Pediatric Emergencies

1
44
Pediatric Emergencies
2
Advanced EMTEducation Standard

• Applies a fundamental knowledge of growth,
  development, aging, and assessment findings to
  provide basic emergency care and transportation
  for a patient with special needs.

3
Multimedia Directory

• Slide 26 Communicating with Toddlers Video
• Slide 36 Caring and Empathy Video
• Slide 93 SIDS Video

4
Objectives

1. Define key terms introduced in this chapter.
2. Discuss the leading reasons that pediatric
   patients require medical attention. 18-30
3. Explain the special considerations in dealing
   with the caregiver of a sick or injured child.
   36-37

5
Objectives

• Describe the major anatomic, physiological, and
  developmental characteristics of pediatric
  patients in each of the following age groups
  18-30
• Infant
• Toddler
• Preschooler
• School age
• Adolescent

6
Objectives

• Give examples of modifications of patient
  assessment and management techniques that
  increase the likelihood of cooperation by
  patients in each of the following age groups
  40-65
• Infant
• Toddler
• Preschooler
• School age
• Adolescent

7
Objectives

1. Given a description of vital signs for pediatric
   patients of various ages, classify the values as
   normal or abnormal. 57-60
2. Use the pediatric assessment triangle to
   determine a pediatric patients status. 39-42
3. Recognize signs of respiratory distress,
   respiratory failure, and respiratory arrest in
   pediatric patients. 74-76

8
Objectives

• Describe the presentation and assessment-based
  prehospital management of the following
  conditions 77-105
• Altered mental status
• Anaphylaxis
• Apparent life-threatening emergencies (ALTE)
• Asthma
• Bronchiolitis
• Cardiac arrest
• Complications of cystic fibrosis

9
Objectives

• Describe the presentation and assessment-based
  prehospital management of the following
  conditions 77-105
• Congenital heart disease
• Croup
• Drowning
• Epiglottitis
• Fever
• Gastrointestinal disorders
• Meningitis

10
Objectives

• Describe the presentation and assessment-based
  prehospital management of the following
  conditions 77-105
• Pneumonia
• Poisoning
• Seizures, including status epilepticus
• Shock
• Sudden infant death syndrome (SIDS)

11
Objectives

• Demonstrate emergency medical care techniques for
  pediatric patients including the following 43-52
• Airway management
• CPR
• Fluid resuscitation
• Management of partial and complete foreign body
  airway obstruction
• Medication administration
• Oxygen administration
• Ventilation

12
Objectives

1. Describe special considerations in the scene
   size-up in suspected SIDS. 92-95
2. Describe special considerations in assisting
   family members in suspected SIDS. 96-98
3. Describe the importance of the presence of
   parents during pediatric resuscitation. 95

13
Objectives

1. Integrate consideration of a pediatric patients
   size and anatomy into the assessment of mechanism
   of injury. 119-123
2. Demonstrate removal of a pediatric patient from a
   child car seat. 131
3. Demonstrate proper spinal immobilization of a
   pediatric patient. 130-132

14
Objectives

1. Explain the importance of injury prevention
   programs to reduce pediatric injuries and deaths.
   124
2. Recognize indications of child abuse and neglect.
   143-145
3. Explain special considerations in managing
   situations in which you suspect child abuse or
   neglect. 143-145

15
Objectives

1. Discuss ways in which you can manage the stress
   that can be associated with pediatric calls, both
   during and after the call. 16

16
Introduction

• Caring for critically ill or injured child can be
  stressful experience for EMS providers.
• Take into account differing epidemiology of
  illness and injury in children and anatomic,
  physiological, and psychosocial differences as
  you evaluate presenting problem.

17
Think About It

• What criteria should Vic and Marcel use to
  develop a general impression of the patients
  condition?
• What questions should they ask of the parents?
• How should they proceed with the assessment of an
  infant?

18
PediatricDevelopment Review

• Figure 44-1 Anatomic and physiologic
  considerations in infants and children.

19
PediatricDevelopment Review

• Infants
• 1 month of age to 1 year of age.
• Body systems immature.
• Liver large for size of abdomen.
• Abdominal wall thin.

20
PediatricDevelopment Review

• Infants
• Ribs pliable.
• Kidneys do not efficiently concentrate urine.
• Bones softer and less well formed.
• Skeletal muscle mass small.

21
PediatricDevelopment Review

• Infants
• Head disproportionately large neck weak.
• Greater surface-area-to-volume ratio increased
  heat loss from body.
• Prone to hypothermia must be kept warm.

22
PediatricDevelopment Review

• Infants
• Airway obstruction can occur very easily tongue
  takes up larger portion of oral cavity.
• Nose small and soft.
• Lungs fragile and easily damaged.

23
PediatricDevelopment Review

• Infants
• Respiratory failure/arrest occurs quickly.
• Water vapor lost with every breath leads to
  dehydration.
• Poor feeding, vomiting, diarrhea, fever can
  result in significant dehydration.

24
PediatricDevelopment Review

• Infants
• Immune system immature less able to fight
  infection.
• Fever in infants always concerning.
• Crying only way of communicating.

25
PediatricDevelopment Review

• Toddlers and Preschool Children
• Toddler child 1 to 3 years of age.
• Preschoolers child 3 to 6 years of age.
• Head still proportionally large.
• Airway small can be obstructed easily.
• Vulnerable to communicable diseases.
• Ear infections upper and lower respiratory tract
  infections common.

26
Communicating with Toddlers Video

• Click here to watch a video on the topic of
  communicating with toddlers.

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27
PediatricDevelopment Review

• Toddlers and Preschool Children
• Croup, bronchiolitis , pneumonia, epiglottitis
  can lead to respiratory distress.
• Strangers can provoke anxiety at this age.
• Establish rapport gain childs trust
  communicate in way he can understand.

28
PediatricDevelopment Review

• School-Age Children
• 6 through 12 years of age.
• Physical proportions more adult-like.
• Approval and acceptance important.
• Beginning to develop understanding of illness,
  loss, death, dying need adults assistance in
  coping with fears.
• Modesty and need for privacy.

29
PediatricDevelopment Review

• Adolescents
• 12 and 18 years of age.
• Vital signs approach adult values.
• Physical growth nearly complete in later years.

30
PediatricDevelopment Review

• Adolescents
• Children complete puberty.
• Not legally capable of making medical decisions.
• Brain has not yet developed adult judgment
  handles emotions differently.

31
PediatricDevelopment Review

• Adolescents
• Sense of invulnerability.
• Risky behaviors.
• Rates of depression and suicide increase.
• Assessment and management of anatomic and
  physiological aspects similar to adults.
• Keep in mind psychosocial differences.

32
Think About It

• Rapid growth and development make pediatric
  patients differ according to age and size
• Neonate
• Infant
• Toddler
• Preschool
• School-age
• Adolescent

33
General Assessment and Management of Pediatric
Patients

• Appropriate equipment differences between adults
  and pediatric patients.
• Principles of scene size-up remain the same.

34
Table 441 Equipment for Pediatric Prehospital
Care
35
General Assessment and Management of Pediatric
Patients

• Do not allow that you are responding for
  pediatric patient distract you.
• Anatomical differences alter patterns of trauma.

36
Caring and Empathy Video

• Click here to watch a video on the topic of
  caring and empathy.

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37
General Assessment and Management of Pediatric
Patients

• Scene Size-Up
• Take into account reactions and needs of parents
  or caregivers.
• Unless parent unable to cooperate, no reason to
  separate child from parents.
• Allow parents to participate as much as possible.
• Child abuse and neglect sometimes reason EMS
  needed.

38
Table 442 Indications of Child Abuse and Child
Neglect
39
General Assessment and Management of Pediatric
Patients

• Figure 44-2 Pediatric assessment triangle
  (PAT).

40
General Assessment and Management of Pediatric
Patients

• Scene Size-Up
• Potential abuse or neglect require law
  enforcement presence.
• When child abuse or neglect or sudden infant
  death syndrome (SIDS) suspected, there are
  observations you must make and document.
• General impression facilitated by use of
  pediatric assessment triangle (PAT).

41
General Assessment and Management of Pediatric
Patients

• Appearance
• Muscle tone
• Interactiveness
• Consolabilty
• Eye contact speech or crying

42
General Assessment and Management of Pediatric
Patients

• Work of breathing
• Abnormal airway noise
• Abnormal positioning
• Retractions nasal flaring
• Circulation to the skin

43
General Assessment and Management of Pediatric
Patients

• Primary Assessment
• If unresponsive and not breathing normally,
  confirm unresponsiveness check for pulse.
• Check infants pulse at brachial artery.
• Check carotid pulse of older child.
• If pulse not detected within 10 seconds, begin
  chest compressions according to American Heart
  Association (AHA) guidelines.

44
Table 443 Pediatric CPR
45
General Assessment and Management of Pediatric
Patients

• Primary Assessment
• Common cause of cardiac arrest in pediatric
  patients is hypoxia due to respiratory failure
  and respiratory arrest.
• AHA allows for EMS provider judgment in making
  ventilation higher priority during
  cardiopulmonary resuscitation (CPR).

46
General Assessment and Management of Pediatric
Patients

• Primary Assessment
• Follow your protocols.
• If patient responsive, or unresponsive but
  breathing, assess airway, breathing, circulation.

47
General Assessment and Management of Pediatric
Patients

• Figure 44-3 (A) Child supine, neck can flex.
  (B) Pad beneath shoulders maintains proper
  alignment of airway structures.

48
General Assessment and Management of Pediatric
Patients

• Primary Assessment
• Assess for partial or complete airway
  obstruction.
• Use padding under shoulders of smaller patients.
• Assess need for assisted ventilations.

49
General Assessment and Management of Pediatric
Patients

• Primary Assessment
• Be prepared to intervene quickly with any child
  who has signs of respiratory distress.
• If hypoxia evident or likely, provide
  supplemental oxygen.

50
General Assessment and Management of Pediatric
Patients

• Figure 44-5 Administering oxygen to infant
  using blow-by method.

51
General Assessment and Management of Pediatric
Patients

• Primary Assessment
• Face mask not appropriate for infants may not be
  tolerated by toddlers.
• Use blow-by oxygen.
• Childrens blood volume small shock can occur
  with little volume loss.

52
General Assessment and Management of Pediatric
Patients

• Primary Assessment
• Control hemorrhage high index of suspicion for
  internal bleeding based on MOI.
• Keep patient with blood loss warm.

53
General Assessment and Management of Pediatric
Patients

• What are the signs of shock (hypoperfusion) in an
  infant or child?

54
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• Younger pediatric patients inability to give
  chief complaint limited language skills to
  elaborate on chief complaint.
• Obtaining medical history may be difficult if
  parent not available on scene.
• Obtain SAMPLE history chief complaint using
  OPQRST to best of your ability.

55
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• Specific history questions to ask
• Displaying normal activity level?
• Recent fever or illness?
• Is there a rash?
• Volume of oral intake? Urinary output?

56
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• Specific history questions to ask
• Diarrhea or vomiting?
• Current or past medical problems?
• Birth complications? Premature?
• Up to date on vaccinations?

57
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• Level of responsiveness determined using AVPU
  method Pediatric Glasgow Coma Scale more precise
  assessment.

58
Table 444 Pediatric Glasgow Coma Scale
59
Table 444 (continued) Pediatric Glasgow Coma
Scale
60
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• Know normal values of pediatric vital signs.

61
Table 445 Normal Pediatric Vital Signs
62
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• Blood pressures difficult to obtain (lt 3 years
  old) and interpret.
• Capillary refill time indication of perfusion
  status in young children.
• Base physical exam on chief complaint.

63
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• Unusual lethargy, flat affect, lack of interest
  in surroundings.
• Unusual patterns of bruising injuries unusual in
  child unusual pattern or location.

64
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• Rashes and petechiae.
• Absence of tears can be sign of dehydration.
• Drainage or bleeding from ear.
• Signs of possible toxic ingestion.

65
General Assessment and Management of Pediatric
Patients

• Secondary Assessment
• In infant, fontanelles bulging or depressed.
• Distended abdomen.
• Child favors, protects, refuses to use an
  extremity.

66
General Assessment and Management of Pediatric
Patients

• Clinical Reasoning Process
• Be prepared to change general impression and
  patients priority for transport.
• Epidemiology of illnesses and injuries different
  in children than in adults.
• Pediatric population compensates well for
  illnesses and injuries short term.

67
General Assessment and Management of Pediatric
Patients

• Clinical Reasoning Process
• Energy stores limited can deteriorate with
  little warning.
• High index of suspicion for shock and impending
  respiratory failure based on MOI and nature of
  illness (NOI).
• Whenever possible, transport pediatric patients
  to facility with pediatric emergency department.

68
General Assessment and Management of Pediatric
Patients

• Treatment
• Always use equipment and supplies appropriate for
  pediatric patients.
• Use basic life-support measures for managing
  airway, breathing, circulation.

69
General Assessment and Management of Pediatric
Patients

• Treatment
• Consider using pediatric-size advanced airway
  laryngeal mask airway (LMA).
• Lower volume and higher rate of ventilations.

70
Table 446 Pediatric Bag-Valve-Mask Ventilation
71
General Assessment and Management of Pediatric
Patients

• Treatment
• If spinal immobilization required, place padding
  under body to avoid hyperflexion of cervical
  spine.
• Use cervical collars and splinting devices
  appropriate to childs size.
• If dehydrated, lost blood volume, or requires
  intravenous medications, start IV follow your
  protocols.

72
General Assessment and Management of Pediatric
Patients

• Reassessment
• Pediatric patients can deteriorate quickly,
  reassess frequently.
• Compare subsequent findings to baseline findings
  to identify trends.
• Monitor effects of any treatments initiated.

73
Think About It

• Assessment and management of pediatric patients
  requires the appropriate equipment, plus
  knowledge of differences between adults and
  pediatric patients.
• Otherwise, you will rely on many of the same
  principles of assessment and management you have
  already learned.

74
Pediatric Medical Emergencies

• Respiratory Emergencies
• Asthma infectious respiratory illnesses cystic
  fibrosis anaphylaxis.
• Pediatric patients can deteriorate rapidly from
  respiratory distress to respiratory failure to
  respiratory arrest.
• Quickly identify problem take measures to
  restore ventilation and oxygenation.

75
Pediatric Medical Emergencies

• Respiratory Emergencies
• May display grunting with expiration.
• Nasal flaring retraction above clavicles and
  between ribs may be prominent as well as belly
  breathing.
• As hypoxia develops, pediatric patients exhibit
  bradycardia.

76
Table 447 Indications of Pediatric Respiratory
Distress
77
Pediatric Medical Emergencies

• Respiratory Emergencies
• Immediate intervention in pediatric patient who
  appears lethargic, limp, or cyanotic.
• Pediatric asthma patients may exhibit dry cough
  indicates inflammation of lower airways.
• Begin oxygen administration humidified oxygen,
  if available.

78
Pediatric Medical Emergencies

• Respiratory Emergencies
• For patients in respiratory failure, immediately
  establish airway, assist with ventilations,
  provide supplemental oxygen.
• Intravenous fluids beneficial with asthma to
  reverse or prevent dehydration follow protocols.
• Be prepared to provide airway and start
  ventilations by bag-valve-mask device.

79
Pediatric Medical Emergencies

• Respiratory Emergencies
• Haemophilis influenza B (Hib) vaccination all but
  eradicated epiglottitis in this age group.
• If epiglottitis suspected, do not place anything
  in mouth do not agitate patient. Transport
  without delay.

80
Pediatric Medical Emergencies

• Respiratory Emergencies
• Laryngotracheobronchitis (croup) viral infection
  of lower airway worsens at night seal bark
  cough.
• Humidified oxygen preferred to prevent drying,
  irritation, further swelling of airway.

81
Pediatric Medical Emergencies

• Respiratory Emergencies
• Pertussis serious, sometimes fatal disease that
  causes coughing fits may last 10 or more weeks.
• Patients gasp for air following coughing fits
  whooping cough.
• DTaP vaccine not recommended until 2 months of
  age series of five vaccinations to confer
  immunity.

82
Pediatric Medical Emergencies

• Respiratory Emergencies
• Bronchiolitis acute viral lower airway disease
  children 2 months and to 2 years of age.
• Airway constriction expiratory wheezing,
  tachypnea, signs of respiratory distress.

83
Pediatric Medical Emergencies

• Respiratory Emergencies
• Respiratory syncytial virus (RSV) common cause.
• Assess significant dehydration consider fluid
  replacement if dehydration severe.

84
Pediatric Medical Emergencies

• Respiratory Emergencies
• Except in newborns, cough and fever common early
  signs of pediatric pneumonia.
• Tachypnea, respiratory distress, lethargy,
  irritability, vomiting.

85
Pediatric Medical Emergencies

• Respiratory Emergencies
• Assist ventilations if respiratory failure or
  arrest.
• Continuous positive airway pressure (CPAP), if
  permitted protocol, may be beneficial for
  patients in severe respiratory distress.

86
Pediatric Medical Emergencies

• Respiratory Emergencies
• Upper respiratory infections with rhinorrhea and
  cough common.
• Anaphylaxis respiratory emergency with signs of
  upper or lower airway obstruction (dyspnea,
  stridor, wheezing).

87
Pediatric Medical Emergencies

• Respiratory Emergencies
• Include questions about allergies exposure to
  allergens.
• Determine if child has epinephrine autoinjector
  and whether it has been used.

88
Pediatric Medical Emergencies

• Respiratory Emergencies
• Cystic fibrosis (CF) two defective genes, one
  inherited from each parent, results in production
  of extremely viscous mucus.
• In respiratory tract, thick secretions obstruct
  airways and lead to life-threatening infection.

89
Pediatric Medical Emergencies

• Respiratory Emergencies
• Do not withhold oxygen IV fluids may assist in
  hydrating mucus.
• CPAP useful for impending respiratory failure.

90
Pediatric Medical Emergencies

• Pediatric Cardiovascular Disorders
• Cardiac arrest usually due to hypoxia.
• Adolescents known to suffer cardiac arrest during
  strenuous activity.
• Cardiac arrest occurs from commotio cordis
  direct blow to chest at vulnerable point in
  cardiac cycle.
• For adolescents, early chest compressions with
  minimal interruption rapid defibrillation.

91
Pediatric Medical Emergencies

• Pediatric Cardiovascular Disorders
• Most pediatric cardiac problems due to congenital
  abnormalities.
• Uncorrected congenital heart defects can lead to
  poor perfusion and hypoxia.
• Treat patient for shock.

92
Pediatric Medical Emergencies

• Sudden Infant Death Syndrome (SIDS)
• SIDS sudden death of infant under 1 year of age
  that cannot be explained despite case
  investigation and autopsy diagnosis of
  exclusion.
• Apparent life-threatening event (ALTE)
  combination of apnea, color change, limpness,
  choking or gagging.
• MUST transport all infants with ALTE to emergency
  department for evaluation.

93
SIDS Video

• Click here to watch a video on the topic of
  sudden infant death syndrome.

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94
Pediatric Medical Emergencies

• Sudden Infant Death Syndrome
• In absence of signs of presumptive death, begin
  CPR in suspected SIDS patient transport with
  continuing resuscitative efforts.
• All cases of sudden, unexpected death fall under
  jurisdiction of medical examiner.
• If child not candidate for resuscitation, treat
  scene as potential crime scene.

95
Pediatric Medical Emergencies

• Sudden Infant Death Syndrome
• Contact law enforcement if not already on scene.
• Do not disturb body or move anything document
  observations about scene.
• Do not treat parents as if they are at fault in
  patients death.

96
Table 448 Documenting the Scene in Suspected
Sudden Infant Death Syndrome
97
Pediatric Medical Emergencies

• Sudden Infant Death Syndrome
• Do not misinterpret normal signs of death as
  signs of abuse.
• In cases of pediatric resuscitation, allow
  parents to be in attendance if possible.

98
Pediatric Medical Emergencies

• Sudden Infant Death Syndrome
• In all cases, parents require emotional support.
• Recognize signs of acute stress reaction in
  yourself and others who responded be prepared to
  seek assistance.

99
Pediatric Medical Emergencies

• Infectious Diseases
• Meningitis viral or bacterial inflammation and
  swelling of meninges that surround central
  nervous system.
• Viral meningitis less severe bacterial
  meningitis can be fatal.
• Viral meningitis fever, headache, photophobia,
  stiff neck.
• Bacterial meningitis seizures and altered mental
  status.

100
Pediatric Medical Emergencies

• Infectious Diseases
• Meningococcal bacteria can enter blood, causing
  damage to blood vessels with bleeding into organs
  and skin (purpura).
• Fever and chills, vomiting, diarrhea, joint,
  muscle, abdominal or chest pain, tachypnea, cold
  hands and feet.
• Meningococcemia can be fatal.

101
Pediatric Medical Emergencies

• Neurologic Disorders
• Child seizures
• Fever (common cause)
• Epilepsy
• Toxins
• Drugs

102
Pediatric Medical Emergencies

• Neurologic Disorders
• Child seizures
• Metabolic disturbances (check for hypoglycemia)
• Trauma
• Intracerebral hemorrhage
• Tumors

103
Pediatric Medical Emergencies

• Neurologic Disorders
• Febrile seizures related to rate fever
  increases short in duration with limited
  postictal state.
• Do not bundle febrile child in blankets do not
  allow child to become chilled.
• What does mnemonic AEIOU-TIPS stand for?

104
Pediatric Medical Emergencies

• Neurologic Disorders
• Hydrocephalus imbalance between formation and
  outflow or absorption of cerebrospinal fluid.
• Large head with bulging fontanelles and
  separation of cranial sutures.

105
Pediatric Medical Emergencies

• Neurologic Disorders
• Once fontanelles closed, increased intracranial
  pressure (ICP) can lead to headaches, changes in
  vision, cognitive difficulties, decreased
  responsiveness, respiratory arrest.
• Treated with ventriculostomy shunt.

106
Pediatric Medical Emergencies

• Diabetes
• In children, usually insulin-dependent diabetes
  mellitus (IDDM), Type II increasing.
• Death from complications of undiagnosed diabetes.
• Diabetic ketoacidosis (DKA)
• Cerebral edema from untreated or poorly treated
  diabetes
• Hypoglycemia

107
Pediatric Medical Emergencies

• Diabetes
• Signs and symptoms
• Altered mental status obtain blood glucose level
  in all patients with altered mental status.
• Severe, persistent diaper rash yeast organisms

108
Pediatric Medical Emergencies

• Diabetes
• Signs and symptoms
• Lethargy or malaise
• Weight loss
• Thirst
• Frequent urination

109
Pediatric Medical Emergencies

• Diabetes
• Look for severe dehydration, presence of ketone
  odor, Kussmauls respirations, vomiting,
  decreased level of responsiveness.
• Hypoglycemia patients being treated for
  diabetes occurs suddenly with irritability
  behavioral changes pale, cool skin seizures
  decreased level of responsiveness.

110
Pediatric Medical Emergencies

• What are the signs of dehydration for children?

111
Pediatric Medical Emergencies

• Gastrointestinal Disorders
• Gastroenteritis vomiting and diarrhea.
• Constipation common.
• Vomiting and diarrhea often due to viruses and
  foodborne illness.
• Abdominal pain appendicitis urinary tract
  infection DKA hernias bowel obstruction
  intussusception volvulus pyloric stenosis
  swallowed foreign bodies.

112
Pediatric Medical Emergencies

• Eye, Ear, Nose, and Throat Disorders
• Conjunctivitis, styes, chalazia.
• Orbital and periorbital cellulitis medical
  emergencies.
• Foreign bodies in eyes, ears, nose.
• Otitis externa, otitis media.
• Epistaxis common.
• Pharyngitis.

113
Pediatric Medical Emergencies

• Behavioral Emergencies
• Depression, mood disorders, substance abuse and
  addiction, anxiety disorders, eating disorders,
  impulse control disorders.
• Risk of suicide increases in adolescents.
• Your safety can be jeopardized by a child or
  adolescent with behavioral emergency, just as it
  can be by adult patient.

114
Pediatric Medical Emergencies

• Toxicologic Emergencies
• Curiosity
• Underdeveloped sense of taste
• Inability to recognize consequences of behavior
• Poor supervision
• Poor childproofing
• Drug and alcohol abuse
• Suicide attempts

115
Pediatric Medical Emergencies

• Toxicologic Emergencies
• Signs and symptoms depend on substance involved.
• Poisoning/overdose patients can deteriorate
  quickly.

116
Pediatric Medical Emergencies

• Toxicologic Emergencies
• Constant awareness of mental status, airway,
  breathing.
• Pediatric dosage of activated charcoal is 1
  gram/kg with minimum of 15 grams follow your
  protocols or advice of poison control or online
  medical direction. Adult dose is usually 2550 g.

117
Think About It

• Coronary artery disease progresses over many
  years, children not at high risk for acute
  coronary syndrome.
• Cardiac arrest usually due to hypoxia.
  Adolescents known to suffer cardiac arrest during
  strenuous activity. Many times, the patient is a
  well-conditioned athlete with no known medical
  problems.

118
Think About It

• Underlying problem sometimes traced to a cardiac
  conduction abnormality or left ventricular
  hypertrophy.
• Many high schools/colleges have public access
  defibrillation, particularly where sports are
  played.

119
Shock and Traumain Pediatric Patients

• Pediatric Mechanisms of Injury
• Most common MOI in pediatric patients due to
  blunt forces.
• In motor vehicle collisions (MVCs), high index of
  suspicion for multiple injuries (head and neck).
• Restrained pediatric occupants can suffer serious
  injury from airbag deployment and seatbelts.

120
Table 4410 National Trauma Triage Protocol
121
Table 4410 (continued) National Trauma Triage
Protocol
122
Table 4410 (continued) National Trauma Triage
Protocol
123
Shock and Traumain Pediatric Patients

• Pediatric Mechanisms of Injury
• Injuries of child struck by vehicle depend on
  speed of vehicle patients height in relation to
  vehicle.
• High-speed impact head, neck, multiple internal
  organ injuries.

124
Shock and Traumain Pediatric Patients

• Assessment and Management
• Three most common causes of pediatric trauma
  death following injury hypoxia, massive
  hemorrhage, traumatic brain injury.

125
Shock and Traumain Pediatric Patients

• Assessment and Management
• In pediatric patient with suspected
  cervical-spine trauma, maintain head in neutral
  position, placing folded towel or blanket under
  shoulders.
• If child does not have gag reflex, insert
  oropharyngeal airway.

126
Shock and Traumain Pediatric Patients

• Assessment and Management
• Prehospital endotracheal intubation in pediatric
  patients associated with worse outcomes.
• Traumatic brain injury, shock, chest trauma can
  result in need for assisted ventilations.

127
Shock and Traumain Pediatric Patients

• Assessment and Management
• Use supplemental oxygen adjust rate and depth
  according to patients size.
• Hyperventilation common mistake in trauma
  patients can worsen cerebral edema impair
  cardiac output.

128
Shock and Traumain Pediatric Patients

• Assessment and Management
• Control external hemorrhage high index of
  suspicion for internal bleeding.
• Keep patient warm.
• Monitor mental status, vital signs, signs of
  perfusion to detect emerging shock.

129
Shock and Traumain Pediatric Patients

• Assessment and Management
• Bradycardia and tachycardia are concerns.
• Capillary refill reliable sign of perfusion in
  pediatric patients.

130
Shock and Traumain Pediatric Patients

• Figure 44-7 Spinal immobilization of pediatric
  patient.

131
Shock and Traumain Pediatric Patients

• Considerations in Spinal Immobilization
• Car seat used to assist in manual stabilization
  of spine during extrication seat and child
  removed from vehicle as unit, then transfer child
  to immobilization device.

132
Shock and Traumain Pediatric Patients

• Considerations in Spinal Immobilization
• Padding may be required under shoulders to
  properly align cervical spine during
  immobilization.
• Childs smaller size increases need for padding
  along sides of body to prevent him from sliding
  from side to side on backboard.

133
Shock and Traumain Pediatric Patients

• Figure 44-8 Rule of Nines.

134
Shock and Traumain Pediatric Patients

• Burns
• Children have thin skin can be burned at much
  lower temperature, shorter duration of exposure
  to heat than adults.
• Many accidental childhood burns can be prevented.

135
Shock and Traumain Pediatric Patients

• Burns
• One in five burns in children result of child
  abuse or child neglect burn patterns should
  increase your suspicion.

136
Shock and Traumain Pediatric Patients

• Drowning
• Primary respiratory impairment resulting from
  submersion in liquid medium.
• Incidence higher in toddlers adolescent males.

137
Shock and Traumain Pediatric Patients

• Drowning
• Most toddler drownings occur in bathtubs and
  swimming pools.
• Risk-taking behavior and alcohol implicated in
  adolescent male group.
• Drowning asphyxia resulting in hypoxia and
  acidosis.

138
Shock and Traumain Pediatric Patients

• Drowning
• Most children who survive drowning rescued within
  2 minutes of submersion.
• Death occurs due to asphyxia, cardiac arrest,
  acute respiratory distress syndrome (ARDS),
  multiple organ dysfunction syndrome (MODS).

139
Shock and Traumain Pediatric Patients

• Drowning
• If patient still in water, perform rescue only if
  it is safe to do so.
• Await trained water rescue personnel.

140
Shock and Traumain Pediatric Patients

• Drowning
• Remove from water as quickly as possible.
• If unresponsive, begin chest compressions
  according to CPR guidelines for patients age.
• Do not delay removal from water for spinal
  immobilization.
• Transport all patients who have been submerged in
  water.

141
Shock and Traumain Pediatric Patients

• Drowning
• For patients in cardiac arrest, begin chest
  compressions immediately.
• Consider airway management, ventilation early.
• Follow your protocols regarding measures to treat
  hypothermia in drowning patients.

142
Shock and Traumain Pediatric Patients

• Figure 44-9 Indications of child abuse (C)
  death from multiple injuries, (D) stocking foot
  burns.

143
Shock and Traumain Pediatric Patients

• Child Abuse and Neglect
• Child abuse improper, intentional, or excessive
  action that causes injury or harm to child.
• Child neglect inadequate provision of attention
  or respect to person entitled to it.
• In many states, you are considered mandatory
  reporter of suspected child abuse or neglect.

144
Shock and Traumain Pediatric Patients

• Child Abuse and Neglect
• You are ethically obligated to report suspicions.
  
• Reporting depends on your protocols and laws in
  your jurisdiction.
• First priorities scene safety provide medical
  treatment for child.
• Carefully document all pertinent information.

145
Table 4411 Documenting Suspected Child Abuse
or Neglect
146
Think About It

• Has your thinking about the case study changed
  since the beginning of the chapter?

147
Chapter Summary

• Pediatric patients not only smaller, but have
  anatomic, physiological, psychosocial differences
  you must consider in assessment and management of
  emergencies.
• Epidemiology of injury and illness different in
  pediatric age group.

148
Chapter Summary

• Keys to successfully managing pediatric calls
• Knowledge of pediatric differences.
• Use of equipment designed for pediatric patients.
• Ability to maintain composure.

149
Chapter Summary

• Key differences in pediatric patients
• Airway and airway management techniques.
• Increased susceptibility to hypothermia and
  dehydration.
• Subtle signs and symptoms of shock despite
  significant blood loss.

150
Chapter Summary

• More vulnerable to effects of infectious illness
  can lead to airway obstruction or respiratory
  distress, respiratory failure, or respiratory
  arrest.
• Hypoxia leading cause of cardiac arrest in
  pediatric patients.

151
Chapter Summary

• SIDS and ALTE affect infant age group.
• Related signs can mimic indications of possible
  child abuse.
• Document scene carefully as potential crime scene
  without implying parents in any way at fault for
  situation.
• Recognize, document, report suspected child abuse
  and neglect.

152
Chapter Summary

• Pediatric patients can receive different patterns
  of trauma than adults subjected to same
  mechanisms because of anatomical differences.
• Blunt mechanisms most common in pediatric
  population likely to produce multisystem trauma.

153
Chapter Summary

• Whenever possible, transport critically ill or
  injured pediatric patients to facility capable of
  specialized pediatric care.