Pediatric Emergencies Lecture Guide PDF

#10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston PEDIATRIC EMERGENCIES Vulnerable Populations: younger à elder Leading cause of death: NOT O...

#10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston PEDIATRIC EMERGENCIES Vulnerable Populations: younger à elder Leading cause of death: NOT ON EXAM Children ages 1-4 years Accidents (unintentional injuries) Congenital malformations, deformations and chromosomal abnormalities Assault (homicide) Children ages 5-9 years Accidents (unintentional injuries) Cancer Congenital malformations, deformations and chromosomal abnormalities Children ages 10-14 years Accidents (unintentional injuries) Intentional self-harm (suicide) Cancer Most pediatric codes result from respiratory failure or shock. Pediatric nurses are certified in: - PALS (Pediatrics Advance Life Support) - PEARS (Pediatrics Emergency Assessment, Recognition, and Stabilization) PEDIATRIC EMERGENCY ASSESSMENT A – Airway – patency, position, audible sounds and obstructions - Ensure the airway is open and clear. Look for any obstructions and listen for abnormal sounds. Secure the airway if compromised. B – Breathing – monitor rate/pattern, O2 status, work of breathing and signs/symptoms of an effort breathing (nasal flaring, use of accessory muscles) - Assess the effectiveness of breathing. Check the rate, effort, and quality of respirations. Look for signs of distress such as retractions, nasal flaring, and cyanosis. Provide oxygen or ventilation support if needed. C – Circulation – skin color, temperature, cap refill, heart rate, strength of pulse (If these are not present start CPR) Pediatric Emergencies - 1 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston - Evaluate circulation by checking heart rate, blood pressure, capillary refill, and skin color. Look for signs of poor perfusion like pallor or mottling. Initiate IV access and fluid resuscitation if necessary. D – Disability (Neuro status) – level of consciences, level of activity, response to the environment, pupils, alter mental status. - Assess neurological status using the AVPU scale (Alert, Voice, Pain, Unresponsive) or Glasgow Coma Scale. Look for signs of altered mental status or seizures. E – Exposure / Environment – Fully expose the child to identify any injuries or signs of illness while maintaining body temperature. Look for rashes, wounds, or other abnormalities. *P – Pain – least important because pain means they’re still alive and breathing *Pediatric Assessment Triangle (PAT)*: rapid assessment tool to quickly evaluate the severity of illness or injury. Appearance, Work of Breathing, Circulation to Skin Common Medical Treatments Suctioning, Oxygen, Bag-Valve-Mask Ventilation, Intubation IV Fluids, Blood Products – improving circulation Cervical Stabilization – to prevent further damage Defibrillation – last resort in emergencies Medication Doses and Equipment Sizes Many pediatric acute care facilities prepare code reference sheets when a child is admitted. Ambulatory care providers often use the color coded Broselow tape to estimate the child’s weight based on the child’s Length. - Tool used to determine the dosage of the medication base on child length Emergency Labs & Diagnostics: ABG’s, Electrolyte and Glucose Levels, CBC, Blood Cultures, Urinalysis, Toxicology panels, Type & Cross, CT, MRI, XRays STABLE SECONDARY ASSESSMENT: Assessment – Inspect, Auscultate, Palpate, Percuss Pediatric Emergencies - 2 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston Interaction with caregivers – child perceive illness base off parents’ stress Establish what the child looks like at baseline when they arrive Full set of VS Give Comfort Measures: sucrose, pacifiers, pain meds, child life specialist Head to toe assessment Assess for child abuse RESPIRATORY EMERGENCIES Respiratory emergencies may lead to respiratory failure and eventually cardiopulmonary arrest in children. Respiratory insufficiency: increase work of breathing but adequate amount of gas exchange Respiratory failure: inability to maintain oxygenation of the blood Apnea Cessation of respirations for more than 20 seconds Can be associated with hypoxemia or bradycardia and can be central or obstructive. Respiratory arrest: Complete cessation of respirations Airway obstruction: Can be due to aspiration of a foreign body PEDIATRIC INTUBATION: rarely Nurses are an essential part of the intubation team helping to set up the equipment, prepare and administer intubation medications, assist with suctioning the oral secretions and preparing the tape to secure the endotracheal (ET) tube. Macintosh Blade: C-curve blade Curved blade. The most used blade, suitable for a wide range of patients. Advantages: Provides a good view of the glottis by indirectly lifting the epiglottis. It's particularly useful in adults and children. Miller Blade: L-straight blade Straight blade. Often used in pediatric patients or adults with a floppy epiglottis. Advantages: Directly lifts the epiglottis to visualize the vocal cords, which can be beneficial in certain anatomical situations. Intubation Medications: focus on atraumatic care - Premedicate before ET tube - Reducing pain and anxiety Pediatric Emergencies - 3 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston - Minimizing the effects of passing the ET tube down the airway - Preventing hypoxia Reducing intracranial pressure (ICP) - Preventing airway trauma and aspiration of stomach contents Other Pediatric Respiratory Emergencies: BRUE (Brief Resolved Unexplained Event) BRUE, or Brief Resolved Unexplained Event, is a brief episode in infants (under 1 year old) that is alarming/scares to the caregiver. The event involves one or more of the following: apnea (cessation of breathing), color change (usually cyanosis or pallor), marked change in muscle tone (hypertonia or hypotonia), or altered level of responsiveness. - The event resolves on its own, and the infant returns to baseline health. SIDS (Sudden Infant Death Syndrome) SIDS, or Sudden Infant Death Syndrome, is the sudden and unexplained death of an otherwise healthy infant, typically during sleep, and often occurring in the first year of life. Prevention: Educate parents on safe sleep practices, such as placing infants on their backs to sleep, using a firm sleep surface, keeping soft bedding and toys out of the crib, and avoiding overheating. PEDIATRIC SHOCK An inadequate delivery of blood to the cells Left untreated, shock is fatal! Must recognize and treat immediately A progressive process that can be either gradual or rapid in onset Pediatric Emergencies - 4 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston TYPES OF SHOCK: *Hypovolemic / Hemorrhagic : Associated with fluid or blood loss. Most common. - Occurs when the body begins to shut down due to heavy blood / fluid loss. o Causes: vomiting, diarrhea, excessive diuretics, heat stroke, burns, cuts, wounds, trauma o Leading cause of death in people with traumatic injuries *Septic Shock: Associated with being septic Severe infection causes dilation of blood vessels, pooling of blood in the vessels. Poisonous substances accumulate in bloodstream and blood pressure decreases, impairing blood flow to cells, tissues, and organs. As a result, the organs fail, causing a profound septic shock. Cardiogenic Shock: infective pump, structure heart disease, arrythmia Distributive Shock: result in the loss of stroke volume rate, often with neurogenic injury Anaphylactic Shock: allergic reaction that leads to widespread vasodilation, causes tachycardia, low blood pressure, not perfusing well, trouble breathing and face swelling/hives Nursing Management in Shock: Monitors ABCDEP, IV access, fluid volume restored and administer meds. Pediatric Emergencies - 5 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston CARDIAC ARRYTHMIAS AND ARRESTS Common Causes: Electrolyte abnormalities and Toxic Drug ingestions History of a serious primary congenital or acquired cardiac defect Potentially lethal arrhythmias, such as prolonged QT syndrome Hypertrophic cardiomyopathy Traumatic cardiac injury or a sharp blow to the chest Pediatric CPR: If a child is pulseless or has a heart rate less than 60 bpm, initiate cardiac compressions. AHA recommends using an AED for children less than 1 who have no pulse and suffered a sudden, witnessed collapse. Common Cardiac Code Meds: - Adenosine – anti-arrhythmic o Say it fast àPush it fast à Fast heart rate (heart monitor on and provider standing by) - Atropine o Say it slow à Slow heart rate - Epinephrine – vasopressor o Can use for bradycardia, anaphylaxis, or asthma Cardiac Rhythm Disturbances: - Slow: Bradyarrhythmia (100BPM) - Absent: Pulseless, Cardiovascular Collapse (V-tac, V-fib, Asystole, PEA) (immediate CPR and support measure) *Great charts in books! Pediatric Emergencies - 6 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston SUBMERSION INJURIES: 3rd leading causing of preventable death Due to lack of supervision Near drowning / Submersion injury – child survives longer than 24 hours after submersion, child submerges in water leading to respiratory impairment and potential death Drowning – submersion that results asphyxia and death within 24 hours, Primary respiratory impairment from being in or under a liquid o Aspirate water à Poor oxygenation, with retention of carbon dioxide à Alveolar surfactant is depleted, and Pulmonary edema occurs à Hypoxemia results in increased capillary permeability and resultant hypovolemia. o Small amount of aspirated water can lead to pulmonary edema *ABCDE!!! Emergency Assessment: PREVENTION is key : Supervision around water, life jackets, swimming lesson INGESTIONS & POISONING: Ingestion of or contact with a harmful substance that can produce toxic effects – most occur in home with oral ingestion being most common. Ex: medications, household chemicals, plansts, food, alcohol, drugs *Children at high risk*: they’re curious and get into everything (2 years old) Adolescents are at high risk: more intentional, alcohol, drugs Prevention is key: Educate, childproofing. Symptoms – N/V, abdominal pain, lethargy, confused, seziures, and respiratory distress. Evaluation – History and Physical Exam, lab tests in cases of known or suspected ingestion Substance ingested and Amount ingested Approximate time of ingestion Change in child’s condition, Treatment administered at home CALL POISON CONTROL! (1-800-222-1222) Management – ABC’s and stabilize, Oxygen, intubation may be necessary Remove dermal and ocular toxins (Eye wash station) Dilute the ingested toxin if acid or alkali with water or milk Gastric lavage (stomach pumping or gastric irrigation) is the process of cleaning out the contents of the stomach. Normally used on a person who has ingested a poison or overdosed on a drug such as alcohol. Activated charcoal – binds to toxin and passes thru GI system Pediatric Emergencies - 7 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston Cathartics – Increase Gastric Motility Antidotes, treatment Know the reversals COMMON POISONOUS SUBSTANCES: Acetaminophen (LIVER DAMAGE!!) Salicylates Corrosives, Hydrocarbons, Lead, Carbon Monoxide, Iron… (Deferoxamine) INJURIES & TRAUMA: Leading cause of death in children and adolescents in unintentional injuries. ABCDE Assessment CLOSED INJURIES: Soft tissues beneath the skin are damaged, but the skin is not broken Contusion: Epidermis is intact, the cells of the dermis are damaged (bruise) Hematoma: Collection of blood beneath the skin, lump with bluish discoloration Crush Injuries: Underlying layers of skin sustain severe damage, can cause few if any external signs, may result in shock, with a sudden blow or blunt trauma Clamping injuries: Can cause severe damage to tissues, nerves, and blood vessels. o Ex. a ring stuck in finger o Want to assess for signs of compromised circulation, remove object as quick as possible and elevate it. Abdominal Injuries (closed): Assess for signs of abdominal pain, bruising, distension, and guarding. Remain NPO, manage pain. OPEN INJURIES: Skin is broken, and the victim is susceptible to external bleeding and wound contamination. Abrasion: A superficial wound caused by rubbing, scraping, or shearing. o (Infection risk) Laceration: A break in the skin; lacerations can have either smooth or rough edges and can be of varying depth (regular or irregular) o (Can cause significant bleeding if blood vessels are cut) Avulsion: The tearing loose of a flap of skin, which may either remain hanging or be torn off altogether. o (Circulation is compromised, worried most about scar) Penetrating and Puncture Wounds: Caused by the penetration of a sharp object through the skin and underlying structures. o (Damage to deep tissue or other organs around) Pediatric Emergencies - 8 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston Impaled Objects: Do not remove the object unless present in an ED or OR, as it may be tamponading bleeding and its removal could worsen hemorrhage. Stabilize to prevent movement and Surround with bulky dressings. o (Object blocks bleeding while inserted, if take out can cause bleeding out) Amputations: limbs torn away from body, blood vessels tend to spasm and retreat into surrounding tissues. o Preserve amputated part for potential reattachment: rinse it, elevate it, wrap up and then on top of ice. Animal Bites: Dog bites! Complications include infection, cellulitis Sometimes human bite too, hard to manage due to number of bacteria in the mouth! o Cat bites is more and easier infected OTHER: Spinal Cord injuries: Do not move the patient. Immobilize the neck and secure the head! Head injuries: Watch for increased ICP = Bleed or swelling, Baseline GCS BLEEDING: Common caused – trauma, falls, accidents, sports injury When you bleed, the body makes more RBC’s, fluid is taken from cells into the bloodstream, platelets collect at the wound site, WBC’s collect at site of infection. The severity of bleeding depends on numerous factors. - Age, weight - Duration - Flow - Internal / external bleeding Initial first aid steps in the bleeding victim: *INFECTION CONTROL*: Protect Yourself! Place a barrier between you and the victim’s blood. GLOVES*!!! Stop the Bleeding: Stay Calm and Reassure the Child & Family Assess the Situation: severity and duration Apply Direct Pressure: flat of our hand and apply direct pressure Elevate the Affected Limb: to reduce blood from area that’s bleeding to prevent further bleeds Apply a Pressure Bandage: to hold and stop the bleeding Tourniquets – typically last resort, use in emergencies situation and it causes to loose circulation to stop bleeding. Internal Bleeding in Pediatric Patients Internal bleeding in pediatric patients can result from trauma, blunt injury, fractures, or injury to vital organs like the spleen, liver, and kidneys. Pediatric Emergencies - 9 of 10 PEDIATRIC EMERGENCIES – Lecture Guide NURS471 – Pediatrics CoursePoint 45, 51; ATI 41-43 Dr. Rebecca N. Weston Internal Bleeding Signs and Symptoms: Being able to recognize what’s going on and symptoms may day dyas à months to pop up S/S: Bleeding from the nose, ears, or rectum Coughing or vomiting blood Rigid abdomen, blood in urine with pelvic fractures Changes in level of consciousness Restlessness and anxious, cool, clammy skin Weak, rapid pulse, rapid breathing First Aid Care for Internal Bleeding: Secure and Maintain an Open Airway: Check for Fractures and Splint if Appropriate: Keep the Patient Quiet and Calm: Position for Shock and Provide Comfort: Supine position is used to direct blood to vital organs. Monitor Vital Signs: Q5 minutes until emergency personnel arrive. Handle Vomiting Appropriately: log roll them to reposition for shock Call for Emergency Medical Services (EMS): Advanced interventions: intravenous fluids, blood transfusions, or surgery Blood Administration: Blood products are transferred into a child's bloodstream to replace lost components, treat anemia, or manage other medical conditions Potential complications: - Allergic reaction (hives, itching, or anaphylaxis) - Fever (mild à severe) - Hemolytic reaction: incompatibility causing RBC destruction - Infection - Fluid overload Pediatric Emergencies - 10 of 10