Paramedic Science: Paediatrics Quiz

Paramedic Science: Health & Human Development 2 - Paediatrics

• Subject: Paramedic Science, Health & Human Development 2, Paediatrics
• Course institution: University of the West of Scotland (UWS)

Anatomical and Physiological Differences

• Children have proportionately larger heads and a larger occiput (the back of the head) compared to adults.
• Infants are obligate nose breathers.
• The larynx is more superior and anterior in children.
• The epiglottis is more cephalic (toward the head), elongated, and flexible in children.
• Mucous membranes are loosely attached in children.
• Cricoid cartilage is the narrowest part of the airway in children.
• Infants and young children rely more on the diaphragm for breathing.
• Infants have a smaller blood volume (approximately 80ml/kg in a 3kg newborn).
• Infants have lower blood pressure and a faster heart rate.
• Infants' larger body surface area to mass ratio increases heat loss.
• Family members may be anxious.
• History of illness may be difficult to establish.
• Children have limited communication skills, making it difficult for them to express pain, symptoms, or anxiety.

Airway

• Larynx is higher and anterior in children.
• Epiglottis is more cephalad, elongated and floppy in children.
• Shape of trachea: Cylindrical in adults, funnel shape in children, and narrowest in the cricoid cartilage.
• Infants and young children use the diaphragm more to breathe than adults.

Breathing

• Children have fewer alveoli in their lungs.
• Intercostal muscles are weaker in children.
• Children use the diaphragm more.
• Children have a higher metabolic rate and higher oxygen consumption.
• Children have a faster respiratory rate.

Circulation

• Infant blood volume is approximately 240ml in a 3kg newborn so even small fluid loss is significant.
• Children have lower blood pressure and a faster heart rate.

Disability

• Children have limited communication skills and may have difficulty expressing pain, symptoms, & anxiety.

Exposure/Environment

• Infants have a higher surface area to mass ratio, increasing heat loss.
• Family members may be anxious.
• It may be difficult to obtain a good history of illness in young children.

Assessment Tools

• Paediatric Assessment Triangle (PAT)
  • Appearance
    • Tone, movement,floppy/listless
    • Interactivity, engagement, reactions
    • Consolability, comfort by parent/carer
    • Gaze, eye contact, 'glassy eyed' behaviour
    • Speech/cry, normal, strong, muffled, weak
  • Work of Breathing
    • Abnormal airway sounds (stridor, grunting, wheezing)
    • Abnormal positioning (upright, sniffing position, tripod)
    • Recession/head bobbing, nasal flaring
  • Circulation
    • Skin colour/temperature
    • Pulse rate/rhythm/depth
    • Heart rate/rhythm
    • Capillary refill (centrally & peripherally)
  • Disability
    • Level of consciousness (AVPU & modified GCS for children < 4), Blood Glucose, Interaction with parent/carer, Pupil response, Posture and tone
• Expose/Examine/Environment - Temperature - Rashes? - Bruising/Injuries?
  • Child Protection Concerns?
• NICE 'Traffic Lights' Clinical Assessment Tool.
• Early recognition and management of respiratory and/or circulatory failure to prevent the majority of paediatric cardiac arrests.

Recognizing Respiratory Distress and Failure

• Assess pallor, cyanosis, and mottling in circulation.

Airway (Further Details)

• Is the airway patent?
• Is positional opening required?
• Is suction required? If suction is needed, keep suction pressure less than 200 mmHg in adults and 80-120 mmHg in neonates.
• Are there any abnormal sounds?
• Minimize anxiety in a conscious child.

Breathing (Further Details)

• Respiratory rate? Adequate? Support with BVM required?
• Any chest movement, recession, or tracheal tug?
• Head bobbing or seesaw breathing?
• Auscultate (listen to the lungs)
• Any air entry?
• Any inspiratory/expiratory noises?
• Oxygen administration
• SPO2

Circulation (Further Details)

• Skin color/temperature
• Pulse rate/rhythm/depth
• Heart rate/rhythm
• Capillary refill time, centrally and peripherally
• Blood pressure
• Urine output?
• Fluid loss, haemorrhage? 80ml/kg normal volume. 20% TBL volume considered cat bleed.

Disability (Further Details)

• Level of Consciousness (AVPU & modified GCS for children < 4)
• Blood Glucose
• Interaction with parent/carer
• Pupil response
• Posture and tone

Sick Child Recognition & Management

• Specific scenarios related to sick children, including history and examination findings are described in detail.
• Differentials are presented including viral infection, meningococcal septicaemia, croup, foreign body airway obstruction, epliglottis, and anaphylaxis.
• Treatment pathways for each potential diagnosis are outlined, including the use of the JRCALC guidelines.

Paediatric Trauma

• Children's height, position, and nature of impact result in different injuries that are more severe.
• Children are smaller target areas compared to adults.
• Children have less body fat, more elastic tissue, and a more flexible skeleton and are more susceptible to organ damage.
• Consider the physiological and anatomical differences when managing paediatric trauma.

SUDI

• Unexpected death in infancy, children and adolescents - follow guidelines.

URTI

• Common reasons for paediatric presentation include tonsillitis/pharyngitis/sore throat (1 week), otitis media (4 days), acute rhinosinusitis (2.5 weeks), acute cough/bronchitis (3 weeks).

Epiglottitis

• Rare, severe and rapidly progressing infection of the epiglottis and surrounding tissue.
• Usually bacterial, e.g. Streptococcus group A and C
• Most common in children 1-6 years of age.
• Leads to total airway obstruction.
• High mortality rate (8%).

Statistics

• 700 children die in England and Wales each year. 50% of deaths involve inappropriate restraint and ejection in RTC's. 30% die at home from falls and burns.