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Unformatted text preview: Pediatrics Topics Roles of the Paramedic in Pediatric Care Growth and Development Assessment Airway Adjuncts and Intravenous Access Medical Emergencies Traumatic Injuries Child Abuse and Neglect Introduction Current research indicates that more than 20,000 pediatric deaths occur each year in the United States. The leading causes of death are age specific. They include motor vehicle collisions, burns, drownings, suicides, and homicides. Role of Paramedics in Pediatric Care Pediatric injuries have become major concerns. Children are at higher risk of injury than adults. Children are more likely to be adversely affected by the injuries they receive. Continuing Education and Training Pediatric Advanced Life Support (PALS) Pediatric Basic Trauma Life Support (PBTLS) Advanced Pediatric Life Support (APLS) Pediatric Emergencies for Paramedics (PEP) It is important to organize or participate in programs that educate children about injury prevention and health care. Figure 2-1 Emergency Medical Services For Children
Federally-funded program aimed at improving the health of pediatric patients who suffer from life-threatening illnesses and injuries General Approach to Pediatric Emergencies
"The observations of the relatives, which must be taken as a substitute must be accepted with reservations, for they are often inexact, exaggerated, colored by preconceived ideas or emphasize matters of a secondary importance" The Diagnosis of Children's Diseases, Graham 1925 Communication and Psychological Support Treatment begins with communication and psychological support. Responding to Patient Needs
The child's most common reaction to an emergency is fear of: Separation Removal from a family place Being hurt Being mutilated or disfigured The unknown Parent's reaction to illness Grief Guilt, shock,anger, denial, Changes in behavior as call progresses Responding to Parents or Caregivers Communication! One paramedic speaks with the adults. Introduce yourself and appear calm. Be honest and reassuring. Keep parents informed. Growth and Development Newborns First hours after birth Newborn, neonate Assessed with A scoring system Neonates Birth to one month. Tend to lose 10% of birth weight, but regain in 10 days. Development centers on reflexes. Personality begins to form. Mother, occasionally father, can comfort child. Neonates, continued Common illnesses include jaundice, vomiting, and respiratory distress. Develop fever with minor illness making it hard to distinguish from major illness. Allow patient to remain in caregiver's lap. Infants
Ages 1 to 5 months. Growth is very rapid during the first year. May stand or walk without assistance. Follow movements. Muscle development develops in cephalocaudal progression. Allow patient to remain in caregiver's lap. Doubled birth weight Changes during infancy Respiratory rate begins to slow, however resp. movement continue to be abdominal. High probability to have infections due to inability of the immune system to produce immunoglobulin A Trachea and bronchi remain small and are easily blocked. Heart rate begins to slow and mostly like will be sinus arrhythmia. Cont'd Thermoregulation becomes more efficient and the ability of the skin to contract and muscles to shiver in response to cold is achieved. Renal structures are still immature and predisposes infants to dehydration. Maturity occurs during the latter half of the second year. Infants 6-12 months May stand or walk without assistance. Active FBAO Almost fully formed personalities Anxiety towards strangers Cling to mother Don't like lying on backs Common illnesses Febrile Seizures Vomiting Diarrhea Dehydration Bronchiolitis MVC Croup Meningitis Toddlers
Ages 1 to 3 years. Great strides in motor development. May stray from parents frequently. Parents are the only ones who can comfort them. Language development begins. Approach child slowly. Understand better than they can speak. Toddlers, continued Examine from head-to-toe. Allow child to hold a favorite blanket or item. Tell child if something will hurt. Infants and young children should be allowed to remain in their mothers' arms. Jeff Forster A small toy may calm a child in the 6 10 year age range. Figure 2-3 Is this your Toddler??? Preschoolers
Ages 3 to 5 years. Increase in fine and gross motor skills. Children know how to talk. Fear mutilation. Seek comfort and support from within home. Distorted sense of time. Have tempers and will express them! Common Preschooler Illnesses Croup Asthma Poisoning Auto accidents Burns Child abuse Ingestion of foreign bodies Drowning Epiglottitis Febrile seizures Meningitis School-Age Children
Ages 612 years. Active and carefree age group. Growth spurts are common. Give this age group responsibility of providing history. Respect modesty. The approach to the pediatric patient should be gentle and slow. Figure 2-4 Common Illness and Injuries in School-Age Children Drowning Auto accidents Bicycle accidents Falls Fractures Sports injuries Child abuse Burns Adolescents Ages 13 to 18. Begins with puberty, which is very childspecific; are very "body conscious." May consider themselves "grownup." Desire to be liked and included by peers. Are generally good historians. Relationships with parents may be strained. Common Adolescent Illness and Injuries Mononucleosis Asthma Auto accidents Sports injuries Drug and alcohol problems Suicidal gestures Sexual abuse Some Approach Ideas From the door Playful? Smiling? Interactive w/caregivers? Introduction Have parents do so Simple questions Stuffed animals Honesty Anatomy and Physiology Anatomical and Physiological Characteristics of Infants and Children Ribs are more horizontal with little curvature, leading to AP chest expansion as opposed to AP and superior elevation less ability to increase tidal volume. Epiglottis is more oblong or u-shaped more difficult to control in airway maneuvers. Less cardiovascular reserve. Compensate through increases in rate rather than contractile force. Starling's reflex does not develop until between 6 and 8 years of age. Heart rates can be much higher in children than adults and should be considered to be critical findings in the acutely ill or injured child. Anatomical and physiological considerations in the infant and child. Figure 2-5 a. In the supine position, an infant's or child's larger head tips forward, causing airway obstruction. b. Placing padding under the patient's back and shoulders will bring the airway to a neutral or slightly extended position. General Approach to Pediatric Assessment Basic Considerations Much of the initial patient assessment can be done during visual examination of the scene. Involve the caregiver or parent as much as possible. Allow to stay with child during treatment and transport. Scene Size-Up
Conduct a quick scene size-up. Take BSI precautions. Look for clues to mechanism of injury or nature of illness. Allow child time to adjust to you before approaching. Speak softly, simply, at eye level. The Basic Steps In Pediatric Assessment Notice the components and signs in the pediatric assessment triangle. Opening the airway in a child. Figure 2-8 Head-tilt/chin-lift method. Figure 2-9 Jaw-thrust method. Figure 2-10 Assessing the airway. Signs of respiratory distress. Notice the conditions that can be determined by quick observation. Respiratory Exam Child place stethoscope, listen to what's underneath Caregiver lift up child's shirt retractions effort paradoxical movement of abdomen Cardiac Exam Distraction Child listen to own or caregivers heart first Cap refill reliable in children Cyanosis of hands, feet normal in newborn Cutus mamorata ( mottling) of legs OK Normal Vital Signs: Infants and Children Table 2-2 Signs of Increased Respiratory Effort Anticipating Cardiopulmonary Arrest Respiratory rate greater than 60 Heart rate greater than 180 or less than 80 (under 5 years) Heart rate greater than 180 or less than 60 (over 5 years) Respiratory distress Trauma Burns Cyanosis Altered level of consciousness Seizures Fever with petechiae Transport Priority Urgent Non-urgent Transitional Phase Depends on seriousness of patient's condition Intended for the non-acutely ill patient Allows patient to become familiar with you and your equipment Focused History and Physical Exam History Nature of illness/injury Length of time ill or injured Presence of fever Effects of illness/injury on behavior Bowel/urine habits Presence of vomiting/diarrhea Frequency of urination Physical Exam Focused or Head-to-Toe Exam Pupils Capillary refill Hydration Pulse oximetry Glasgow Coma Scale Mild GCS 1315 Moderate GCS 912 Severe GCS less than or equal to 8 Glascow Coma Scale Modifications for Infants Vital Signs Pulse Respirations Blood pressure (children over 3 years of age) Children under 3 years of age...we use what finding? Wong-Borg FACES Pain Scale Taking the brachial pulse. Taking the femoral pulse. Pediatric Weights and Pound-Kilogram Conversion Table 2-5 If available, noninvasive monitoring, including pulse oximetry and temperature measurement, should be used in prehospital pediatric care. Kenneth Kerr Ongoing Assessment Reassess the patient since conditions can change rapidly. Reassess every 15 minutes in stable patients. Reassess every 5 minutes in unstable patients. General Management of Pediatric Patients Summary of BLS Maneuvers in Infants and Children Delivering abdominal thrusts (a) on a responsive child and (b) on an unresponsive child. Clearing an Infant's Airway
Procedure 21 Recognize and assess for choking. Look for breathing difficulty, ineffective cough, and lack of a strong cry. Give up to 5 back blows. Then administer 5 chest thrusts. If the infant becomes unresponsive, perform a tongue-jaw lift and look for a foreign body. Suctioning Decrease suction pressure to less than 100 mm/Hg in infants. Avoid excessive suctioning time--less than 15 seconds per attempt. Avoid stimulation of the vagus nerve. Check the pulse frequently. Pediatric-size suction catheters. Top: soft suction catheter. Bottom: rigid or hard suction catheter. Suction Catheter Sizes for Infants and Children Table 2-7 Oxygenation
Adequate oxygenation is the hallmark of pediatric patient management. To overcome a child's fear of the nonrebreather mask, try it on yourself or have the patient try it on before attempting to place it on the child. Equipment Guidelines According to Age and Weight Inserting an oropharyngeal airway in a child with the use of a tongue blade. a. In an adult, the airway is inserted with the tip pointing to the roof of the mouth, then rotated into position. b. In an infant or small child, the airway is inserted with the tip pointing toward the tongue and pharynx, in the same position it will be in after insertion. Ventilation
Avoid excessive bag pressure and volume. Obtain chest rise and fall. Allow time for exhalation. Flow-restricted, oxygen-powered devices are contraindicated. Do not use BVMs with pop-off valves. Apply cricoid pressure. Avoid hyperextension of the neck. In placing a mask on a child, it should fit on the bridge of the nose and cleft of the chin. In Sellick's maneuver, pressure is placed on the cricoid cartilage, compressing the esophagus, which reduces regurgitation and helps bring the vocal cords into view. ...
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- Spring '08