pediatricspediatrics
Family MattersFamily Matters
When a child is ill or injured, you When a child is ill or injured, you may have several patients, not just may have several patients, not just one.one.
Children mimic caregiver behavior Children mimic caregiver behavior
Be calm, professional, and sensitive.Be calm, professional, and sensitive.
pediatricspediatrics
Anatomic DifferencesAnatomic Differences Less circulating bloodLess circulating blood Lose body heat more easilyLose body heat more easily Bones are more flexibleBones are more flexible Less fat surrounding organsLess fat surrounding organs Could be much internal damage Could be much internal damage
with little external visible traumawith little external visible trauma
pediatricspediatrics
Skeletal DifferencesSkeletal Differences
Bones are prone to fracture Bones are prone to fracture with stress.with stress.
Infants have two openings Infants have two openings in the skull called in the skull called fontanels.fontanels.– close by 18 months.close by 18 months.
pediatricspediatrics
Airway DifferencesAirway Differences– Larger tongue Larger tongue
relative to the mouthrelative to the mouth
– Less well-developed Less well-developed rings of cartilage in rings of cartilage in the tracheathe trachea
– Head tilt-chin lift Head tilt-chin lift may occlude the may occlude the airway.airway.
pediatricspediatrics
Breathing DifferencesBreathing Differences
Infants breathe faster than Infants breathe faster than children or adults.children or adults.
Infants use the diaphragm Infants use the diaphragm when they breathe.when they breathe.
Sustained, labored breathing Sustained, labored breathing may lead to respiratory may lead to respiratory failure.failure.
pediatricspediatrics
Circulation DifferencesCirculation Differences
The heart rate increases for The heart rate increases for illness and injuryillness and injury
Very effective vasoconstriction Very effective vasoconstriction keeps vital organs nourishedkeeps vital organs nourished
Pale, extremities, decreased Pale, extremities, decreased cap refill are early signs of cap refill are early signs of perfusion problemsperfusion problems
pediatricspediatrics
Approach to Approach to AssessmentAssessment
level of activity, work of breathing, and skin colorlevel of activity, work of breathing, and skin color cap refill cap refill ALS backup or immediate transport?ALS backup or immediate transport? Pediatric patients crash harder than Pediatric patients crash harder than
adultsadults Transport to peds facilities when Transport to peds facilities when
possiblepossible
pediatricspediatrics
Treatment Treatment ConsiderationsConsiderations
OxygenOxygen - treat same as adult – Use - treat same as adult – Use “blow-by” administration if needed“blow-by” administration if needed
Patient position Patient position - same as adult - same as adult
*Remember* airway and breathing *Remember* airway and breathing are focusare focus
pediatricspediatrics
Growth and Growth and DevelopmentDevelopment
Usually grouped into stagesUsually grouped into stages– InfantInfant– ToddlerToddler– PreschoolPreschool– School-age School-age – AdolescentAdolescent
pediatricspediatrics
InfantInfant first year of lifefirst year of life
respond physical respond physical stimulistimuli
crying is main means crying is main means of expressionof expression
have caregiver hold pthave caregiver hold pt
pediatricspediatrics
ToddlerToddler 1 to 3 years of age1 to 3 years of age mobilemobile may resist may resist
separationseparation don’t like being don’t like being
restrainedrestrained can be distractedcan be distracted
pediatricspediatrics
PreschoolPreschool 3 to 6 years of age3 to 6 years of age can understand directionscan understand directions can identify painful areascan identify painful areas fearful of painfearful of pain allow them to handle allow them to handle
equipmentequipment explain what you are going to explain what you are going to
dodo
pediatricspediatrics
School-Age ChildSchool-Age Child 6 to 12 years of age6 to 12 years of age begin to think like adultsbegin to think like adults can be included when taking medical can be included when taking medical
historyhistory should be familiar with physical examshould be familiar with physical exam allow them to make choices when allow them to make choices when
possiblepossible
pediatricspediatrics
The AdolescentThe Adolescent 12 to 18 years of age12 to 18 years of age concerned about body imageconcerned about body image may have strong feelings about may have strong feelings about
being observedbeing observed respect their privacyrespect their privacy they understand painthey understand pain explain any procedureexplain any procedure
pediatricspediatrics
RespirationsRespirations Abnormal respirations are a Abnormal respirations are a
common sign of illness or injurycommon sign of illness or injury Less than 3, count rise and fall of Less than 3, count rise and fall of
abdomenabdomen Note effort of breathing/noisesNote effort of breathing/noises Note if they are cryingNote if they are crying
pediatricspediatrics
Respiration NotesRespiration Notes
Less than 12 breaths/min Less than 12 breaths/min More than 60 breaths/min, More than 60 breaths/min, ALOC and/or an inadequate tidal ALOC and/or an inadequate tidal
volume volume
= ventilation with a BVM = ventilation with a BVM devicedevice
pediatricspediatrics
PulsePulse Infants -brachial Infants -brachial
or femoral or femoral Child- use Child- use
carotidcarotid Count at least 1 Count at least 1
minuteminute Note strengthNote strength
pediatricspediatrics
Blood PressureBlood Pressure
Use right size cuffUse right size cuff
Difficult scene? Don’t Difficult scene? Don’t waste timewaste time
Under 3? No BPUnder 3? No BP
pediatricspediatrics
Skin SignsSkin Signs important important
signsign feel for feel for
temperature temperature and moistureand moisture
always check always check capillary refillcapillary refill
pediatricspediatrics
FeverFever–Common CausesCommon Causes
InfectionsInfections Neoplasm (cancer)Neoplasm (cancer) Drug ingestionDrug ingestion Collagen vascular diseaseCollagen vascular disease High environmental temperaturesHigh environmental temperatures
pediatricspediatrics
Emergency Care for Emergency Care for FeverFever
Ensure BSIEnsure BSI Begin passive coolingBegin passive cooling
– Remove clothing/coveringsRemove clothing/coverings
– Damp towels Damp towels No iceNo ice No alcoholNo alcohol No cold water bathsNo cold water baths
pediatricspediatrics
Febrile SeizuresFebrile Seizures common in children 6 months common in children 6 months
to 6 yearsto 6 years most caused by high fevermost caused by high fever hx of infectionhx of infection generalized grand mal seizuregeneralized grand mal seizure less than 15 minutesless than 15 minutes
pediatricspediatrics
TreatmentTreatment
ABC’sABC’s protect patientprotect patient recovery positionrecovery position high flow oxygenhigh flow oxygen suction prnsuction prn passivepassive cooling measures cooling measures transporttransport
pediatricspediatrics
DehydrationDehydration
Dry lips and gumsDry lips and gums Fewer wet diapersFewer wet diapers Sunken eyes Sunken eyes Poor skin turgorPoor skin turgor Sleepy or irritableSleepy or irritable Sunken fontanelsSunken fontanels
pediatricspediatrics
Care for DehydrationCare for Dehydration Assess the ABCsAssess the ABCs
Obtain baseline vital signsObtain baseline vital signs
ALS backup may be needed ALS backup may be needed for IV administrationfor IV administration
pediatricspediatrics
Airway ObstructionAirway Obstruction
CroupCroup– An infection of the airway below An infection of the airway below
the level of the vocal cords, the level of the vocal cords, caused by a viruscaused by a virus
EpiglottitisEpiglottitis– Infection of the soft tissue in the Infection of the soft tissue in the
area above the vocal cordsarea above the vocal cords Foreign body AspirationForeign body Aspiration
pediatricspediatrics
CroupCroup
barking coughbarking cough stridorstridor wheezingwheezing ralesrales accessory muscle useaccessory muscle use nasal flaringnasal flaring grunting grunting
pediatricspediatrics
EpiglottitisEpiglottitis
severe dyspneasevere dyspnea stridorstridor inability to swallow - inability to swallow -
DROOLINGDROOLING feverfever tripod positiontripod position
pediatricspediatrics
Foreign body aspirationForeign body aspiration
Partial Partial BlockageBlockage– coughingcoughing– accessory accessory
muscle usemuscle use– nasal flaringnasal flaring– wheezingwheezing
Complete Complete BlockageBlockage- no soundno sound- no cryno cry- stridorstridor- cyanosiscyanosis- loss of loss of
consciousnessconsciousness
pediatricspediatrics
treatmenttreatment
ABC’sABC’s high flow oxygen high flow oxygen position of comfortposition of comfort
do not do not attempt to visualize the throat!attempt to visualize the throat!
do not do not put anything into patient’s mouth.put anything into patient’s mouth.
pediatricspediatrics
AsthmaAsthma
dyspneadyspnea wheezingwheezing accessory muscle useaccessory muscle use nasal flaringnasal flaring respiratory rate - observerespiratory rate - observe
pediatricspediatrics
TreatmentTreatment
ABC’sABC’s high flow oxygenhigh flow oxygen position of comfortposition of comfort transporttransport
pediatricspediatrics
What is the most What is the most frequent cause of frequent cause of cardiac arrest in cardiac arrest in
pediatrics?pediatrics?
pediatricspediatrics
want to save a want to save a pediatric patient?pediatric patient?
aggressive ventilation & high aggressive ventilation & high flow oxygenflow oxygen
pediatricspediatrics
USC video!USC video!
Pediatric respiratory distress Pediatric respiratory distress
pediatricspediatrics
MeningitisMeningitis
Inflammation of meningesInflammation of meninges Bacterial or viralBacterial or viral Permanent brain Permanent brain
damage/deathdamage/death
pediatricspediatrics
Signs and Symptoms of Signs and Symptoms of Meningitis Meningitis
FeverFever ALOCALOC HeadachHeadach
ee SeizureSeizure Stiff neck Stiff neck
VomitingVomiting PhotophobiaPhotophobia IrritabilityIrritability Bulging Bulging
fontanelfontanel
pediatricspediatrics
Neisseria meningitidisNeisseria meningitidis
rapid onset rapid onset pinpoint cherry-red spots or pinpoint cherry-red spots or
larger purple/black rashlarger purple/black rash sepsis, shock, and deathsepsis, shock, and death all suspected cases considered all suspected cases considered
contagiouscontagious
pediatricspediatrics
TreatmentTreatment
BSIBSI ABC’sABC’s protect patientprotect patient high flow oxygenhigh flow oxygen passive cooling for feverpassive cooling for fever monitor for shockmonitor for shock TransportTransport Call ALS for backup if unstableCall ALS for backup if unstable
pediatricspediatrics
Submersion InjurySubmersion Injury
Drowning or near drowningDrowning or near drowning Second most common cause of Second most common cause of
unintentional deathunintentional death ABC’sABC’s May be in respiratory or cardiac May be in respiratory or cardiac
arrestarrest C-spine precautions?C-spine precautions? Be ready to suctionBe ready to suction Keep warmKeep warm
pediatricspediatrics
PoisoningPoisoning
Poisoning is common in childrenPoisoning is common in children Ask specific questions of Ask specific questions of
caregiverscaregivers Focus on the ABCsFocus on the ABCs Give oxygenGive oxygen Provide transportProvide transport Child’s condition could change at Child’s condition could change at
any timeany time
pediatricspediatrics
Pediatric Resuscitation Pediatric Resuscitation Tape Measure Tape Measure (Aka: (Aka:
Broslow tape)Broslow tape) Used to Used to
determine determine height, height, weight, weight, and proper and proper equipment.equipment.
pediatricspediatrics
Interossius IVInterossius IV
Used if traditional IV sites are Used if traditional IV sites are difficult to assessdifficult to assess
Medication delivered into bone Medication delivered into bone marrowmarrow
PainfulPainful
pediatricspediatrics
Transporting Infants and Transporting Infants and ChildrenChildren
Children require padding under the torso Children require padding under the torso Newborns should be in special incubatorsNewborns should be in special incubators Do not hold child during the actual Do not hold child during the actual
transporttransport Drive with due careDrive with due care Do not allow your emotions to take controlDo not allow your emotions to take control
pediatricspediatrics
Sudden Infant Death Sudden Infant Death SyndromeSyndrome
SIDS - “crib death”SIDS - “crib death”
pediatricspediatrics
SIDSSIDS
Definition - unexplained death Definition - unexplained death of an apparently healthy of an apparently healthy infant.infant.
7500+ cases per year in U.S.7500+ cases per year in U.S. Leading cause of death in Leading cause of death in
infants <1 year oldinfants <1 year old more cases in winter monthsmore cases in winter months
pediatricspediatrics
Sudden Infant Death Sudden Infant Death Syndrome (SIDS)Syndrome (SIDS)
Several known risk factors:Several known risk factors:– Mother younger than 20 years oldMother younger than 20 years old– Mother smoked during pregnancyMother smoked during pregnancy– Low birth weightLow birth weight– Putting babies to sleep on stomachPutting babies to sleep on stomach– Siblings of SIDS babiesSiblings of SIDS babies
pediatricspediatrics
Tasks at SceneTasks at Scene
Assess and manage patientAssess and manage patient Communicate with and Communicate with and
support the familysupport the family Assess the sceneAssess the scene
pediatricspediatrics
Assessment and Assessment and ManagementManagement
Diagnosis of exclusionDiagnosis of exclusion Can be other causes of conditionCan be other causes of condition Regardless of cause, TX is sameRegardless of cause, TX is same Infant may have signs of Infant may have signs of
postmortem changespostmortem changes It is ok to work up an obviously It is ok to work up an obviously
dead babydead baby If no postmortem changes, begin If no postmortem changes, begin
CPR immediatelyCPR immediately
pediatricspediatrics
Communication and Communication and Support of FamilySupport of Family
The death of child is very stressful for the The death of child is very stressful for the familyfamily
Parents guilt is overwhelmingParents guilt is overwhelming Provide support in whatever ways you Provide support in whatever ways you
cancan IT IS NOT YOUR PLACE TO JUDGEIT IS NOT YOUR PLACE TO JUDGE Use the infant’s name Use the infant’s name Allow family time with the infantAllow family time with the infant
pediatricspediatrics
Scene AssessmentScene Assessment
Inspect the environment, noting:Inspect the environment, noting:– Signs of illness, including medicationsSigns of illness, including medications– General condition of the houseGeneral condition of the house– Family interactionFamily interaction– Site where infant was discoveredSite where infant was discovered
pediatricspediatrics
Support GroupsSupport Groups
Know your local phone Know your local phone numbers for referralsnumbers for referrals
Arrange for proper debriefingArrange for proper debriefing
pediatricspediatrics
Child AbuseChild Abuse
Any improper or excessive action Any improper or excessive action that injures or harms a child or infantthat injures or harms a child or infant
physical, sexual, emotional abuse physical, sexual, emotional abuse and neglectand neglect
More than 2 million cases reported More than 2 million cases reported annuallyannually
Be aware of signs of child abuse and Be aware of signs of child abuse and report it to authoritiesreport it to authorities
pediatricspediatrics
Questions Regarding Questions Regarding Signs of Abuse Signs of Abuse (1 of 4)(1 of 4)
Is the injury typical?Is the injury typical?
Is reported method of injury consistent with Is reported method of injury consistent with injuries?injuries?
Is the caregiver behaving appropriately?Is the caregiver behaving appropriately?
Is there evidence of drinking or drug Is there evidence of drinking or drug abuse?abuse?
pediatricspediatrics
Questions Regarding Questions Regarding Signs of Abuse Signs of Abuse (2 of 4)(2 of 4)
Delay in seeking care?Delay in seeking care?
Good relationship between child Good relationship between child and caregiver?and caregiver?
Multiple injuries at various Multiple injuries at various stages of healing?stages of healing?
Any unusual marks or bruises?Any unusual marks or bruises?
pediatricspediatrics
Questions Regarding Questions Regarding Signs of Abuse Signs of Abuse (3 of 4)(3 of 4)
Are there several types of Are there several types of injuries?injuries?
Any burns on the hands or feet Any burns on the hands or feet involving a glove distribution?involving a glove distribution?
Unexplained decreased level of Unexplained decreased level of consciousness?consciousness?
pediatricspediatrics
Questions Regarding Questions Regarding Signs of Abuse Signs of Abuse (4 of 4)(4 of 4)
Is the child clean and an Is the child clean and an appropriate weight?appropriate weight?
Any rectal or vaginal bleeding?Any rectal or vaginal bleeding?
What does the home look like? What does the home look like?
pediatricspediatrics
Other IndicatorsOther Indicators
Withdrawn, fearful or hostile childWithdrawn, fearful or hostile child Refusal to discuss MOIRefusal to discuss MOI History of “accidents”History of “accidents” Conflicting storiesConflicting stories Caregiver lack of concernCaregiver lack of concern
pediatricspediatrics
Emergency Medical Emergency Medical CareCare
ABCsABCs
Transport if you Transport if you suspectsuspect child abusechild abuse
Do not make accusationsDo not make accusations
EMT-Bs must report all EMT-Bs must report all suspected cases of child suspected cases of child abuseabuse
pediatricspediatrics
Sexual AbuseSexual Abuse
Children of any age or either Children of any age or either gender can be victimsgender can be victims
Limit examinationLimit examination
Do not allow child to wash, Do not allow child to wash, urinate, or defecateurinate, or defecate
Document carefullyDocument carefully
TransportTransport
pediatricspediatrics
EMS Response to EMS Response to Pediatric EmergenciesPediatric Emergencies You may experience a wide You may experience a wide
range of emotions range of emotions You may feel anxiousYou may feel anxious Practice helpsPractice helps After difficult incidents, a After difficult incidents, a
debriefing may be helpfuldebriefing may be helpful