ul><ul><li>Manage in the same manner as adults </li></ul></ul>
  32. 33. Other Considerations PASG, Burns <ul><li>Pneumatic Anti Shock Garments </li></ul><ul><ul><li>Use ONLY if child fits </li></ul></ul><ul><ul><li>Do not inflate abd compartment </li></ul></ul><ul><ul><li>Indication </li></ul></ul><ul><ul><ul><li>S/S hypoperfusion </li></ul></ul></ul><ul><ul><ul><li>S/S of pelvic instability </li></ul></ul></ul><ul><li>Criticality of burns </li></ul><ul><ul><li>Cover with sterile dressing </li></ul></ul><ul><ul><li>Possible transport to a burn center per protocol </li></ul></ul>
  33. 34. Care of the traumatically injured pediatric <ul><li>Assure airway position and patency </li></ul><ul><li>Use modified jaw thrust </li></ul><ul><li>O2 </li></ul><ul><li>Assist ventilation in resp distress </li></ul><ul><li>Ventilate with BVM in resp arrest </li></ul><ul><li>Immobilization </li></ul><ul><li>IMMEDIATE transport </li></ul>
  34. 35. Abuse and Neglect <ul><li>Abuse </li></ul><ul><ul><li>Improper or excessive action so as to injure or cause harm </li></ul></ul><ul><li>Neglect </li></ul><ul><ul><li>Giving insufficient attention/respect to an individual who has a right to that attention </li></ul></ul><ul><li>S/S of Abuse </li></ul><ul><ul><li>Multiple bruises in different stages of healing </li></ul></ul><ul><ul><li>Injury inconsistent with MOI </li></ul></ul><ul><ul><li>Repeated calls to the same location </li></ul></ul><ul><ul><li>Fresh burns </li></ul></ul><ul><ul><li>Parents seem inappropriately unconcerned </li></ul></ul><ul><ul><li>Conflicting stories </li></ul></ul><ul><ul><li>Fear on the part of the child to discus how they were hurt </li></ul></ul><ul><li>S/S of Neglect </li></ul><ul><ul><li>Lack of adult supervision </li></ul></ul><ul><ul><li>Malnourished appearing child </li></ul></ul><ul><ul><li>Unsafe living environment </li></ul></ul><ul><ul><li>Untreated chronic illness </li></ul></ul><ul><li>CNS injuries are the most lethal in the field (Shaken Baby Syndrome) </li></ul><ul><li>Do NOT accuse in the field </li></ul><ul><li>Required reporting by state law </li></ul><ul><ul><li>What you SEE and what you HEAR </li></ul></ul><ul><ul><li>NOT what you THINK </li></ul></ul>
  35. 36. Virginia Child Abuse Hotline <ul><li>In State </li></ul><ul><ul><li>(800) 552-7096 </li></ul></ul><ul><li>Out of State </li></ul><ul><ul><li>(804) 786-8536 </li></ul></ul>
  36. 37. Special Needs Children <ul><li>Examples: </li></ul><ul><ul><li>Premature babies with lung disease </li></ul></ul><ul><ul><li>Babies and children with heart disease </li></ul></ul><ul><ul><li>Infants/children with neurological disease </li></ul></ul><ul><ul><li>Children with chronic diseases </li></ul></ul><ul><li>Often these pt are at home technologically dependant </li></ul>
  37. 38. Infants and Children Special Needs Children <ul><li>Tracheostomy Tube </li></ul><ul><ul><li>Complications: </li></ul></ul><ul><ul><ul><li>Obstruction, Bleeding, Air leak, Dislodged, Infection </li></ul></ul></ul><ul><ul><li>Care: </li></ul></ul><ul><ul><ul><li>Maintain open airway </li></ul></ul></ul><ul><ul><ul><li>Suction </li></ul></ul></ul><ul><ul><ul><li>Maintain position of comfort </li></ul></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul><ul><li>Home Ventilators </li></ul><ul><ul><li>Care: </li></ul></ul><ul><ul><ul><li>Assure patency of airway </li></ul></ul></ul><ul><ul><ul><li>Artificially ventilate with O2 </li></ul></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul><ul><ul><ul><li>The parents will be familiar with the equipment </li></ul></ul></ul><ul><li>Shunts </li></ul><ul><ul><li>Device running from brain to abd to drain excess CSF </li></ul></ul><ul><ul><li>Will find reservoir on side of skull </li></ul></ul><ul><ul><li>Be prepared for AMS </li></ul></ul><ul><ul><li>Prone to resp arrest </li></ul></ul><ul><ul><ul><li>Manage airway </li></ul></ul></ul><ul><ul><ul><li>Assure adequate ventilation </li></ul></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul>
  38. 41. Infants and Children Special Needs Children <ul><li>Central Lines </li></ul><ul><ul><li>Complications </li></ul></ul><ul><ul><ul><li>Cracked line </li></ul></ul></ul><ul><ul><ul><li>Infection </li></ul></ul></ul><ul><ul><ul><li>Clotting off </li></ul></ul></ul><ul><ul><ul><li>Bleeding </li></ul></ul></ul><ul><ul><li>Care </li></ul></ul><ul><ul><ul><li>If bleeding, apply pressure </li></ul></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul><ul><li>Gastronomy Tube and Gastric Feeding </li></ul><ul><ul><li>Tube inserted directly into stomach for feeding </li></ul></ul><ul><ul><li>Be alert for breathing problems: </li></ul></ul><ul><ul><ul><li>Assure adequate airway </li></ul></ul></ul><ul><ul><ul><li>Have suction ready </li></ul></ul></ul><ul><ul><ul><li>If diabetic Hx, anticipate AMS </li></ul></ul></ul><ul><ul><ul><li>O2 </li></ul></ul></ul><ul><ul><ul><li>Transport </li></ul></ul></ul><ul><ul><ul><ul><li>Sitting </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lying on Right side, head elevated </li></ul></ul></ul></ul>
  39. 42. Family Response <ul><li>Multiple patients </li></ul><ul><ul><li>Child cannot be cared for in isolation from family </li></ul></ul><ul><li>Calm, supportive interaction with family </li></ul><ul><ul><li>Improves ability to deal with child </li></ul></ul><ul><ul><li>Calm parents = Calm child </li></ul></ul><ul><ul><li>Agitate parents = Agitate child </li></ul></ul><ul><li>Parents may respond with anger/hysteria </li></ul><ul><li>Allow parents to remain part of the care unless condition does not allow </li></ul><ul><li>Parents should instructed to calm child </li></ul><ul><ul><li>Transport in position of comfort </li></ul></ul><ul><ul><li>Hold O2, etc </li></ul></ul><ul><li>Parents are EXPERTS on what is normal and abnormal for their child </li></ul>
  40. 43. Provider Response <ul><li>Anxiety from lack of experience </li></ul><ul><li>Fear of failure </li></ul><ul><li>Stress of identifying pt with own child </li></ul><ul><li>Much of adult learning applies to children </li></ul><ul><li>REMEMBER the differences </li></ul><ul><li>PRACTICE </li></ul>
  41. 44. That does it…

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