www.romduck.com
“It’s hardly ever good when the rescuer’s
pulse or respiratory rate is greater
than that of their pediatri...
www.romduck.com
Pediatric Emergencies
Scene Management: The Missing Piece
Arrangement
Prep and Plan ahead
Assurance
Commun...
www.romduck.com
Crapronyms
AAAAAAAAAAAAAAAAAAAAAAAAAY!
(Arrangement) Always assign an assistant ahead.
(Assurance) Anticip...
www.romduck.com
Arrangement (because you’re in EMS)
References
Broslow Tape
Pedi-Wheel
Reference Cards
Reference Books
Sma...
www.romduck.com
Arrangement (At the start of shift)
Check your gear
What Peds equipment?
How do we carry it?
Where do we c...
www.romduck.com
Arrangement (before you step out)
What is our game plan?
Who is the Clinical Lead?
With whom are we interf...
www.romduck.com
Assurance (they’ll meet you at the door)
Family and Bystanders
Expectations?
“Who are you?”
What to do
Be ...
www.romduck.com
Assurance (they’ll meet you at the door)
Family and Bystanders
Differing Cultures
“Who are you talking to?...
www.romduck.com
Assurance (Makes Parents Happy)
Treat your children well.
LISTEN to parent and child.
Ask (and use) their ...
www.romduck.com
Assurance (Makes Parents Happy)
Treat your children well.
Each and every child is the most…
Special
Smart
...
www.romduck.com
Assessment:
What do we need to know?
Can you tell if the child is
Critical or Not Critical just by looking...
www.romduck.com
The Pediatric Assessment Triangle
Adapted from the AAP’s Pediatric Education for Prehospital
Professionals...
www.romduck.com
General Appearance
Are they with it or out of it?
T Tone
I Interactiveness
C Consolability
L Look/gaze
S S...
www.romduck.com
Work Of Breathing
Be
W Work
A Abnormal Sounds
R Retractions
E Extreme Nasal Flaring
Are they fighting for ...
www.romduck.com
Circulation to Skin
T Temperature - Skin
T Time - Capillary Refill
P Pulse
Are they compensating?
www.romduck.com
Respiratory Distress
Gen. Appearance
With it or not?
Critical or Not Critical
Circulation to Skin?
With it...
www.romduck.com
Seizure? Hypoperfusion?
Gen. Appearance
With it or not?
Work of Breathing
Fighting for air?
Circulation to...
www.romduck.com
Hypovolemic Shock?
Gen. Appearance
With it or not?
Work of Breathing
Fighting for air?
Circulation to Skin...
www.romduck.com
Not Critical. Cold?
Gen. Appearance
With it or not?
Work of Breathing
Fighting for air?
Circulation to Ski...
www.romduck.com
Assessment
Any single RED FLAG = SICK
Critical=
QUICK
Not Critical=
Not QUICK
www.romduck.com
Caring for Critical Kids
Airway
Obstruction
Choking
Croup
Epiglottitis
Trauma
RespiratoryF
ailure
Cardiac
...
www.romduck.com
Caring for Critical Kids
Fluid Loss
Bleeding
Vomiting
Dehydration
Burns
Circulatory
Failure
Cardiac
Arrest...
www.romduck.com
Inconsolable Infants
T – Trauma (bites?)
I - Infection
M – Maternal Stress
S – Strangled Part
(Hair Tourni...
www.romduck.com
Action: Tips for Tots
www.romduck.com
Infant 1 mo. – 1 yr.
 Try to keep the child with a caregiver or familiar face.
 Use reassuring facial ex...
www.romduck.com
Toddler 1 yr. – 3 yr.
 Use family, friends, toys to reassure.
 May perceive illness as punishment.
 Lea...
www.romduck.com
Pre-School 3 yr. – 6 yr.
 Greatly fear blood, pain and “disfigurement”.
 Independent and modest.
 Expla...
www.romduck.com
School Age 6 yr. – 12 yr.
 Question the patient directly.
 Respect, do not “baby” them.
 Do not embarra...
www.romduck.com
Adolescent >12y/o
 Identity and peer relationships are a priority.
 Body image &“disfigurement” are of g...
www.romduck.com
Adolescent >12y/o
 Be careful not to be aggressive or condescending.
 Approach physical assessment as wi...
www.romduck.com
Action: Transport (Let’s go!)
Child
Stretcher
Car Seat
Their Own
Built-In
Inflatable
Flexible
www.romduck.com
Action: Transport (Let’s go!)
Family & Bystanders
Get A Ride
Ride with us
Front
Back
Drive Themselves
www.romduck.com
And Finally…
Awesome YOU!
www.romduck.com
Pediatric Training Programs
PEPP
PALS
PEARS
APLS
EPiC
www.romduck.com
Crapronyms!
Arrangement
Prep and Plan ahead
Assurance
Communicate with family and
bystanders
Assessment
Co...
www.romduck.com
http://www.flickr.com/photos/40912998@N00/3003827251/
Pediatrics: Scene Management - The Missing Piece.
Upcoming SlideShare
Loading in …5
×

Pediatrics: Scene Management - The Missing Piece.

1,243 views

Published on

Pediatric Emergencies are difficult for everyone. Emotions run high for patients, parents, bystanders and yes, even emergency responders. In addition, trying to recall or look-up pediatric-specific vitals, values and medication doses can be tremendously stressful. Because of this, providers often miss the simple steps that can make an important difference in our care. With an approach of “first-things-first” this program will show how to manage the scene of a pediatric emergency with confidence, care and compassion.

Find more at www.romduckworth.com

2 Comments
1 Like
Statistics
Notes
No Downloads
Views
Total views
1,243
On SlideShare
0
From Embeds
0
Number of Embeds
83
Actions
Shares
0
Downloads
0
Comments
2
Likes
1
Embeds 0
No embeds

No notes for slide

Pediatrics: Scene Management - The Missing Piece.

  1. 1. www.romduck.com “It’s hardly ever good when the rescuer’s pulse or respiratory rate is greater than that of their pediatric patient.” -Lou E. Romig MD, FAAP, FACEP www.jumpstarttriage.com Romig’s Rule of Vital Sign Comparisons
  2. 2. www.romduck.com Pediatric Emergencies Scene Management: The Missing Piece Arrangement Prep and Plan ahead Assurance Communicate with family and bystanders Assessment Communicate with patient Action Lead, follow or get out of the way.
  3. 3. www.romduck.com Crapronyms AAAAAAAAAAAAAAAAAAAAAAAAAY! (Arrangement) Always assign an assistant ahead. (Assurance) Anticipate and answer adult anxiety, agitation and aggressive appearance. (Assessment) Arrive assuming an age appropriate assessment. (Action) Adapt and allow awesome action, You! Crappy Acronyms
  4. 4. www.romduck.com Arrangement (because you’re in EMS) References Broslow Tape Pedi-Wheel Reference Cards Reference Books Smart Phone Apps
  5. 5. www.romduck.com Arrangement (At the start of shift) Check your gear What Peds equipment? How do we carry it? Where do we carry it? Is it ready to go?
  6. 6. www.romduck.com Arrangement (before you step out) What is our game plan? Who is the Clinical Lead? With whom are we interfacing? What is our Good / Bad plan? Everybody take a deep breath.
  7. 7. www.romduck.com Assurance (they’ll meet you at the door) Family and Bystanders Expectations? “Who are you?” What to do Be Polite Be Caring Assign Assistance Balance Calm and Concern
  8. 8. www.romduck.com Assurance (they’ll meet you at the door) Family and Bystanders Differing Cultures “Who are you talking to?” Be Polite Be Caring Assign Assistance Balance Calm and Concern Know Your Response Area
  9. 9. www.romduck.com Assurance (Makes Parents Happy) Treat your children well. LISTEN to parent and child. Ask (and use) their name. Keep them comfortable. Pain Management Emotional Comfort Relieve fear and anxiety
  10. 10. www.romduck.com Assurance (Makes Parents Happy) Treat your children well. Each and every child is the most… Special Smart Beautiful Whatever you can think of …child in the world.
  11. 11. www.romduck.com Assessment: What do we need to know? Can you tell if the child is Critical or Not Critical just by looking at them?
  12. 12. www.romduck.com The Pediatric Assessment Triangle Adapted from the AAP’s Pediatric Education for Prehospital Professionals (PEPP) course. www.PEPPsite.com Critical= QUICK Not Critical= Not QUICK
  13. 13. www.romduck.com General Appearance Are they with it or out of it? T Tone I Interactiveness C Consolability L Look/gaze S Speech/cry
  14. 14. www.romduck.com Work Of Breathing Be W Work A Abnormal Sounds R Retractions E Extreme Nasal Flaring Are they fighting for air?
  15. 15. www.romduck.com Circulation to Skin T Temperature - Skin T Time - Capillary Refill P Pulse Are they compensating?
  16. 16. www.romduck.com Respiratory Distress Gen. Appearance With it or not? Critical or Not Critical Circulation to Skin? With it Normal Critical Work of Breathing Fighting for air? Fighting
  17. 17. www.romduck.com Seizure? Hypoperfusion? Gen. Appearance With it or not? Work of Breathing Fighting for air? Circulation to Skin? Not with it Normal Abnormal Critical or Not CriticalCritical
  18. 18. www.romduck.com Hypovolemic Shock? Gen. Appearance With it or not? Work of Breathing Fighting for air? Circulation to Skin? Normal Normal Abnormal Critical or Not CriticalCritical
  19. 19. www.romduck.com Not Critical. Cold? Gen. Appearance With it or not? Work of Breathing Fighting for air? Circulation to Skin? Normal Normal Normal Critical or Not CriticalNot Critical
  20. 20. www.romduck.com Assessment Any single RED FLAG = SICK Critical= QUICK Not Critical= Not QUICK
  21. 21. www.romduck.com Caring for Critical Kids Airway Obstruction Choking Croup Epiglottitis Trauma RespiratoryF ailure Cardiac Arrest Respiratory Depression Seizures Poisoning Overdose Head Injury
  22. 22. www.romduck.com Caring for Critical Kids Fluid Loss Bleeding Vomiting Dehydration Burns Circulatory Failure Cardiac Arrest Fluid Distribution Anaphylaxis Sepsis Sick Heart Hurt Heart
  23. 23. www.romduck.com Inconsolable Infants T – Trauma (bites?) I - Infection M – Maternal Stress S – Strangled Part (Hair Tourniquet?) C – Cardiorespiratory Disease R - Reflux I – Intolerant of Milk E - Eyes S – Surgical (testicular torsion)
  24. 24. www.romduck.com Action: Tips for Tots
  25. 25. www.romduck.com Infant 1 mo. – 1 yr.  Try to keep the child with a caregiver or familiar face.  Use reassuring facial expressions and tone.  Little stranger anxiety at this age.  Will accept undressing but will want to stay warm.  Toe to Head Exam.  Have parent / caregiver assist with exam.  Just LOOK at those chubby cheeks!
  26. 26. www.romduck.com Toddler 1 yr. – 3 yr.  Use family, friends, toys to reassure.  May perceive illness as punishment.  Learning independence and modesty.  They’ll understand more than they can speak.  Be selective in undressing.  Avoid hog-tying them, but don’t wait around forever for cooperation.
  27. 27. www.romduck.com Pre-School 3 yr. – 6 yr.  Greatly fear blood, pain and “disfigurement”.  Independent and modest.  Explain what’s happening in child’s terms.  Curious and talkative.  Like to have choices.
  28. 28. www.romduck.com School Age 6 yr. – 12 yr.  Question the patient directly.  Respect, do not “baby” them.  Do not embarrass them.  Talk directly to your patient.  Explain what’s going to happen.  Ask about common interests. Movies, School, Sports
  29. 29. www.romduck.com Adolescent >12y/o  Identity and peer relationships are a priority.  Body image &“disfigurement” are of great concern.  Emotional response can be highly understated or exaggerated.  Patient may regress to an earlier emotional stage.  Variable development in this group can make contact difficult.
  30. 30. www.romduck.com Adolescent >12y/o  Be careful not to be aggressive or condescending.  Approach physical assessment as with an adult.  Do not try to be “Cool”, “With it” or “Jiggy”.  Be cautious when questioning about drugs, sexual history or other sensitive issues.  Do NOT lie to the patient.  Be reassuring and respectful.
  31. 31. www.romduck.com Action: Transport (Let’s go!) Child Stretcher Car Seat Their Own Built-In Inflatable Flexible
  32. 32. www.romduck.com Action: Transport (Let’s go!) Family & Bystanders Get A Ride Ride with us Front Back Drive Themselves
  33. 33. www.romduck.com And Finally… Awesome YOU!
  34. 34. www.romduck.com Pediatric Training Programs PEPP PALS PEARS APLS EPiC
  35. 35. www.romduck.com Crapronyms! Arrangement Prep and Plan ahead Assurance Communicate with family and bystanders Assessment Communicate with patient Action Lead, follow or get out of the way. AAAAAAAAAAAAAAAAAAAAAAAAAY!
  36. 36. www.romduck.com http://www.flickr.com/photos/40912998@N00/3003827251/

×