Untitled Quiz

Child Emergency Care Overview

• Paramedics are called to the scene of a motor vehicle collision to care for a 6-year-old child in distress.
• The child appears stressed and fearful, requiring immediate paramedic intervention.

Developmental Differences

• Newborns and Infants (Birth-1 year): Show minimal stranger anxiety but dislike separation from parents. They do not like being suffocated by an oxygen mask and require warmth. Assessment should begin with heart and lungs, followed by the head.
• Toddlers (1-3 years): Dislike being touched and dislike separation from parents. They object to having their clothes removed or being suffocated by an oxygen mask. May perceive illness/injury as punishment. Fear of needles, pain, and should be examined from the trunk downwards.
• Preschool Children (3-6 years): Do not like being touched, dislike separation from parents, and object to having clothing removed. May be scared of blood, pain, permanent injury, or may be modest. They perceive illness or injury as punishment. Assessment should be conducted from the trunk downward.
• School-Age Children (6-12 years): Afraid of blood, pain, permanent injury, are modest, and fear disfigurement.
• Adolescents (12-18 years): Fear permanent injury, disfigurement, and may want a private assessment, separate from parents or guardians.

Airway Management

• Anatomic and Physiologic Concerns: Small airways in children easily block due to swelling and secretions, and the tongue can block the airway in an unresponsive infant or child.
• Opening the Airway: Airway positioning differs in infants and children; do not hyperextend the neck.
• Suctioning: Emphasizes sizing, depth, and technique of suctioning.
• Using Airway Adjuncts: Oropharyngeal and nasopharyngeal airways are used as adjuncts; do not use for initial artificial ventilation They should not have a gag reflex. Correct sizing is critical.
  • Technique for insertion: Use a tongue depressor, insert the blade at the base of the tongue; push down on the tongue while lifting the airway upwards. Insert the airway directly, without rotation.
• Oxygen Therapy: Blow-by oxygen, nonrebreather masks are preferred; ensure correct size mask.
• Artificial Ventilation: Pop-off valves, mask sizing, trauma considerations, mask seal; two or one-hand techniques, Mouth-to-mask artificial ventilation, use of bag-valve masks (squeeze slowly and evenly for appropriate chest rise, Rates for children/infants are 20 breaths/minute), Provide 100% oxygen concentration with an oxygen reservoir.
• Assessment: Note overall well-being versus sickness, mental status, effort of breathing, color, quality of cry/speech, interaction with environment and parents, emotional state, response to assessment, tone/body position, breath sounds (present, absent, stridor, wheezing), circulation (brachial or femoral pulses, peripheral pulses, capillary refill, blood pressure if older than 3), approach to assessment (trunk-to-head for infants and children to reduce anxiety).

Common Problems

• Airway Obstruction: Small removable objects can block the airway.
  • Partial obstruction: Infant or child alert and sitting, stridor, crowing, noisy, retractions on inspiration, pink, good peripheral perfusion, still alert but not unresponsive. Emergency care: Allow position of comfort, assist positioning when appropriate; do not lay the child down. May sit on parent's lap; offer oxygen; transport; do not agitate, limited exam. Avoid taking blood pressure.
  • Complete obstruction: Altered mental status or cyanosis (and partial obstruction), no cry or speech, child's cough ineffective, respiratory difficulty, accompanied by stridor, loss of responsiveness, altered mental status. Emergency care: Emergency care- responsive patient, emergency care- unresponsive patient.
• Respiratory Emergencies: Distinguishing upper airway obstruction (stridor on inspiration) from lower airway disease (wheezing, rapid breathing -tachypnea). Complete airway obstruction: no cry, no speaking, cyanosis, no coughing. Respiratory distress: Nasal flaring, retractions, stridor, audible wheezing, grunting, Respiratory failure: Respiratory rate >60/min, decreased muscle tone, severe use of accessory muscles, poor peripheral perfusion, altered mental status, grunting; Respiratory arrest: Breathing rate <10/min, limp muscle tone, unresponsive, slower/absent heart rate, weak or absent distal pulses.
  • Emergency care to each type is described in the slides.
• Seizures: Chronic seizures are rarely life-threatening; febrile seizures should be considered life-threatening. May be brief or prolonged. Assess for injuries, potential cause: fever, infection, poisoning, hypoglycemia, trauma, or low oxygen levels, and or possible idiopathic causes. Focused assessment: Has the child had prior seizures? Is this a normal seizure pattern? Has the child taken antiseizure medications?
  • Emergency care should include ensuring a patent airway, positioning on the side if no cervical spine trauma, having suction readily available, providing oxygen/ventilation as needed, and transport.
• Altered Mental Status: Caused by hypoglycemia, poisoning, post-seizure, infection, head trauma, decreased oxygen levels, hypoperfusion (shock). Emergency Care includes ensuring airway patency, preparing to ventilate/suction , and transport.
• Poisoning: A common reason for infant/child ambulance calls. Identify the suspected poison through detailed history, bring container to receiving facility.
  • Emergency Care for responsive patients includes contacting medical control, considering activated charcoal administration, providing oxygen, and transport.
• Fever: Common reason for infant/child ambulance calls. Many causes, but meningitis is a severe cause. Fever with a rash is a serious concern. Emergency Care includes administering oxygen, transport, and vigilance for potential seizures.
• Shock: Not a primary cardiac event; but may be caused by Diarrhea and dehydration, trauma, vomiting, blood loss, and infection. Less common causes include allergic reactions, poisoning, and cardiac issues. Signs and symptoms include: Rapid respiratory rate, pale, cool, and clammy skin, weak or absent peripheral pulses, delayed capillary refill, decreased urine output. Emergency care includes ensuring airway/oxygen, being prepared for possible ventilation, managing bleeding, elevating legs, keeping the child warm, and transport.
• Near Drowning: Artificial ventilation is the top priority. Trauma, Hypothermia, and ingestion (especially alcohol) should be considered. Emergency care includes protecting the airway, suctioning if necessary, awareness for secondary drowning syndrome, transport to hospital.
• Sudden Infant Death Syndrome (SIDS): Unexpected death of infants in the first year of life; causes unknown. Emergency care includes resuscitation attempts unless rigor mortis is noted; avoiding judgmental or blame-oriented comments to the distraught parents.
• Trauma: Injuries are the leading cause of death in infants and children. Blunt injuries are most common, often presenting differently than in adults. Causes of trauma include: Motor vehicle crashes (un-restrained passengers with head/neck injuries, restrained passengers with abdominal/spine injuries), bicycle accidents, pedestrian accidents, falls, burns, and/or sports injuries. Child abuse is also a trauma consideration. Emergency care for head injuries: Maintaining an open and patent airway (modified jaw thrust), immobilizing the spine, avoiding the use of sandbags to stabilize the head, being alert for vomiting and having suction ready. Chest injuries: Ensuring adequate oxygenation; immobilizing and transporting.. Abdominal injuries: more common in children, often hidden; consider trauma in patients deteriorating without external indicators, air in stomach can interfere with respiration. Burns require assessment of criticality and transport to an appropriate facility.
• Infants and Children with Special Needs: Includes premature babies, those with lung disease, heart disease, neurologic disease, and chronic diseases. Often these children are technologically dependent. Emergency Care for special needs includes managing airways, using suction when available, maintaining comfort and providing any needed transport/care.

Summary

• Infants and Children with Special Needs: Tracheostomy tube, home mechanical ventilators, central lines, gastrostomy tubes and gastric feeding, shunts, reactions to ill/injured children, family's reaction, EMT's reaction. Specific instructions for emergency care, with suggestions for device use and types of care.