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Chapter 39Pediatric Medical Emergencies
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Normal Childhood Development General Considerations Airway Problems Hypoperfusion
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Overview
Cardiac Arrest SIDS Altered Mental Status Stress in Caring for Children
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Normal Childhood Development
Neonate: 0 to 1 month old– Allow mother to hold child during assessment– Common illnesses: jaundice, vomiting, respiratory
distress, fever– Congenital birth defects begin to appear
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Young infant: 1 to 5 months old– Growing rapidly and becoming increasingly aware
of the surrounding environment– Common illnesses: SIDS, vomiting, diarrhea,
meningitis, child abuse, accidents
Normal Childhood Development
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Young infant: 1 to 5 months old– Make slow movements and use gentle handling– Keep covered as much as possible
Normal Childhood Development
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Older infant: 6 to 12 months old– Becoming more active and walking– Exhibit stranger anxiety– Common illnesses: febrile seizures, vomiting,
diarrhea, dehydration, bronchiolitis, MVCs, croup, child abuse, poisoning, falls
Normal Childhood Development
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Toddler: 1 to 3 years old– Constantly moving, becoming more independent– Needs encouragement and reassurance– May believe illness is punishment
Normal Childhood Development
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Toddler: 1 to 3 years old– Take a toe-to-head approach– Common illnesses: MVCs, vomiting, diarrhea,
febrile seizures, ingestions, falls, child abuse, croup, meningitis, FBAO
Normal Childhood Development
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Preschooler: 3 to 5 years old– Play is more sophisticated– Very attached to parents and possessions– Explain in simple and honest terms– Common illnesses: croup, asthma, ingestions,
MVCs, burns, child abuse, FBAO, drownings, epiglottitis, febrile seizures, meningitis
Normal Childhood Development
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School age: 6 to 12 years old– Growing quickly and very active– Increase in injuries– Get as much history information for child as
possible– Common emergencies: drowning, motor vehicle
collisions, bicycle accidents, fractures, falls, sports injuries, child abuse, burns
Normal Childhood Development
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Adolescent: 12 to 15 years old– Body image is very important– Peers are very important– Risk taking behavior is common– Common illnesses: mononucleosis, asthma, motor
vehicle collisions, sports injuries, suicide gestures, sexual abuse, pregnancy
Normal Childhood Development
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Stop and Review
What are the developmental differences among the various age groups of children?
What are the anatomical differences between children and adults?
What is a child’s typical response to illness?
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General Considerations
Initial approach– Place yourself at eye level
with child– Introduce yourself to both
child and parent– Explain why you are there
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
General Considerations
Gathering a history– Alter technique based upon age– Question the child in a friendly manner– Ask the parent for confirmation
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General Considerations
Performing a physical examination– Carefully observe the child– The child’s behavior can tell a lot about
how she is feeling– Try to gain child’s confidence– Anything that may cause pain should be
done last
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Stop and Review
What are some techniques for assessment and examination in children of various developmental ages?
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Airway Problems
Foreign body airway obstruction – May be complete or partial obstruction– Open the airway and check for breathing– Reposition the airway
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Airway Problems
Foreign body airway obstruction– For an infant, provide back blows and chest
thrusts– For an older child, perform the Heimlich maneuver
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Trouble Breathing
Croup– Viral illness causes swelling of the airways– Fall and winter are prime times – Lasts several days
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Trouble Breathing
Croup – Harsh sounding cough– Worse at night than in the day– Humidified oxygen and transport
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Trouble Breathing
Epiglottitis– Bacterial infection– Inflammation of the epiglottis causes airway
obstruction– Sudden fever, brassy cough, and sore throat– Ventilate and transport to the nearest hospital
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Pediatric Asthma
Asthma– Reversible spasm of smaller airways– Wheezing– Child works harder to breathe– May have a bronchodilating medication
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Pediatric Asthma
Upper respiratory infection– Inflammation and secretions
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Hypoperfusion
The most common cause is large fluid loss from dehydration due to vomiting, diarrhea or blood loss
Tachycardia, pale skin, delayed capillary refill, nausea
Will progress to altered mental status and a fall in blood pressure
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Cardiac Arrest
Most common cause is respiratory arrest Respiratory failure leads to hypoxia, which
leads to cardiac failure and cardiac arrest 100% oxygen and chest compressions
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SIDS
Leading cause of death in children one week to one year in age
Usually occurs during sleep; more frequent in winter months
Cause of death is unknown
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Altered Mental Status
Seizures – The most common are febrile seizures brought on
by a rapid increase in body temperature– Attend to the ABCs, undress the child, wipe with
moist cloths, fan the child
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Altered Mental Status
Diabetes– The result of altered glucose utilization – If conscious, provide sugar by mouth– If unconscious, transport immediately
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Altered Mental Status
Behavioral– If the altered mental status is the result of a
behavioral disorder, there will generally be a history of similar episodes
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Altered Mental Status
Poisoning– Signs include spilled bottle of
chemical or medications, a smell on the breath, discoloration of mouth or lips, or vomitus with pill fragments or a chemical smell
– Maintain airway and breathing, then follow local protocol
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Altered Mental Status
Infections– Colds, flu, gastroenteritis, strep throat,
mononucleosis, chicken pox– Most are not life threatening– Meningitis affects the brain and is very serious
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Stress in Caring for Children
Child– The illness is frightening, but the
examination by a stranger can be even more so
– Try to put the child at ease by being calm and honest
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Stress in Caring for Children
Family– Allow to participate in care of child– Keep informed of what is going on– If the parent cannot be calmed, separate her from
the child
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Stress in Caring for Children
Provider– Often invokes feelings of fear or anxiety– After the call, talk about feelings with coworkers
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Stop and Review
How are airway emergencies handled? How are respiratory emergencies treated? How is hypoperfusion in children handled? What is the most common cause of
cardiac arrest? How is altered mental status managed
in a child?