3. Barry Kidd 2010 3
Emotional & BehavioralEmotional & Behavioral
Development: InfantDevelopment: Infant
īŽ Time of rapid change/physical growthTime of rapid change/physical growth
īŽ Birth to 6 monthsBirth to 6 months
īŽ Recognize parents, has emotional tiesRecognize parents, has emotional ties
īŽ Easier to examine, lacks strengthEasier to examine, lacks strength
īŽ Poor head controlPoor head control
īŽ Rolls overRolls over
īŽ Hands to and in mouthHands to and in mouth
4. Barry Kidd 2010 4
Behavioral & EmotionalBehavioral & Emotional
Development : InfantDevelopment : Infant
īŽ 6 months to 1 year old6 months to 1 year old
īŽ Infant has a clear need of parent/careInfant has a clear need of parent/care
providerprovider
īŽ Infant has an ability to stand, crawl, exploreInfant has an ability to stand, crawl, explore
īŽ Infant is distressed by separationInfant is distressed by separation
īŽ Likely will resist being examinedLikely will resist being examined
īŽ You will likely have parents hold/maintainYou will likely have parents hold/maintain
contactcontact
īŽ The infant crying/holding parents is a copingThe infant crying/holding parents is a coping
mechanismmechanism
5. Barry Kidd 2010 5
Behavioral & EmotionalBehavioral & Emotional
Development: Toddler (1-3yrs.)Development: Toddler (1-3yrs.)
īŽ Age of intense activity and discoveryAge of intense activity and discovery
īŽ Holes need to be filled upHoles need to be filled up
īŽ Taste and touch everything!Taste and touch everything!
īŽ Only parents can be trustedOnly parents can be trusted
īŽ Difficulty in examining/resistanceDifficulty in examining/resistance
īŽ Have limited language/comprehensionHave limited language/comprehension
īŽ Provide support (parents/toys/talk)Provide support (parents/toys/talk)
6. Barry Kidd 2010 6
Behavioral & EmotionalBehavioral & Emotional
Development:Preschooler (3-6)Development:Preschooler (3-6)
īŽ The child has progressed from motorThe child has progressed from motor
development to psychomotor skillsdevelopment to psychomotor skills
refinement.refinement.
īŽ Full awareness of body/body partsFull awareness of body/body parts
īŽ Concrete thought process/interpretationConcrete thought process/interpretation
īŽ Vivid imagination/dramatizesVivid imagination/dramatizes
īŽ Fears the unknown/loss of body functionFears the unknown/loss of body function
īŽ Thinks illness/injury is a punishmentThinks illness/injury is a punishment
7. Barry Kidd 2010 7
Behavioral & Emotional Development:Behavioral & Emotional Development:
School Age (6-12)School Age (6-12)
īŽ Differing levels of behavior/developmentDiffering levels of behavior/development
īŽ Learning from school, peers,familyLearning from school, peers,family
īŽ Understands rational explanationsUnderstands rational explanations
īŽ Is easiest to examine and manageIs easiest to examine and manage
īŽ Issues of modesty are importantIssues of modesty are important
īŽ May regress to other level under stressMay regress to other level under stress
īŽ Fear of death and disabilityFear of death and disability
8. Barry Kidd 2010 8
Behavioral & EmotionalBehavioral & Emotional
Development: Adolescent (13-18)Development: Adolescent (13-18)
īŽ Mental development greatly advancedMental development greatly advanced
īŽ Feel invincible/immune to illness-injuryFeel invincible/immune to illness-injury
īŽ Preoccupied with body appearancePreoccupied with body appearance
īŽ Capable of over-reacting/hysteriaCapable of over-reacting/hysteria
īŽ Feel independent/adequate historiansFeel independent/adequate historians
īŽ Fear of death and disabilityFear of death and disability
īŽ Extremely modestExtremely modest
9. Barry Kidd 2010 9
PEDIATRIC EMERGENCIES:PEDIATRIC EMERGENCIES:
EpidemiologyEpidemiology
īŽ Trauma is the leading cause of death inTrauma is the leading cause of death in
infants and children (0-18 yrs. old)infants and children (0-18 yrs. old)
īŽ Motor vehicle incidents most frequentMotor vehicle incidents most frequent
īŽ BurnsBurns
īŽ DrowningDrowning
īŽ FallsFalls
īŽ FirearmsFirearms
10. Barry Kidd 2010 10
EPIDEMIOLOGY: TraumaEPIDEMIOLOGY: Trauma
īŽ Head Trauma: #1 cause of mortalityHead Trauma: #1 cause of mortality
īŽ Blunt Abdominal Trauma: #2 causeBlunt Abdominal Trauma: #2 cause
īŽ Orthopedic TraumaOrthopedic Trauma
īŽ Thoracic TraumaThoracic Trauma
īŽ May be isolated or Multi-systems traumaMay be isolated or Multi-systems trauma
11. Barry Kidd 2010 11
EPIDEMIOLOGY: MedicalEPIDEMIOLOGY: Medical
īŽ Respiratory EmergenciesRespiratory Emergencies
īŽ Altered Temperature ControlAltered Temperature Control
īŽ SeizuresSeizures
īŽ SepsisSepsis
īŽ DehydrationDehydration
īŽ Metabolic EmergenciesMetabolic Emergencies
īŽ Congenital DefectsCongenital Defects
īŽ Toxicological EmergenciesToxicological Emergencies
12. Barry Kidd 2010 12
Provider-Family :Provider-Family :
INTERACTIONS: FAMILYINTERACTIONS: FAMILY
īŽ When a child is ill or injured- the parents areWhen a child is ill or injured- the parents are
impacted as well.impacted as well.
īŽ Parents reaction is one of âacute griefâParents reaction is one of âacute griefâ
īŽ May view situation as âloss of controlâMay view situation as âloss of controlâ
īŽ May be demanding to gain controlMay be demanding to gain control
īŽ Relinquishing child to provider-feel helplessRelinquishing child to provider-feel helpless
īŽ Want answers/directions-NOW!Want answers/directions-NOW!
īŽ Will he/she walk again?/Will they die?Will he/she walk again?/Will they die?
13. Barry Kidd 2010 13
Provider - Family:Provider - Family:
INTERACTIONS: ProviderINTERACTIONS: Provider
īŽ Acknowledge the parents feelingsAcknowledge the parents feelings
īŽ Provide reassuranceProvide reassurance
īŽ Involve the parents with assessmentInvolve the parents with assessment
īŽ Be very communicativeBe very communicative
īŽ Remain calm/Project confidenceRemain calm/Project confidence
īŽ Develop trust with parents/patientDevelop trust with parents/patient
īŽ Give Information/Simple languageGive Information/Simple language
īŽ Assure needs/care of other childrenAssure needs/care of other children
14. Barry Kidd 2010 14
PEDIATRIC ASSESSMENTPEDIATRIC ASSESSMENT
īŽ Anatomic & Physiological DifferencesAnatomic & Physiological Differences
īŽ Approaches to the child/communicationApproaches to the child/communication
īŽ Chief ComplaintChief Complaint
īŽ AppearanceAppearance
īŽ Physical ExaminationPhysical Examination
īŽ ABCsABCs
īŽ Vital SignsVital Signs
īŽ Review of SystemsReview of Systems
15. Barry Kidd 2010 15
PEDIATRIC ASSESSMENT:PEDIATRIC ASSESSMENT:
Anatomy & Physiology: (head)Anatomy & Physiology: (head)
īŽ Head is larger and heavierHead is larger and heavier
-proportionately until age 4, v. adult-proportionately until age 4, v. adult
īŽ Infants have anterior fontanel which isInfants have anterior fontanel which is
normally soft and flat.normally soft and flat.
īŽ Fontanels can be used as an indicator ofFontanels can be used as an indicator of
increased ICP or dehydration.increased ICP or dehydration.
īŽ Bones are soft and separated by cartilageBones are soft and separated by cartilage
until age twountil age two
16. Barry Kidd 2010 16
Anatomy & Physiology: airwayAnatomy & Physiology: airway
īŽ The face is smaller/flexible nasal bridgeThe face is smaller/flexible nasal bridge
īŽ Newborns/infants are obligate nasalNewborns/infants are obligate nasal
breathers- passages easily obstructedbreathers- passages easily obstructed
īŽ Tongue is large/mandibular muscles areTongue is large/mandibular muscles are
immatureimmature
īŽ Airway diameter is small (4 v. 20mm)Airway diameter is small (4 v. 20mm)
īŽ Tracheal rings are more elasticTracheal rings are more elastic
īŽ Vocal cords are high/more anteriorVocal cords are high/more anterior
17. Barry Kidd 2010 17
Anatomy & Physiology:Anatomy & Physiology:
(thoracic)(thoracic)
īŽ Ribs are elastic: more cartilageRibs are elastic: more cartilage
īŽ Rib cage has greater complianceRib cage has greater compliance
īŽ Diaphragm-primary respiratory muscleDiaphragm-primary respiratory muscle
īŽ Chest muscles not well developedChest muscles not well developed
īŽ Lung tissue fragile-pulmonary contusionLung tissue fragile-pulmonary contusion
īŽ Mobile mediastinumMobile mediastinum
īŽ Respiratory rates are fasterRespiratory rates are faster
īŽ Cardiac rates are fasterCardiac rates are faster
18. Barry Kidd 2010 18
Anatomy & Physiology:Anatomy & Physiology:
(Abdomen)(Abdomen)
īŽ Abdominal breathers- observe abdomenAbdominal breathers- observe abdomen
to determine resp-rateto determine resp-rate
īŽ Abdominal muscles are immatureAbdominal muscles are immature
īŽ Limited protection of organs resultant fromLimited protection of organs resultant from
lack of musculaturelack of musculature
īŽ Increased vulnerability to blunt forceIncreased vulnerability to blunt force
traumatrauma
19. Barry Kidd 2010 19
Anatomy & Physiology:Anatomy & Physiology:
(extremities)(extremities)
īŽ Bones are softer until adolescenceBones are softer until adolescence
īŽ Greater susceptibility to fractures due toGreater susceptibility to fractures due to
bending and splinteringbending and splintering
īŽ Long bones develop from growth plates orLong bones develop from growth plates or
epiphysis- fractures in these areas areepiphysis- fractures in these areas are
more criticalmore critical
īŽ Increased activity level -types leads to aIncreased activity level -types leads to a
variety of orthopedic traumavariety of orthopedic trauma
20. Barry Kidd 2010 20
Anatomy & Physiology:Anatomy & Physiology:
(Nervous system)(Nervous system)
īŽ Development throughout childhoodDevelopment throughout childhood
īŽ Motor development proceeds bilaterallyMotor development proceeds bilaterally
from head to toefrom head to toe
īŽ Sensation is present everywhere from theSensation is present everywhere from the
time of birth-infants feel paintime of birth-infants feel pain
īŽ All brain cells are present at birth but areAll brain cells are present at birth but are
not fully developed-increasednot fully developed-increased
susceptibility to brain traumasusceptibility to brain trauma
21. Barry Kidd 2010 21
Anatomy & Physiology:Anatomy & Physiology:
(Integumentary System)(Integumentary System)
īŽ Body surface are is larger in proportion toBody surface are is larger in proportion to
body mass.body mass.
īŽ Skin is thinner with less subcutaneous fat.Skin is thinner with less subcutaneous fat.
īŽ Neonates are further compromised due toNeonates are further compromised due to
immature thermal regulation mechanisms.immature thermal regulation mechanisms.
īŽ Very susceptible to hypothermiaVery susceptible to hypothermia
22. Barry Kidd 2010 22
PEDIATRIC:PEDIATRIC:
Approach/CommunicationApproach/Communication
īŽ Evaluate location/position of childEvaluate location/position of child
īŽ Look for environmental clues/mechanismsLook for environmental clues/mechanisms
of injuryof injury
īŽ Observe the interactions of the child withObserve the interactions of the child with
the parents or care providersthe parents or care providers
īŽ Take history from parents/providersTake history from parents/providers
īŽ Donât overlook the patientâs ability toDonât overlook the patientâs ability to
provide you with informationprovide you with information
23. Barry Kidd 2010 23
PEDIATRIC:PEDIATRIC:
Approach-CommunicationApproach-Communication
īŽ Give the child a chance to trust you firstGive the child a chance to trust you first
īŽ Use age appropriate languageUse age appropriate language
īŽ Provide a toy and include EMS equipmentProvide a toy and include EMS equipment
as appropriateas appropriate
īŽ Project a calm demeanorProject a calm demeanor
īŽ Use parent as a role model/involveUse parent as a role model/involve
īŽ Ask questions to gain the childâsAsk questions to gain the childâs
participation- but donât waste time!participation- but donât waste time!
24. Barry Kidd 2010 24
PEDIATRIC: Chief Complaint-PEDIATRIC: Chief Complaint-
History of the Present Illness: hpiHistory of the Present Illness: hpi
īŽ Why was the EMS initiated?Why was the EMS initiated?
īŽ Present illness-symptomsPresent illness-symptoms
īŽ Duration-chronology-onsetDuration-chronology-onset
īŽ Pre-arrival treatment/physician contactPre-arrival treatment/physician contact
Birth weight, complications, neonatal hxBirth weight, complications, neonatal hx
īŽ SAMPLE informationSAMPLE information
25. Barry Kidd 2010 25
Pediatric Assessment:Pediatric Assessment:
Appearance-Appearance-
īŽ Observe environment-mechanismsObserve environment-mechanisms
īŽ Evaluate all subjective informationEvaluate all subjective information
īŽ Observe for any apparent signsObserve for any apparent signs
īŽ Observe for any apparent abnormalitiesObserve for any apparent abnormalities
īŽ Listen to the childâs cry, voice, breathingListen to the childâs cry, voice, breathing
īŽ Observe the skin colorObserve the skin color
īŽ Observe level of orientation, attention span,Observe level of orientation, attention span,
l.o.c.,l.o.c.,
26. Barry Kidd 2010 26
PHYSICAL EXAMINATION:PHYSICAL EXAMINATION:
ABCâsABCâs
īŽ Determine level ofDetermine level of
consciousness/responsivenessconsciousness/responsiveness
īŽ Airway-patent-secureAirway-patent-secure
īŽ Breathing- adequacy-supplementBreathing- adequacy-supplement
īŽ CirculationCirculation
īŽ Blood lossBlood loss
īŽ Central pulsesCentral pulses
īŽ Peripheral pulses-Capillary refill time (CRT)Peripheral pulses-Capillary refill time (CRT)
27. Barry Kidd 2010 27
AIRWAY: assessmentAIRWAY: assessment
īŽ Crying-talking = a patent airwayCrying-talking = a patent airway
īŽ Hoarseness= an airway obstruction orHoarseness= an airway obstruction or
inflammationinflammation
īŽ Moaning = altered L.O.C.Moaning = altered L.O.C.
īŽ Stridor= airway obstruction or vocal cordStridor= airway obstruction or vocal cord
inflammationinflammation
īŽ Wheezing= bronchial secretionsWheezing= bronchial secretions
īŽ Grunting= severe respiratory distressGrunting= severe respiratory distress
28. Barry Kidd 2010 28
AIRWAY: assessmentAIRWAY: assessment
īŽ Gurgling= a penetrating chest woundGurgling= a penetrating chest wound
īŽ Observe the abdomen to determine respiratoryObserve the abdomen to determine respiratory
rate/characterrate/character
īŽ observe for nasal flaring, sternal retractionsobserve for nasal flaring, sternal retractions
,cyanosis or mottling as signs of respiratory,cyanosis or mottling as signs of respiratory
distressdistress
īŽ Auscultate the lungs: midaxillary, midclavicular-Auscultate the lungs: midaxillary, midclavicular-
just beneath clavicles,listen for breaths at end ofjust beneath clavicles,listen for breaths at end of
crycry
29. Barry Kidd 2010 29
CIRCULATORY: assessmentCIRCULATORY: assessment
īŽ Skin temp. is best indicator of early shockSkin temp. is best indicator of early shock
īŽ Use forehead, chin or sternumUse forehead, chin or sternum
īŽ Estimate blood loss: 80cc/kg/wt =totalEstimate blood loss: 80cc/kg/wt =total
blood volume (pediatric)blood volume (pediatric)
īŽ Evaluate distal pulses/central pulsesEvaluate distal pulses/central pulses
īŽ Determine blood pressure: 80+(2 x age) =Determine blood pressure: 80+(2 x age) =
systolic BP (normotensive)systolic BP (normotensive)
30. Barry Kidd 2010 30
PEDIATRIC: Vital SignsPEDIATRIC: Vital Signs
īŽ Pulse: Central & Peripheral/SpO2Pulse: Central & Peripheral/SpO2
īŽ Respiration: rate/character/strengthRespiration: rate/character/strength
īŽ Blood Pressure (only for older children)Blood Pressure (only for older children)
īŽ TemperatureTemperature
īŽ Skin colorSkin color
32. Barry Kidd 2010 32
REVIEW of SYSTEMS:REVIEW of SYSTEMS:
assessmentassessment
īŽ Extremities- alignment, Range of motionExtremities- alignment, Range of motion
īŽ Skin- temperature, color, textureSkin- temperature, color, texture
īŽ Neurological- GCS, mentation, level ofNeurological- GCS, mentation, level of
activity (active v. passive) posturing-activity (active v. passive) posturing-
decortication/decerebration/rigiditydecortication/decerebration/rigidity
īŽ Reassessment of Vital SignsReassessment of Vital Signs
īŽ Continuous observation: trends/changes-Continuous observation: trends/changes-
variationsvariations
33. Barry Kidd 2010 33
MEDICAL EMERGENCIESMEDICAL EMERGENCIES
īŽ RESPIRATORY EMERGENCIES -mostRESPIRATORY EMERGENCIES -most
commonly encountered-highest mortalitycommonly encountered-highest mortality
rate:rate:
īŽ AsthmaAsthma
īŽ CroupCroup
īŽ EpiglottitisEpiglottitis
īŽ Foreign bodyForeign body
īŽ General respiratory distressGeneral respiratory distress
34. Barry Kidd 2010 34
ASTHMAASTHMA
īŽ Chronic recurrent lower airway diseaseChronic recurrent lower airway disease
with episodic attacks of bronchialwith episodic attacks of bronchial
constrictionconstriction
īŽ Response to allergen, stress, activityResponse to allergen, stress, activity
īŽ Inspiratory/expiratory wheezingInspiratory/expiratory wheezing
īŽ Coarse rhonchi, sometimes cyanoticCoarse rhonchi, sometimes cyanotic
īŽ Apprehensive/combativeApprehensive/combative
īŽ May lead to ventilatory failureMay lead to ventilatory failure
35. Barry Kidd 2010 35
ASTHMA: EMS managementASTHMA: EMS management
īŽ Assessment/oxygen via peds maskAssessment/oxygen via peds mask
īŽ Assisted medications-bronchodilatorsAssisted medications-bronchodilators
īŽ Status Asthmaticus .Status Asthmaticus .
īŽ Minimal air movement/aggressive mgmt.Minimal air movement/aggressive mgmt.
36. Barry Kidd 2010 36
CROUPCROUP
īŽ Upper respiratory viral infectionUpper respiratory viral infection
īŽ swelling and inflammation of larynx, subglotticswelling and inflammation of larynx, subglottic
tissue and sometimes trachea and bronchitissue and sometimes trachea and bronchi
īŽ More common in spring and fallMore common in spring and fall
īŽ Usually with cold symptoms 1-3 daysUsually with cold symptoms 1-3 days
īŽ Barking-âseal likeâ coughBarking-âseal likeâ cough
īŽ Moderate to severe respiratory distress withModerate to severe respiratory distress with
associated signs/symptomsassociated signs/symptoms
37. Barry Kidd 2010 37
CROUP: EMS ManagementCROUP: EMS Management
īŽ Oxygen via NRB if toleratedOxygen via NRB if tolerated
īŽ Blow-by oxygen in high concentrationBlow-by oxygen in high concentration
otherwiseotherwise
īŽ Keep quiet -do not agitateKeep quiet -do not agitate
īŽ Do not attempt manual airway as croupDo not attempt manual airway as croup
may be confused with epiglottitismay be confused with epiglottitis
īŽ Rapid transport/Ventilate as indicatedRapid transport/Ventilate as indicated
38. Barry Kidd 2010 38
EPIGLOTTITISEPIGLOTTITIS
īŽ Bacterial infection localized to the epiglottisBacterial infection localized to the epiglottis
īŽ Acute swelling of the epiglottis causing a totalAcute swelling of the epiglottis causing a total
airway obstructionairway obstruction
īŽ Affects children 3-6, but can occur in anyoneAffects children 3-6, but can occur in anyone
īŽ Sudden onset-child in tripod positionSudden onset-child in tripod position
īŽ Secretions, drooling, respiratory distress isSecretions, drooling, respiratory distress is
severesevere
39. Barry Kidd 2010 39
EPIGLOTTITIS-EPIGLOTTITIS-
EMS ManagementEMS Management
īŽ Do not manipulate the airwayDo not manipulate the airway
īŽ Maintain tolerable position-never supineMaintain tolerable position-never supine
īŽ Oxygen via mask or blow byOxygen via mask or blow by
īŽ Minimize movement/agitationMinimize movement/agitation
īŽ Immediate transportImmediate transport
īŽ Positive pressure ventilation -if indicatedPositive pressure ventilation -if indicated
40. Barry Kidd 2010 40
Altered Temperature Control:Altered Temperature Control:
Fever/hyperthermiaFever/hyperthermia
īŽ Response to an infection or from brainâsResponse to an infection or from brainâs
inability to effect thermoregulationinability to effect thermoregulation
īŽ Greater than 38 C. is cause for concernGreater than 38 C. is cause for concern
īŽ Can lead to febrile seizuresCan lead to febrile seizures
īŽ Core temperature can rise whichCore temperature can rise which
increases oxygen demand and can causeincreases oxygen demand and can cause
metabolic acidosismetabolic acidosis
īŽ Be aware of environmental factorsBe aware of environmental factors
41. Barry Kidd 2010 41
Fever/hyperthermia:Fever/hyperthermia:
EMS managementEMS management
īŽ ABCâs, vital signs,ABCâs, vital signs,
īŽ Treat seizures accordinglyTreat seizures accordingly
īŽ Promote rapid cooling-sponging to lowerPromote rapid cooling-sponging to lower
temperaturetemperature
īŽ Give oral fluids based on LOC ( have parentsGive oral fluids based on LOC ( have parents
administer)administer)
īŽ Evaluate necessity for transportEvaluate necessity for transport
īŽ Be concerned with a lethargic child having aBe concerned with a lethargic child having a
temperature over 39 C.temperature over 39 C.
42. Barry Kidd 2010 42
HYPOTHERMIAHYPOTHERMIA
īŽ Pediatric patients are at a high riskPediatric patients are at a high risk
īŽ Larger ratio of body surface area/massLarger ratio of body surface area/mass
īŽ Core body temperature below 35 C.Core body temperature below 35 C.
īŽ EtiologyEtiology
īŽ EnvironmentalEnvironmental
īŽ TraumaTrauma
īŽ Metabolic conditionsMetabolic conditions
īŽ SepsisSepsis
43. Barry Kidd 2010 43
HYPOTHERMIA:HYPOTHERMIA:
EMS ManagementEMS Management
īŽ Assessment/ABCsAssessment/ABCs
īŽ Oxygen via mask-warm humidification?Oxygen via mask-warm humidification?
īŽ Warm environment-external re warmingWarm environment-external re warming
īŽ Core temperature monitoringCore temperature monitoring
īŽ Cautious with movement/re warmingCautious with movement/re warming
44. Barry Kidd 2010 44
SEIZURESSEIZURES
īŽ Abnormal electrical discharge in the brainAbnormal electrical discharge in the brain
which causes abnormal movements andwhich causes abnormal movements and
altered mental statusaltered mental status
īŽ Varying etiologies-PediatricVarying etiologies-Pediatric
īŽ Fever (febrile seizures)Fever (febrile seizures)
īŽ TraumaTrauma
īŽ Meningitis, encephalitisMeningitis, encephalitis
īŽ Metabolic disorders -diabetic/toxic intakeMetabolic disorders -diabetic/toxic intake
46. Barry Kidd 2010 46
MENINGITISMENINGITIS
īŽ Bacterial or viral infection of the meningesBacterial or viral infection of the meninges
of the brain and/or spinal cord.of the brain and/or spinal cord.
īŽ 5-10% mortality rate-treated: antibiotics5-10% mortality rate-treated: antibiotics
īŽ 90% of cases in children (1 mo-5 yrs.)90% of cases in children (1 mo-5 yrs.)
īŽ Abrupt onset of symptoms: petechiae,Abrupt onset of symptoms: petechiae,
fever, apprehension,fever, apprehension,
īŽ Nuchal rigidity: Kerningâs/ Bruzinskiâs signNuchal rigidity: Kerningâs/ Bruzinskiâs sign
48. Barry Kidd 2010 48
MENINGITIS:MENINGITIS:
EMS ManagementEMS Management
īŽ Wear gown, gloves, eye protection-highlyWear gown, gloves, eye protection-highly
infectiousinfectious
īŽ Assessment/Oxygen-ventilate if neededAssessment/Oxygen-ventilate if needed
īŽ IV access via peripheralIV access via peripheral
īŽ 20cc/kg fluid bolus if shock like signs and20cc/kg fluid bolus if shock like signs and
symptomssymptoms
īŽ Rapid transportRapid transport
īŽ Appropriate facility- primary/tertiary?Appropriate facility- primary/tertiary?
49. Barry Kidd 2010 49
SEPSIS/SEPTIC SHOCKSEPSIS/SEPTIC SHOCK
īŽ SEPSIS-bacterial infection of the bloodSEPSIS-bacterial infection of the blood
īŽ Associated frequently with meningitisAssociated frequently with meningitis
īŽ Newborns at great risk-immune systemNewborns at great risk-immune system
īŽ SEPTIC SHOCK-Complication of Sepsis:SEPTIC SHOCK-Complication of Sepsis:
pooling of blood in extremities, dilation ofpooling of blood in extremities, dilation of
vesselsvessels
īŽ Related to other illnesses, pallor, shock,Related to other illnesses, pallor, shock,
mottling, poor sucking/feeding, ICP-upmottling, poor sucking/feeding, ICP-up
50. Barry Kidd 2010 50
SEPSIS/SEPTIC SHOCKSEPSIS/SEPTIC SHOCK
EMS: ManagementEMS: Management
īŽ Assessment /ABCâsAssessment /ABCâs
īŽ Oxygen-ventilate as neededOxygen-ventilate as needed
īŽ Intubate as requiredIntubate as required
īŽ IV access via peripheralIV access via peripheral
īŽ IV fluid bolus at 20cc/kg IV push-repeatIV fluid bolus at 20cc/kg IV push-repeat
īŽ Rapid transport-donât delayRapid transport-donât delay
īŽ Tertiary care facility is most appropriateTertiary care facility is most appropriate
51. Barry Kidd 2010 51
DEHYDRATIONDEHYDRATION
īŽ Acute loss of body fluids from numerousAcute loss of body fluids from numerous
causes:causes:
īŽ Fever, Vomiting, diarrhea,Fever, Vomiting, diarrhea,
īŽ Diabetic ketoacidosis-renal profusionDiabetic ketoacidosis-renal profusion
īŽ Poor formula preparationPoor formula preparation
īŽ Water is 75% of pediatric body weightWater is 75% of pediatric body weight
īŽ Infants who are dehydrated can lose up toInfants who are dehydrated can lose up to
15% of body weight15% of body weight
52. Barry Kidd 2010 52
DEHYDRATION:DEHYDRATION:
EMS ManagementEMS Management
īŽ Assessment- ABCs: Sunken fontanellesAssessment- ABCs: Sunken fontanelles
īŽ Historical data: last wet diaper?Historical data: last wet diaper?
īŽ Severe dehydration=life threateningSevere dehydration=life threatening
īŽ Administer CPR as needed for circulatoryAdminister CPR as needed for circulatory
collapsecollapse
īŽ Transport to tertiary facility per medicalTransport to tertiary facility per medical
control as indicatedcontrol as indicated
53. Barry Kidd 2010 53
METABOLIC: KETOACIDOSISMETABOLIC: KETOACIDOSIS
īŽ Cells cannot utilize glucose for energy -bodyCells cannot utilize glucose for energy -body
attempts to breakdown fatsattempts to breakdown fats
īŽ known diabetic-unbalanced insulin doseknown diabetic-unbalanced insulin dose
īŽ Early-polyuria, polydipsia (the patient displaysEarly-polyuria, polydipsia (the patient displays
excessive thirst) ,weight lossexcessive thirst) ,weight loss
īŽ Acute-ketone breath, Kussmaul respirations,Acute-ketone breath, Kussmaul respirations,
dehydration, rigid abdomen, comatose conditiondehydration, rigid abdomen, comatose condition
īŽ Life threatening emergencyLife threatening emergency
54. Barry Kidd 2010 54
METABOLIC: HypoglycemiaMETABOLIC: Hypoglycemia
īŽ Inadequate levels of blood glucoseInadequate levels of blood glucose
īŽ Variance in activity/growth in pediatricsVariance in activity/growth in pediatrics
īŽ Mild- hunger, weakness, tachycardiaMild- hunger, weakness, tachycardia
īŽ Severe - altered LOC, sweating,Severe - altered LOC, sweating,
seizures, : must replace glucoseseizures, : must replace glucose
īŽ Can occur in neonates - blood glucoseCan occur in neonates - blood glucose
levels are routinely checked.levels are routinely checked.
īŽ Can be life threateningCan be life threatening
55. Barry Kidd 2010 55
METABOLIC EMERGENCIESMETABOLIC EMERGENCIES
EMS ManagementEMS Management
īŽ Assessment-ABCâs- good historianAssessment-ABCâs- good historian
īŽ Oxygen via mask-ventilate as requiredOxygen via mask-ventilate as required
īŽ IV access via peripheralIV access via peripheral
īŽ Administer D25%/W 2-4mg/kg asAdminister D25%/W 2-4mg/kg as
required,required,
īŽ Protect airwayProtect airway
56. Barry Kidd 2010 56
CONGENITALCONGENITAL
ABNORMALITIES: PediatricABNORMALITIES: Pediatric
īŽ Congenital birth defects typically occur toCongenital birth defects typically occur to
the heart and the surrounding greatthe heart and the surrounding great
vessels.vessels.
īŽ When blood from the two circulatoryWhen blood from the two circulatory
pathways mix-hypoxemia occurs.pathways mix-hypoxemia occurs.
īŽ Talk to parents-What is normalTalk to parents-What is normal
īŽ Dydrhythmias, CHF, cyanosis, mottlingDydrhythmias, CHF, cyanosis, mottling
īŽ Respiratory distress-general precursorRespiratory distress-general precursor
57. Barry Kidd 2010 57
Congenital Abnormalities:Congenital Abnormalities:
EMS ManagementEMS Management
īŽ Assessment/ABCsAssessment/ABCs
īŽ Parents know more than us!!Parents know more than us!!
īŽ Oxygen/ventilateOxygen/ventilate
īŽ For a cyanotic spell-the knee chestFor a cyanotic spell-the knee chest
position is bestposition is best
īŽ Contact medical controlContact medical control
īŽ Tertiary facility where treated is the mostTertiary facility where treated is the most
appropriate receiverappropriate receiver
58. Barry Kidd 2010 58
ââHIGH TECH KIDSâHIGH TECH KIDSâ
īŽ Variety of chronic or terminal illnessesVariety of chronic or terminal illnesses
īŽ Congenital defectsCongenital defects
īŽ Cystic FibrosisCystic Fibrosis
īŽ SIDS candidates/ PremiesSIDS candidates/ Premies
īŽ Feeding disordersFeeding disorders
īŽ TraumaTrauma
īŽ Ventilators, Infusion pumps, central lines,Ventilators, Infusion pumps, central lines,
feeding tubes, trachs, hospicefeeding tubes, trachs, hospice
59. Barry Kidd 2010 59
PEDIATRIC TOXICOLOGYPEDIATRIC TOXICOLOGY
īŽ Poisoning is a major cause of death inPoisoning is a major cause of death in
children under 5 years oldchildren under 5 years old
īŽ 90% occur in childâs home/parent present90% occur in childâs home/parent present
at timeat time
īŽ Drug experimentation/suicide attemptsDrug experimentation/suicide attempts
īŽ Any consumable material is suspectAny consumable material is suspect
īŽ Toddlers are high risk group due to theirToddlers are high risk group due to their
exploratory natureexploratory nature
60. Barry Kidd 2010 60
PEDIATRIC TOXICOLOGYPEDIATRIC TOXICOLOGY
EMS: ManagementEMS: Management
īŽ Gather adequate history/environmentalGather adequate history/environmental
assessment-labels, clues, residue etc.assessment-labels, clues, residue etc.
īŽ Assessment/ABCsAssessment/ABCs
īŽ Oxygen via mask/ventilate-intubateOxygen via mask/ventilate-intubate
īŽ Information assessment-poison controlInformation assessment-poison control
īŽ Medical Control- advanced toxicologicalMedical Control- advanced toxicological
interventions- HazMat as requiredinterventions- HazMat as required
61. Barry Kidd 2010 61
PEDIATRIC TRAUMAPEDIATRIC TRAUMA
īŽ Leading cause of death in childrenLeading cause of death in children
īŽ Four times greater than cancerFour times greater than cancer
īŽ MVI= 44% of deathsMVI= 44% of deaths
īŽ Burns = 15%Burns = 15%
īŽ Drowning= 14.6%Drowning= 14.6%
īŽ Aspiration=3.5%Aspiration=3.5%
īŽ Firearms= 4%Firearms= 4%
62. Barry Kidd 2010 62
PEDIATRIC TRAUMAPEDIATRIC TRAUMA
(frequency)(frequency)
īŽ Head:Head: 38%38%
īŽ ExtremitiesExtremities 32%32%
īŽ AbdomenAbdomen 11%11%
īŽ ChestChest 9%9%
īŽ Blunt trauma is most common mechanismBlunt trauma is most common mechanism
īŽ Effective management is criticalEffective management is critical
63. Barry Kidd 2010 63
Pediatric Trauma AssessmentPediatric Trauma Assessment
īŽ Children with trauma die from hypoxia andChildren with trauma die from hypoxia and
hypoperfusion secondary to specifichypoperfusion secondary to specific
injuriesinjuries
īŽ Airway (stabilize C-spine)Airway (stabilize C-spine)
īŽ Breathing (O2/ventilate/intubate)Breathing (O2/ventilate/intubate)
īŽ Circulation(bleeding,central/peripheral)Circulation(bleeding,central/peripheral)
īŽ Disability (LOC / neuro)Disability (LOC / neuro)
īŽ Exposure (thermoregulation)Exposure (thermoregulation)
64. Barry Kidd 2010 64
Pediatric Trauma ManagementPediatric Trauma Management
īŽ Assure Scene SafetyAssure Scene Safety
īŽ Effective Incident Size-UpEffective Incident Size-Up
īŽ Effective Incident ManagementEffective Incident Management
īŽ Request Additional ResourcesRequest Additional Resources
īŽ Patient AssessmentPatient Assessment
īŽ Determine Load/Go StatusDetermine Load/Go Status
īŽ Rapid TransportRapid Transport
īŽ Appropriate Patient CareAppropriate Patient Care
65. Barry Kidd 2010 65
SPECIAL CONSIDERATIONS:SPECIAL CONSIDERATIONS:
Pediatric TraumaPediatric Trauma
īŽ Capillary refill is the best indicator of perfusionCapillary refill is the best indicator of perfusion
and early shock in peds.and early shock in peds.
īŽ Hyperventilation is indicated early on withHyperventilation is indicated early on with
suspected head trauma/monitor and manage thesuspected head trauma/monitor and manage the
airway.airway.
īŽ Understand ranges for pediatric vital signs:Understand ranges for pediatric vital signs:
watch for trends--watch for trends--
66. Barry Kidd 2010 66
NEONATAL RESUSCITATION:NEONATAL RESUSCITATION:
Neonates in perspective:Neonates in perspective:
īŽ Neonates must make three physiologicalNeonates must make three physiological
adaptations after birth:adaptations after birth:
īŽ Changing the circulatory patternChanging the circulatory pattern
īŽ Emptying lungs/ventilationEmptying lungs/ventilation
īŽ Maintaining thermoregulationMaintaining thermoregulation
īŽ Only about 10-20% require resuscitativeOnly about 10-20% require resuscitative
support to make these transitionssupport to make these transitions
67. Barry Kidd 2010 67
Physiology of birth (neonates)Physiology of birth (neonates)
īŽ Chest is compressed during vaginal delivery:Chest is compressed during vaginal delivery:
fluid forced out/recoil-air influid forced out/recoil-air in
īŽ Cutting the umbilical cord ends fetal circulation:Cutting the umbilical cord ends fetal circulation:
Peripheral vascular resistance begins-pulmonaryPeripheral vascular resistance begins-pulmonary
circulationcirculation
īŽ Neonates lose heat rapidly after birthNeonates lose heat rapidly after birth
īŽ Large body surface areaLarge body surface area
īŽ Thin skin/little fat-insulationThin skin/little fat-insulation
īŽ Conserve heat by flexion of extremitiesConserve heat by flexion of extremities
68. Barry Kidd 2010 68
Anatomy/Physiology (neonates)Anatomy/Physiology (neonates)
īŽ 37-40 weeks gestation (full term) 7.5 lbs37-40 weeks gestation (full term) 7.5 lbs
īŽ Premature: less than 37 wks.: 1-4 lbsPremature: less than 37 wks.: 1-4 lbs
īŽ Obligate nose breathers/irregular breathing withObligate nose breathers/irregular breathing with
apnea/obstructed naresapnea/obstructed nares
īŽ Maternal complications predicate resuscitationMaternal complications predicate resuscitation
īŽ Maternal illnessMaternal illness
īŽ Substance abuseSubstance abuse
īŽ HemorrhageHemorrhage
īŽ Delivery complicationsDelivery complications
69. Barry Kidd 2010 69
NEONATAL ASSESSMENTNEONATAL ASSESSMENT
īŽ Maternal history/delivery complicationsMaternal history/delivery complications
īŽ Presenting part-during birthPresenting part-during birth
īŽ Presence of meconiumPresence of meconium
īŽ Vital signs: BP:55/30-75/40 P: 120-160 R:Vital signs: BP:55/30-75/40 P: 120-160 R:
30-60, Temp: 96.8-98.630-60, Temp: 96.8-98.6
īŽ APGAR SCORE : (1-5 minutes after)APGAR SCORE : (1-5 minutes after)
īŽ Reflexes: sucking,blinking, noiseReflexes: sucking,blinking, noise
īŽ Management based on assessmentManagement based on assessment
70. Barry Kidd 2010 70
APGAR SCORING ( 1APGAR SCORING ( 1
min/5min)min/5min)
īŽ A: Appearance or colorA: Appearance or color
īŽ P: PulseP: Pulse
īŽ G: Grimace with cryingG: Grimace with crying
īŽ A: Activity or muscle toneA: Activity or muscle tone
īŽ R: Respiratory effortR: Respiratory effort
īŽ Score of 7-10: normalScore of 7-10: normal
īŽ Score of 4-6: stimulate,suction, oxygenScore of 4-6: stimulate,suction, oxygen
īŽ Score of O-3: ResuscitationScore of O-3: Resuscitation
71. Barry Kidd 2010 71
Neonatal ManagementNeonatal Management
īŽ Suction, dry, position, stimulate,warm,Suction, dry, position, stimulate,warm,
īŽ Oxygenate : blow by o2Oxygenate : blow by o2
īŽ VentilateVentilate
īŽ CPR: if rate less than (60-80)CPR: if rate less than (60-80)
īŽ Meconium Aspiration: suctionMeconium Aspiration: suction