Chapter 35 (Block 3)

how to make a pediatric patient feel more calm when treating them

caring for the parents as well—> remaining calm, efficient, professional, and sensitive

what age range do many physical and emotional changes occur during childhood

birth to 18

stages of thoughts and behaviors

1. infancy

2. toddler

3. preschool-age

4. school-age

5. adolescent

how old are infants

first year of life

how old are preschoolers

3-6 years old

how old are toddlers

1-3 years old

how old are school-age children

6-12 years old

how old are adolescents

12-18 years old

• spends most time sleeping and eating

• respond mainly to physical stimuli

• cannot tell the difference between parents and strangers

• crying is one of the main does of expression

• predisposed to hypothermia

0-2 months

what does an inconsolable infant signify in 0-2 months

significant illness

• more active at this stage

• may follow objects with eyes

2-6 months

what is a sign of serious illness, depressed mental status, or delay in development in age 2-6 months

persistent crying, irritability, or lack of eye contact

• become mobile, which predisposes them to physical danger

• place things in their mouth leading to choking or poisoning

• may cry if separated from their parents or caregivers

6-12 months

what could be a symptom of serious illness 6-12 months

persistent crying or irritability

how to access infant

• observe from distance

• have caregiver hold baby during physical assessment

• provide sensory comfort like warm hands

• do painful procedures at end of assessment

growth and development changes in infancy until 3 years

rapid changes

• explores by nature and not afraid

• lack molars and may not be able to chew food fully increasing risk of choking

12-18 months

assessment for 12-18 months and where to start assessment

• stranger anxiety

• resist separation from caregiver

• has a hard time describing pain

• can be distracted

at feet

• has a rich imagination and can be fearful of pain

3-6 years

why are 3-6 year olds scared of pain

they believe injury is the result of bad behavior in the past

what is a high risk for 3-6 year olds

foreign body aspiration airway obstruction

assessment for 3-6 year olds and where to start assessment

at feet

• they can understand directions and tell you where it hurts

• history obtained from caregivers

• communicate with child simply and directly

• appeal to child’s imagination

• don’t lie to patient

• can be easily distracted

• cover injections or wounds with bandages

• keep child covered as much as possible (modesty)

• beginning to act more like adults

  • think in concrete terms

  • respond sensibly to questions

  • can help take care of themselves

• school is important

• begin to understand death

6-12 years

assessment for 6-12 year olds and where to start it

start with head and move to feet

• talk a little more like adults

• gain trust by talking to child not caregiver

• give child choices if possible

• ask only the type of questions that let you control the answer

• don’t debate or bargain with patient

• allow child to listen to their heartbeat through the stethoscope

• physically similar to adults

• puberty begins

  • concerned abt body image and appearance

  • strong feelings abt privacy

• time of experimentation and risk-taking

13-18 year olds

assessment for 13-18 year olds

• can understand complex concepts and treatment options

• give them choices and guiding them

• EMT of same gender should do a physical examination if possible

• allow them to speak openly and ask questions

• risk taking behaviors

• talk to them to distract them

• females may be pregnant

how are pediatric airways different than adults

1. smaller in diameter and shorter in length

2. lungs are smaller

3. heart is higher in chest

4. glottic opening is higher and more anterior

5. proportionally larger tongue

6. narrowing funnel-shaped upper airway

how are pediatric necks diff than adults

appears nonexistent

as child develops, neck is proportionally larger bc vocal cords and epiglottis reach correct adult position

infant trachea precautions

diameter of their trachea is same size as drinking straw

airway can be easily obstructed with blood, swelling, etc

infants are nose breathers and may need more suctioning and airway maintenance

respiratory rate for newborns

20-60 breaths/min

oxygen demand for children vs. adults

risks

have twice the oxygen demand

higher risk for hypoxia

respiratory compromise for children

pressure on their abdomen

straps being too tight during spinal immobilization device

how does hypoventilation occur in children

gastric distention interferes with movement of diaphragm

breath sounds in children

what is easier to hear and why

what is harder to hear

breath sounds are easier hear bc their chest walls are thin

detection of poor air movement or complete absence of breath sounds may be harder to hear

hypoventilation

breathing too slow or shallow to meet body’s demands

normal infant pulse

160 bpm or more

how do children compensate for decreased perfusion

by constricting the vessels in the skin

perfusion

the delivery of oxygen rich blood to the body’s organs and tissues

signs of vasoconstriction in children

pallor (early sign)

weak distal pulse

delayed cap refill

cool hands/feet

pallor

unnatural or extreme lack of color in mucous membrane and skin

pulse rate for newborn to 3 months

85 to 205 bpm

pulse rate for 3 months to 2 years

100 to 190 bpm

pulse rate for 2 to 10 years

60-140 bpm

pulse rate for 10+ years

60-100 bpm

head to body ratio is smaller or larger in children

larger

Why are pediatric patients more vulnerable to nervous system/head injuries?

their nervous system is immature, underdeveloped, and not well protected

Why are pediatric patients more prone to brain bleeding after trauma?

their brain tissue and cerebral are fragile and more prone to bleeding from blunt force

Why is the pediatric brain especially vulnerable to low oxygen or low blood pressure?

it requires more cerebral blood flow, oxygen, and glucose

What can cause secondary brain damage in pediatric patients?

hypotension and hypoxic events

Are spinal cord injuries common in pediatric patients?

no its less common, usually ligaments are injured instead

what to do if pediatric patient has suspected neck injury

perform manual-in line stabilization or follow local protocol

risks of pediatrics having less developed abdominal muscles

less protection from trauma

liver, spleen, and kidneys are more prone to bleeding and injury

higher risk for multiple organ injury

what allows children’s bones to grow

open growth plates

why are children more prone to stress fractures

their growth plates make their bones softer and more flexible

what can happen if there is injury to growth plates

abnormal bone growth/length

How should strains and sprains be treated in pediatric patients?

immobilize

fontanelles

located

the flexible and soft membrane gaps between skull bones

located at front and back of head

thoracic cage

risks

elastic and bendy

made of cartilaginous connective tissue

ribs and vital organs are less protected

skin composition

risks

thinner skin and less subcutaneous fat

will burn easier and more deep

more fluid and heat loss

body surface area to body mass ratio

implications

higher body surface area to body mass

larger fluid and heat losses

pediatric assessment triangle (PAT)

why do you use

forms a general impression

• doesn’t require you to touch the patient or use equipment

• can be performed in less than 30 seconds

3 sections of pediatric assessment triangle (PAT)

1. appearance (TICLS)

2. work of breathing

3. circulation to skin

TICLS

what is it and what does it stand for

helps determine if patient is sick or not sick

tone

interactiveness

consolability

look or gaze

speech or cry

how to test for appearance in PAT

use TICLS

how to see work of breathing in PAT

abnormal airway noise, accessory muscle use, retractions, head bobbing, nasal flaring, tachypnea, tripod position

how to see circulation to the skin in PAT

pallor, mottling, cyanosis

mottling

patchy discolored skin caused from poor perfusion

PAT

stable

unstable

stable: continue with remainder of assessment process

unstable: assess XABC’s, treat life threats, transport immediately

XABCDE

what is does and what are they

assesses and treats any life threats as you identify them

Exsanguination

Airway

Breathing

Circulation

Disability

Exposure

position for airway

neutral sniffing position

palpate brachial pulse for

infants

palpate carotid pulse for

children older than 1 years old

what do strong central pulses mean

the child is not hypotensive but still need to test for shock

what are children more prone to during hands on examination

hypothermia

cover patient as much as possible and should be kept warm during transport

when to use a car seat when transporting pediatrics and how

spine injury precautions

less than 40 lb

mount car seat to a stretcher

immobilize on long backboard or other suitable spinal immobilization device

respiratory rate for infant

30-60 breaths/min

respiratory rate for toddler

24-40 breaths/min

respiratory rate for preschool age

22-34 breaths/min

respiratory rate for school age

18 to 30 breaths per minute

respiratory rate for adolescent

12 to 16 breaths/min

if a caregiver can’t come with you to the hospital, you…

get their name and phone number

which age range of children should be assessed starting at the feet an ending at the head

infants, toddlers, and pre-school age

which age range of children should be assessed using the head to toe approach

school-aged children and adolescents

what to check for during physical examinations for head

bruising, swelling, and hematomas

fontanelles in infants

what to check for during physical examinations for nose

nasal congestion and mucus bc it can cause respiratory distress

how to help with nasal congestion and mucus

gentle bulb or catheter suction

what to check for during physical examinations for ears

drainage from ears

battle signs

presence of pus

skull fracture indications

drainage from ears

battle signs

battle signs

bruising behind ears

infection indication

pus

what to check for during physical examinations for mouth

active bleeding and loose teeth

smell of their breath

what to check for during physical examinations for neck

tracheal area for swelling and bruising

movement of neck and possible fever

what to check for during physical examinations for chest

penetrating trauma, lacerations, bruises, or rashes

feel clavicle and every rib for tenderness/deformity

what to check for during physical examinations for back

inspect for lacerations, penetrating injuries, bruises, or rashes

what to check for during physical examinations for abdomen

inspect for distention

palpate for guarding

tenderness or masses

look for seat belt abrasions or bruising

3 signs to look for when assessing a pediatric abdomen

guarding

tenderness

rigidity

What are 3 reflexive motor actions present in newborns?

Sucking, rooting, and grasping

what to check for during physical examinations for extremities

assess for symmetry

compare both sides for color, warmth, size of joints, swelling, and tenderness

put each joint in full ROM and note if pain

BP not assessed in patients of what age

3 or younger