Pediatric Emergency Care (PDF)

Your dispatcher called you to take care of patients after motor vehicle collision, you find a child of 6 years of age, she seems in stress and fear, as a paramedic what you will do to help that child? Slide 1 Chapt...

Your dispatcher called you to take care of patients after motor vehicle collision, you find a child of 6 years of age, she seems in stress and fear, as a paramedic what you will do to help that child? Slide 1 Chapter 31 Infant and Child Emergency Care Slide 2 Overview  Developmental Differences in Infants and Children  Newborns and Infants  Toddlers  Preschool Children  School-Age Children  Adolescents Slide 3 Overview  The Airway  Anatomic and Physiologic Concerns  Opening the Airway  Suctioning  Using Airway Adjuncts  Oxygen Therapy  Blow-by Oxygen  Nonrebreather Masks  Artificial Ventilations  Assessment Slide 4 Overview  Common Problems in Infants and Children  Airway Obstruction  Respiratory Emergencies  Seizures  Altered Mental Status  Poisoning  Fever  Shock  Near Drowning  Sudden Infant Death Syndrome Slide 5 Overview  Trauma  Head Injury  Chest Injury  Abdominal Injury  Burns  Other Trauma Considerations  Child Abuse and Neglect  Signs and Symptoms of Child Abuse and Neglect  Emergency Care for Abused and Neglected Patients Slide 6 Overview  Infants and Children with Special Needs  Tracheostomy Tube  Home Mechanical Ventilators  Central Lines  Gastrostomy Tubes and Gastric Feeding  Shunts  Reactions to Ill and Injured Infants and Children  The Family’s Reaction  The Emergency Medical Technician’s Reaction Slide 7 Developmental Differences in Infants and Children  Newborns and infants  Birth to 1 year of age  Minimal stranger anxiety  Do not like to be separated from parents  Do not want to be suffocated by an oxygen mask  Need to be kept warm  Breathing rate best obtained at a distance  Examine heart and lungs first, head last Slide 8 Developmental Differences in Infants and Children  Toddlers  1 to 3 years of age  Do not like to be touched  Do not like being separated from parents  Do not like having clothing removed  Do not want to be suffocated by an oxygen mask  Assure child that he was not bad. Children think their illness/injury is punishment  Afraid of needles  Fear of pain  Should be examined trunk-to- head approach Slide 9 Developmental Differences in Infants and Children  Preschool children  3 to 6 years of age  Do not like to be touched  Do not like being separated from parents  Do not like having clothing removed. Remove, exam, replace  Do not want to be suffocated by an oxygen mask  Assure child that he was not bad. Children think that the illness/injury is a punishment  Afraid of blood  Fear of pain  Fear of permanent injury  Modest Slide 10 Developmental Differences in Infants and Children  School-age children  6 to 12 years of age  Afraid of blood  Fear of pain  Fear of permanent injury  Modest  Fear of disfigurement Slide 11 Developmental Differences in Infants and Children  Adolescents  12 to 18 years of age  Fear of permanent injury  Modest  Fear of disfigurement  Treat them as adults  These patients may desire to be assessed privately, away from parents or guardians Slide 12 The Airway  Anatomic and physiologic concerns  Small airways throughout the respiratory system are easily blocked by secretions and airway swelling  Tongue is large relative to small mandible and can block airway in an unresponsive infant or child  Positioning the airway is different in infants and children, do not hyperextend the neck Slide 13 The Airway  Anatomic and physiologic considerations  Infants are obligate nose breathers  Suctioning a secretion-filled nasopharynx can improve breathing problems in an infant  Children can compensate well for short periods of time  Compensate by increasing breathing rate and increased effort of breathing  Compensation is followed rapidly by decompensation due to rapid respiratory muscle fatigue and general fatigue of the infant Slide 14 The Airway  Opening the airway  Position to open airway is different—head-tilt chin- lift; do not hyperextend  Jaw thrust with spinal immobilization Slide 15 The Airway  Suctioning  Sizing  Depth  Technique Slide 16 The Airway  Using airway adjuncts  Oropharyngeal airway  Adjunct, not for initial artificial ventilation  Should not have a gag reflex  Sizing Slide 17 The Airway  Using airway adjuncts  Technique for insertion  Use tongue depressor  Insert tongue blade to the base of tongue  Push down against the tongue while lifting upward  Insert oropharyngeal airway directly in without rotation Slide 18 The Airway  Using airway adjuncts  Nasopharyngeal airways  Adjunct, not for initial artificial ventilation  Sizing Slide 19 The Airway  Using airway adjuncts  Technique for insertion  Should not be used in cases of head trauma Slide 20 Oxygen Therapy  Blow-by oxygen  Hold tubing 2 from face  Insert tubing into a paper cup  Parents may assist  Nonrebreather masks  Preferred method for delivery  Use correct size mask Slide 21 Artificial Ventilation  Pop-off valves  Mask sizing/bag sizing  Trauma considerations  Mask seal  Two hand  One hand Slide 22 Artificial Ventilation  Mouth-to-mask artificial ventilations Slide 23 Artificial Ventilation  Use of bag-valve-mask  Squeeze bag slowly and evenly enough to make chest rise adequately  Rates for child and infant are 20 breaths/minute  Provide oxygen at 100% concentration by using an oxygen reservoir Slide 24 Assessment  General impression of well versus sick child can be obtained from overall appearance  Assess mental status  Effort of breathing  Color  Quality of cry/speech  Interaction with environment and parents  Emotional state  Response to the EMT-Basic  Tone/body position Slide 25 toys 26 Assessment  Approach to evaluation  Begin from across the room  Mechanism of injury  Assessment of surroundings  General impression of well versus sick  Respiratory assessment  Note chest expansion/symmetry  Effort of breathing  Nasal flaring  Stridor, crowing, or noisy  Retractions  Grunting  Respiratory rate  Perfusion assessment—skin color Slide 27 Assessment  Hands-on approach to infant or child patient assessment  Assess breath sounds  Present  Absent  Stridor  Wheezing Slide 28 Assessment  Hands-on approach  Assess circulation  Assess brachial or femoral pulse  Assess peripheral pulses  Assess capillary refill  Assess blood pressure in children older than 3 years; use appropriate size cuff  Assess skin color, temperature, and moisture Slide 29 Assessment  Hands-on approach to infant or child patient assessment  Detailed physical exam—begin with a trunk-to-head approach  Situation- and age-dependent  Should help reduce the infant’s or child’s anxiety Slide 30 Common Problems in Infants and Children Slide 31 Airway Obstruction  Small removable parts can easily obstruct the infant’s or child’s airway Slide 32 Airway Obstruction  Partial obstruction  Infant or child who is alert and sitting  Stridor, crowing, or noisy  Retractions on inspiration  Pink  Good peripheral perfusion  Still alert, not unresponsive Slide 33 Airway Obstruction  Partial obstruction  Emergency care  Allow position of comfort, assist younger child to sit up; do not lay down. May sit on parent’s lap  Offer oxygen  Transport  Do not agitate child  Limited exam. Do not assess blood pressure Slide 34 Airway Obstruction  Complete obstruction  Altered mental status or cyanosis and partial obstruction  No crying or speaking and cyanosis  Child’s cough becomes ineffective  Increased respiratory difficulty accompanied by stridor  Victim loses responsiveness  Altered mental status Slide 35 Airway Obstruction  Complete obstruction  Emergency care—responsive patient Slide 36 Airway Obstruction  Complete obstruction  Emergency care—unresponsive patient Slide 37 Respiratory Emergencies  Recognize the difference between upper airway obstruction and lower airway disease  Upper airway obstruction—stridor on inspiration  Lower airway disease  Wheezing and breathing effort on exhalation  Rapid breathing (tachypnea) without stridor Slide 38 Respiratory Emergencies  Complete airway obstruction  No crying  No speaking  Cyanosis is present  No coughing Slide 39 Respiratory Emergencies  Respiratory distress  Nasal flaring  Retractions  Stridor  Audible wheezing  Grunting Slide 40 Respiratory Emergencies  Respiratory failure  Respiratory rate >60/min  Cyanosis  Decreased muscle tone  Severe use of accessory muscles  Poor peripheral perfusion  Altered mental status  Grunting Slide 41 Respiratory Emergencies  Respiratory arrest  Breathing rate