This document provides an overview of common medical emergencies that may present in school-aged children, including allergic reactions, asthma, foreign body aspiration, croup, hypoglycemia, hypovolemia, seizures, overdose/poisoning, and cardiac arrest. It reviews pediatric patient assessment, anatomical and physiological differences between children and adults, signs and symptoms, and basic life support treatment for these conditions. The objectives are to identify common pediatric emergencies, review treatment, and describe respiratory distress and failure in children.
Children and adults differ physically and mentally.
As a nurses it is necessary to learn the differences to deliver the care accordingly.
CLASSIFICATION:
Anatomical differences
Physiological differences
Psychological differences
Children are more prone to dehydration than adults. At the same time, exposure to many chemical agents and some biological agents leads to vomiting and diarrhea.
As a result, children may be more symptomatic and show symptoms earlier than adults.
Children have a higher proportion of rapidly growing tissues than adults, and some agents, including ionizing radiation and mustard gas, significantly affect rapidly growing tissues.
As a result, children are more prone to ionizing radiation and other agents that affect rapidly growing tissue than adults.
Children have relatively small airways compared with adults. The smaller the caliber of the airway, the greater the reduction in airflow as a result of increased pulmonary secretions that occur following exposure to chemicals or edema from inhalation of hot gases
As a result, children suffer more pulmonary pathology than adults at the same level of exposure.
Children and adults differ physically and mentally.
As a nurses it is necessary to learn the differences to deliver the care accordingly.
CLASSIFICATION:
Anatomical differences
Physiological differences
Psychological differences
Children are more prone to dehydration than adults. At the same time, exposure to many chemical agents and some biological agents leads to vomiting and diarrhea.
As a result, children may be more symptomatic and show symptoms earlier than adults.
Children have a higher proportion of rapidly growing tissues than adults, and some agents, including ionizing radiation and mustard gas, significantly affect rapidly growing tissues.
As a result, children are more prone to ionizing radiation and other agents that affect rapidly growing tissue than adults.
Children have relatively small airways compared with adults. The smaller the caliber of the airway, the greater the reduction in airflow as a result of increased pulmonary secretions that occur following exposure to chemicals or edema from inhalation of hot gases
As a result, children suffer more pulmonary pathology than adults at the same level of exposure.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. This presentation covers only a snapshot of the
subjects presented that are relevant for this
setting- You are encouraged to do further
research and dive deeper into each topic. Not
all pediatric emergencies are covered in this
presentation- only some common conditions.
4. Objectives
• Identify common pediatric medical emergencies
that present in the prehospital environment.
• Review BLS treatment for common pediatric
medical emergencies.
• Describe the signs and symptoms of respiratory distress
and failure in a child
• List and describe the anatomical and physiological
differences between children and adults
5. INTRODUCTION
As kids and teens grow and change, there’s a lot to keep track of. So,
health care providers screen for different things at different times in a
child’s life. They can do this in different ways.
During the exam, health care providers can screen for issues with a
child’s:
•Growth/development
•vision
•hearing
•dental health
•spine
Using a blood test or other kind of test, they can screen for:
•lead poisoning
•anemia
•high cholesterol
6. Body mass index
(BMI) is a person’s weight in kilograms divided by
the square of height in meters.
It is an inexpensive and easy way to screen for
weight categories that may lead to health problems.
For children and teens, BMI is age- and sex-specific
and is often referred to as BMI-for-age.
7.
8. Signs: are elicited in the patient ,
they constitute the features of the
condition in that patient that can be
seen.
Symptoms: are features which
patients report.
9.
10. Faceandbody habitus.
• Does the patient's appearance suggest any
particular diseases
• Is there an abnormal distribution of body hair
• Is there anything about the patient to trigger
thoughts about Paget’s disease, Mar-
Specific signs are associated with different diseases:
consider the nails (koilonychia= iron deficiency),
subcutaneous nodules (rheumatoid, neurofi
broma?),
and look for
lymph nodes (cervical, axillary, inguinal).
11. Skin
colour:
• Blue/purple =
cyanosis (can
also be central
only, p28).
• Yellow =
jaundice
(yellow skin can
also be caused
by uraemia,
pernicious
anaemia,
12. Skin colour:
• Pallor: this is non-
specific; anaemia is
assessed from the
palmar skin creases
(when
spread) and
conjunctivae the
patient
is probably anaemic.
• Hyperpigmentation:
Addison’s,
haemochromatosis
(slate-grey)
13. Pediatric Patient Assessment
• Pulse/resp rates may change rapidly
• Crying complicates
• Stable appearance doesn’t mean no problem
• All actions take into account developmental stage
continued
14. Assessment
Use clues based on child’s
behavior
• Activity level
• Eye contact
• Irritable or agitated?
• Response to teachers
voice
16. Anatomy and Physiology
• Inherent differences in intellect, size, proportion,
and metabolism
• Large variations in behavior, vital signs, ability to
cope occur at various stages of development
17. NOSE: Generally smaller, increased resistance,
Smaller septum & nasal bridge is flat and flexible . . .
Obligatory nose breathers
VOCAL CORDS: located at C3-4 versus C5-6 in
adults . . . Larynx is more anterior
Contributes to aspiration if neck is hyperextended
CRICOID RING Is the narrowest part of the airway
instead of vocal cords
AIRWAY DIAMETER is 4 mm vs.. 20 mm in adult
TRACHEAL RINGS more elastic & cartilaginous,
can easily crimp off trachea
More SMOOTH MUSCLE, makes airway more
reactive or sensitive to foreign substances
Airway: Child vs Adult
18. Airway
• Relatively small mouths and airways
• Tongue is proportionally larger & bulbous until about age
8
• Tonsils & adenoids swelling can cause respiratory distress
• Glottis opening is narrow
• Foreign body obstruction concerns
contin
ued
20. Body Surface Area
Children do not have a
larger body surface area
than adults. They have a
larger PERCENTAGE of
surface area for their
weight than adults do.
This is because children
do not have highly
developed muscle.
Most of their mass is fat
and water which weighs
less. Bones are also less
dense at a younger age.
21. • Head to Body ratio and
relative size and location of
anatomic features make
children more susceptible to
head and abdominal injury
• Underdeveloped anatomy
leads to chest pliability and
less protection of thoracic
cage and less effective use
of accessory muscles
• Arrest – Cardiac arrest
typically results from
untreated respiratory arrest
Child vs Adult
22. Skin, Bones, Joints
• Surface area is greater, skin is thinner
• Less muscle mass & body fat
• Musculoskeletal system is immature and grows
rapidly
• Bones, joints, ligaments are softer & more flexible
• Higher rate of internal organ injury
• Greenstick fractures
• Growth plate issues
23. Thorax - Child vs Adult
• Horizontal ribs – more diaphragmatic
breathing
• Flatter Diaphragm
• Ribs & Sternum is cartilage - less
stability of chest wall, requires more
use of diaphragm
• Less pulmonary reserve
• Heart takes up more thoracic space
• Poor accessory muscle development
• Larger abdominal organs - pushes up
diaphragm
25. Look for signs of airway obstruction
• increased chest and abdominal
movements (See-Saw)
• Accessory Muscle Use
• Central cyanosis
• Absent to no Breath sounds
• Depressed consciousness
Treat airway obstruction as a medical emergency
• In the majority of cases, simple methods of
airway management are all that is necessary - -
Positioning,
• Chin Lift,
26. Look for general signs of respiratory
distress, sweating, cyanosis,
accessory muscle use – It is vital to
diagnose and treat immediately life
threatening conditions (Severe
Asthma, Tension Pneumothorax,
Foreign Body)
•Respiratory Rate & rhythm
•Equal chest expansion
•Breath sounds
•Stridor, Rales, Rhonchi, Wheezing
•Air Exchange
•Chest deformity
•Abdominal distension
27. Respiratory pathology that may compromise circulatory state - - - tension
pneumothorax
• Look for signs of poor cardiac output
• Peripheral and central pulses
• Blood Pressure
• Reduced level of consciousness
• Low urine output (less wet diapers)
• Reduced PO intake
• Look for signs of bleeding
In almost all medical/surgical emergencies, consider hypovolemia to be the
primary cause of shock unless proven otherwise.
28. Signs of Disability - - coma/convulsion - -Common causes of unconsciousness include
profound hypoxia, hypercapnea, cerebral hypoperfusion or recent sedative/analgesic drug
ingestion
•Review ABC’s – exclude hypoxia and hypotension
• Assess tone, Pupil size
• R/O Accidental Ingestion – give appropriate
antagonist where available
• Monitor LOC
• Blood Glucose Level
D can also stand for signs of dehydration
• Signs of shock have already been looked for
while assessing circulation but specific
examination for skin turger, sunken eyes, dry
mucus membranes
29. Check Temperature - - Kids will become hyper/hypo thermic faster than an adult
Look all over the body - - - back, groin
Assess in well lit area
30. Hyperglycemia (high blood sugar)
• What is it?
• What causes it?
• Almost exclusively
related to diabetes
mellitus type 1 in
pediatric patients.
• May have triggers.
• Signs & Symptoms
• The “3 P’s” of
hyperglycemia
• Polyuria
• Polyphagia
• Polydipsia
• Headache
• Altered mental status
• Kussmaul respirations
• Smell of ketones
• Mngt: BLS
• ABCs
• Provide oxygen and
ventilations as
needed
31. Hypoglycemia (Low blood sugar)
• What is it?
• What causes it?
• Usually a complication
of insulin
administration in a
child with type 1
diabetes.
• Poor feeding/missed
meal
• Signs & Symptoms
• Hunger
• Irritability
• Altered mental status
• Pallor and diaphoresis
• Usually a sudden
onset
• Treatment: BLS
• ABCs
• Provide oxygen and ventilations as needed
• Oral glucose
• IM glucagon
32. Hypovolemia (low blood volume)
• What is it?
• An inadequate amount
of fluid in the body.
• What causes it?
• Bleeding due to injuries
• Vomiting and diarrhea
• Blood loss
• Diabetic ketoacidosis
• Exertion and/or poor
fluid intake
• Signs and Symptoms
• Generalized weakness
• Lethargy
• Altered mental status
• Pallor
• Dry skin and mucus
membranes
• Sunken fontanelles
• Poor skin turgor
• Tachycardia
• Hypotension
Management: BLS
• ABCs
• Provide oxygen and ventilations as needed
• Monitor glucose
33. Cardiac Arrest (Heart stops beating)
• What is it?
• The cessation of the
mechanical activity of
the heart.
• What causes it?
• Primary medical
causes in children:
• Airway or respiratory
problems
• Shock
• Signs & Symptoms
• Unresponsiveness
• Apnea
• No palpable pulse
• Management: BLS
• ABCs
• Provide oxygen and
ventilations as needed
• IV/IO epinephrine
1:10,000
• Attach AED and follow
prompts.
• No AED use for
newborns (<1 hour)
34. Respiratory Failure/Cardiac Arrest
• Young children are susceptible
• Heart and respiratory rate increase
• Respiratory system becomes exhausted – fails
• Hypoxia follows, then cardiac arrest
• Bradycardia with resp distress is an ominous sign
37. Basics
Upper respiratory viral
infection
Occurs mostly among
ages 6 months to 3 years
More prevalent in fall and
spring
Edema develops,
narrowing the airway
lumen (Steeple Sign)
Severe cases may result
in complete obstruction
Croup
38. Croup
• Physical exam/Assessment
• Tachycardia, tachypnea
• Skin color - pale, cyanotic,
mottled
• Decrease in activity or
LOC
• Fever
• Breath sounds - wheezing,
diminished breath sounds
• Stridor, barking cough,
hoarse cry or voice
• Any difficulty swallowing?
• Drooling present
39. Management
Assess & monitor ABC’s
High flow humidified O2; blow
by if child won’t tolerate mask
Limit exam/handling to avoid
agitation
Be prepared for respiratory
arrest, assist ventilations and
perform CPR as needed
Do not place instruments in
mouth or throat
Rapid transport
Croup
40. Aspirated Foreign Body
• Basics
• Common among the 1-3
age group who like to put
everything in their mouths
• Running or falling with
objects in mouth
• Inadequate chewing
capabilities
• Common items - gum, hot
dogs, grapes and peanuts
41. Assessment
Complete obstruction will
present as apnea
Partial obstruction may present
as labored breathing,
retractions, and cyanosis
Objects can lodge in the lower
or upper airways depending on
size
Object may act as one-way
valve allowing air in, but not
out
Aspirated Foreign Body
42. Aspirated Foreign Body
Complete Obstruction
Attempt to clear using BLS
techniques
Attempt removal with direct
laryngoscopy and Magill forceps
Cricothyrotomy may be indicated
Partial obstruction
Make child comfortable
Administer humidified oxygen
Encourage child to cough
Have intubation equipment
available
Transport to hospital for removal
with bronchoscope
47. Asthma
• What is it?
• A completely reversible
obstructive airway disease.
• Three components:
• Bronchospasm
• Edema
• Excessive mucus
production
• What causes it?
• Environmental & genetic
factors
• Exacerbations are caused
by a trigger.
• Pollen, dust, smoke, animal
dander
• Temperature changes
• Physical activity
• Signs & Symptoms
• Dyspnea
• Wheezing
• Coughing
• Pertinent negatives
• Treatment: BLS
• ABCs
• Provide oxygen & ventilations as needed
• Assist with metered-dose inhaler
• Epi-Pen or IM epinephrine administration
48. •Ingestion of a potentially
toxic substance, drug,
household or industrial
chemical, plant or waste
products
Ingestions/Poisonings
History
Home environment
Medications in home
Where are chemicals stored?
Hobby-related exposures
Physical clues (open bottles,
plants with missing leaves, etc)
49. Physical exam
• Vital signs
• Excitation or
•Depression
• Pupils
• Mental Status
• Skin
• Management
• ABC’s
• Decontamination
Unknown Ingestions
Laboratory workup.
Every child should
have…
Acetaminophen level
Salicylate level
Ethanol level
Chemistry panel
including LFT’s
Calculate anion gap
Urinalysis
Consider urine toxicology
screen, ABG, urine,
pregnancy, imaging (CXR or
KUB), Osmolality
51. Ingestion Management
Management:
• Stabilize and ABC’s as needed
• Oxygen as needed
• IV with Normal Saline (keep Hydrated)
• NG if unconscious or will not drink
•Give activated charcoal
• If opiate poisoning
• Narcan
• If acetaminophen poisoning
• N-acetylcysteine
52. Causes
• Vaccines
• Drugs
• Insect bites
• Food
• Latex
• Venoms
Anaphylaxis
Usually begins within a few minutes after
exposure evident within 15”
Symptoms – Sneezing, Coughing, Itching, Flushing
of skin, Facial edema
Anxiety, Palpitations, Nausea, Vomitting, Respiratory
Distress, Hypotesnion
53. •Recumbent Position
• Elevate Feet
• Establish and maintain
airway
• Oxygen
• Epinephrine per
protocol
Anaphylaxis Management
54. Seizures
Common Age Range - 6 mos - 6 yrs
The CNS of children is more
immature, making children
more likely to seize
•1% of all patients in ED are
Pediatric seizure patients
• Occurs in 2-5% of pediatric
patients
• 80% are febrile
• Other causes
• Infection
• CNS
• Immunizations
General considerations
• Stabilize and ABC’s as
needed
• Oxygen as needed
• Watch for aspiration
• Watch glucose
• Treat fever
Febrile seizures that
continue for more than
five minutes should be
treated.
55. Seizures
• Febrile are most common
• 6 mos. To 5 years
• Combination of infection,
high temp
• Most are generalized, short,
harmless
• Status epilepticus
• Lasts longer than 10 mins.
• Prolonged post-ictal state
• 3 or more in a row, no return
to normal
• True emergency
• Absence
56.
57. Burns
Second leading cause of pediatric deaths
Scald burns are most common
Rule of nine is different for children
Each leg worth 13.5%
Head worth 18%
Thermal Injuries & Burns
Risk Factors
Excessive sun exposure
Hot water heaters set too high
Exposure to chemicals or electricity
Thin skin
Carelessness with burning cigarettes
Faulty electrical wiring
58. Thermal Injuries
Management of Burns
• Stabilize ABC’s
•Primary Survey
•Establish Airway and Assist
Ventilation if needed
•Keep saturations 97%
•Fluid Resuscitation
59. Thermal Injuries
Transfer to Burn Center
• Second-degree burn over
10% BSA or any third degree
burn
• Electrical or lightening burns
• Inhalation injury
• Chemical Burn
•Circumferential burn
60. Meningitis
• Meningitis is
caused by an
infection
• Develops over 1-
4 days,
contagious
• Lethargy, fever,
headache, stiff
neck
• True medical
emergency
61. Trauma
• Chest/abdomen injuries
transfer energy to organs
• Contusions and internal
bleeding may result
• Commitio cordis is life
threat
• Blow to the chest,
interrupts normal
electrical pattern of heart
• Extremities
• Greenstick fractures may
occur
62. Child Abuse and Neglect
• Legal, not medical terms
• Are crimes
• Reporting requirements vary by state
• Transcends culture, class, race, religion
• Abusers are parents, relatives or close adults
• It can also be teachers
• Shaken baby syndrome.
64. Take-a-ways
• Kids can deteriorate quickly –
you constantly have to be on
your toes!
• Anatomy and Physiology is
different than adults - - Be
aware of the differences and
the impact disease can make
• Use the ABCDE Assessment
tool
• Do a thorough systematic
approach and reassess often
65. Take home note:
Remember that an adequate airway
and oxygen-rich approach may be the
difference between life and death
Sick pediatric patients can be terrifying,
but they usually only have one thing
wrong.
Support their airway,
breathing and
cardiovascular status and
their amazing bodies will
usually take care of the
rest
Discussion Points: The assessment slides, which actually include the next 6 slides as well, focus on the special considerations which must be made for children. As you discuss this you will see that the OEC Technician must take into account the age of the child, his/her behaviors, and whether or not the caregiver is present. Notable differences are that, in younger children, once the area of pain is noted that area will be palpated last, rather than first as with an adult, and that the child may need to be distracted or invited to participate in the assessment.
The pediatric assessment triangle.
Discussion Points: The book gives many more details than can be put on a slide – if you have students who are parents they will likely be aware of many of the variations children demonstrate at their various stages of development. Review the stages with your students.
Discussion Points: Review the A&P differences of the airway.
The respiratory anatomy of children compared to that of adults.
Discussion Points: Details in the text include the benefits to the child of their less developed body, but also the concerns related to the types of injury which might be seen.
Danger, response, send for help
Blood sugar levels are over 250, often over 300.
DKA results in acidosis and electrolyte changes, causing a wide range of problems.
Excess sugar spills into the urine, drawing water with it and causing dehydration.
Diabetes mellitus type 1: AKA juvenile onset diabetes, insulin dependent diabetes.
Autoimmune disease.
The beta cells of the pancreas are destroyed over time. Beta cells are the insulin producing cells of the Islets of Langerhans in the pancreas.
Insulin is required for cells to utilize glucose.
Hyperglycemia can also occur in children with infections or other medical problems, especially if the have diabetes.
Signs and Symptoms
Polyuria: frequent urination, polyphagia: frequent eating/hunger, polydipsia: frequent drinking
Kussmaul respirations are deep and rapid.
Ketones have a fruity or alcoholic odor.
GI distress is common and serious issues such as pancreatitis can be associated with DKA.
Dehydration can lead to hypovolemic shock.
Onset is usually occurs over at least 24 hours.
Nancy Caroline’s Emergency Care in the Streets, 8th edition
What causes it?
Usually due to taking too much insulin, taking insulin and not eating, or due to excessive exertion or illness.
Signs and symptoms
AMS can range from minor confusion to seizure and complete unresponsiveness.
Nancy Caroline’s Emergency Care in the Streets, 8th edition
The Maryland Medical Protocols for Emergency Medical Services Providers, 2018
Children are sensitive to fluid balance changes.
Even just a day or two of vomiting and diarrhea can cause hypovolemia.
Look for sunken fontanelles in children <2 years of age, especially in children <1 year of age.
Test for skin tenting.
Nancy Caroline’s Emergency Care in the Streets, 8th edition
Cardiac arrest in children is often due to a respiratory problem. Hypoxia causes bradycardia, quickly followed by cardiac arrest.
Common shock states: hypovolemic, cardiogenic, septic, and anaphylaxic.
Nancy Caroline’s Emergency Care in the Streets, 8th edition
The Maryland Medical Protocols for Emergency Medical Services Providers, 2018
Discussion Points:
The importance of this is noted in the text – that cardiac arrest in children is most often associated with respiratory failure.
Responsive infant: 5 back thrusts and 5 chest compressions, repeating.
Unresponsive infant: CPR with airway visualization (remove object if seen).
All others
Responsive: Abdominal thrusts (Heimlich)
Unresponsive: CPR with airway visualization (remove object if seen).
In asthma, inflammation of the airways reduces their diameter, causing respiratory difficulty.
Asthma is a chronic condition with reversible exacerbations.
The smooth muscles of the bronchioles constrict, become swollen, and become obstructed with mucus.
Difficult to diagnose in young children (bronchiolitis, RSV, etc.)
Causes include genetic and environmental factors. Environmental factors include exposure to cockroaches, cigarette smoke, and air pollution.
Asthma exacerbations always have a cause, even if the cause is not identified.
Signs and symptoms
A quiet chest is a bad chest!
Look for nasal flaring, tripoding, retractions, accessory muscle use, etc.
Cough may be productive or non-productive.
Pertinent negatives: wet lungs sounds, fever, GI distress, rhinorrhea... Hx of asthma?
Nancy Caroline’s Emergency Care in the Streets, 8th edition
Discussion Points:
Seizures may be seen more often in children than adults, so understanding the types and characteristics is vital. Additional details are found in the text.
Discussion Points:
We are still in topics that OEC techs may not see at their area, but they will be ready for real life applications.
Discussion Points:
The 3 problems on this page may represent different age groups for patients, but any of these may be found on the slopes. The issue of internal bleeding, the ability of the younger child to compensate, and shock can be reviewed here.
Discussion Points:
Additional information on recognizing abuse is found in a later slide. Here the issue is understanding a bit about the topics of abuse and neglect. In some states, not reporting suspected abuse is a crime, so this is a serious matter. You should inform students of the reporting requirements in your area.
• Physical abuse in a child: multiple fatal injuries.
• Physical abuse in a child: cuts from restraints.
• Physical abuse in a child: burns from a stove.
