pediatrics JCCC EMT (EMS 132)

neonate age

0-28 days

infant age and considerations

1 month-1 year - keep equipment warm. If stable do toe to head exam. Older than 6 months have seperation anxiety.

Toddler age and considerations

1-3

dont like being touched or having clothing removed

preschoolers age and considerations

3-6

concrete thinking “take your blood pressure”

explain what you will do, then do immediately

fear pain and may think it is punishment

school age and considerations

6-12

explain each procedure

afraid of disability 

BP vitals sign hacks

lower limit= 70 + (age x 2)

median= 80 + (age x 2)

upper limit= 90 + (age x 2)

diastolic = 2/3 of systolic 

newborn blood volume

about 350 ml (a can of soda)

pediatric airway considerations

bigger tongue

smaller airway diameter

epiglottis is higher in the neck

can kink airway if overextended

excessive pressure on chin can block airway (use good BVM technique)

the lungs are the last to develop- more fragile tissue

soft spots on infant heads and when they close

fontanelles

anterior 18 months

posterior 6 months 

pediatric ribs

bend rather than break - can cause internal damage with no external signs

more horizontal ribs (dont protect liver and spleen as much)

underdeveloped chest muscles (lack protection)

pediatric tidal volume formula

5-7cc/kg

pediatric emergencies considerations

treat airway management aggresively

compensate a lot, then crash (dont let vitals fool you) 

hypotension is a later sign of decompensation

bones and muscles in pediatrics

splinter rather than snap

motor development occurs from head to toe

metabolism

o2 and glucose burn up faster

unable to store glucose as much

body surface area (skin)

child body surface area is large compared to overall body size

skin is thinner with less fat and muscle

initial assessment for a child

PAT- pediatric assessment triangle

1st look at Work of breathing

then circulation (skin color, temp, moisture, cap refill)

then apearence (acting normal? Gaze? Limp posture, etc)

it starts with WOB normally

PAT apearence mneumonic

TICLS

Tone

interactivity and irritability

Consolability (think breast feeding for babies)

look or gaze

speech or cry

AVPU for young child

A- awake, curious, interested, attentive

V- turns his head to sounds

P- moans or cries to pain

U- unresponsive

pediatric GCS

breathing assessment considerations

obtan RR before touching them

obtain breath sound first or last (dont want them upset)

history for pediatrics (and exp ?s)

they can start answering questions around 4

talk to parents

who was taking care of them

sickness at school?

progression of illness

dehydration?

poopy/wet diaper? How many?

Are they acting normal- toys, games, activity?

breathing emergencies with peds considerations

humidify o2 if possible

remember that they may contine to compensate even through failure

croup 

Infection of upper airway causes swelling & airway narrowing beneath the glottis (larynx).

Signs & symptoms are slow in onset & include:

•Hoarse cough with “seal bark”quality

•Stridor

•Restlessness

walk outside in cool air

high flow 02- humidify

ALS

epiglottitis

×RARE Bacterial infection that causes inflammation & swelling of the epiglottis (Hib vaccine—2 months)

×Age: 3 - 7 years (usually)

×Rapid onset accompanied by a high fever

s/s

•Pain on swallowing

•High fever

•Drooling

•Tripod position

Inspiratory stridor

suction mouth or nose first in babies?

mouth

bronchiolitis

Viral infection of the bronchioles resulting in inflammation

usually from RSV

Signs & Symptoms:

•Poss fever, cough, rhinorrhea, swelling of tongue/lips, rash, labored breathing, FBAO

•Dyspnea

•Possible hx of: prematurity, respiratory illnesses, contact w/others who are ill

•Family history of asthma, allergies, eczema

•Ask about changes in feeding patterns & wet diapers

•Children < 2 years almost always have bronchiolitis & not asthma

•Children > 2 years almost always have asthma & not bronchiolitis

•Emergency Care:

•Supplemental O₂

•Suction secretions

•HFNC , CPAP, SGA considered situationally

meningitis

×Infection of the brain & spinal cord - can be fatal.

×Fever in an infant under the age of 3 months is considered meningitis until proven otherwise!

×Signs & symptoms include:

×Ear or respiratory tract infection

×High fever & rash

×Lethargy, irritability, AMS, nausea, vomiting

×Bulging anterior fontanelle if adequately hydrated

×Stiff neck - generally not observable in infant

SIDS (sudden infant death syndrome)

also- what to look for

×The sudden & unexpected death of an infant in which autopsy fails to identify the cause of death.

×Usually between 1 month & 1 year.

×Peak incidence at 4 months.

×Most cases involve a previously healthy infant, often born prematurely.

look for scene clues

-sleep enviornment (sleep on stomach or side, with lots of blankets?)

-maternal risk factors

-sleeping with parents 

-siblings with sids

-male baby?

Care:

• ask the time the baby was put to bed- they should sleep in short increments 

• CPR unless obvious signs of death 

• care for family 

BRUE/ALTE

Brief Resolved Unexplained Event/Apparent Life-Threatening Event:

×Age: <1 year

×Time: <1 minute

•Breathing change (absent, decreased, irregular)

•Color change (central cyanosis or pallor)

•Marked change in muscle tone (hyper/hypotonia)

•Altered level of responsiveness (increased irritability or decreased)

death of a child care for family

•Use the child’s name

•Use the word “dead” or “died”

•Acknowledge feelings, avoid “I know how you feel”

•Offer to call family members or religious support

•Keep instructions short, simple

•Ask each adult family member individually if he/she wants to hold the child

shaken baby syndrome

•Shaken-Baby Syndrome: Abuser violently shakes infant or small child, creating whiplash-type motion that causes acceleration-deceleration injuries.

DOPE 

used for trouble shooting tracheostomy tubes

×DOPE = Dislodgement, obstruction, pneumothorax, equipment.

Long term venous access device permits administration of medications, fluids, etc., into the child’s bloodstream.

name and complications

central lines

×Most common complications:

×Infection at site

×Occlusion

×Bleeding at site

×Air embolus

where do we transport children

childrens mercy missouri

Neisseria Meningitides

a bacterium that causes rapid onset of meningitis symptoms leading to shock or death. Comes with rash