Pediatric Emergencies

adolescents

children between ages 12 and 18 years

apparent life-threatening event (ALTE)

an event that causes unresponsive, cyanosis, and apnea in an infant, who then resumes breathing with stimulation.

blanch

to turn white

bradypnea

slow respiratory rate: ominous sign in a child that indicates impending respiratory arrest.

bronchiolitis

Inflammation of the bronchioles that usually occurs in children younger than 2 years and is often caused by respiratory.

central pulses

pulses that are closest to the core (central) part of the body where the vital organs are located; include the carotid, femoral, and apical pulses.

child abuse

a general term applying to all form of abuse and neglect of children

croup

a viral inflammatory disease of the upper respiratory system that may cause a partial airway obstruction and is characterized by a barking cough; usually seen in children

epiglottitis

a bacterial infection in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction.

fontanelles

areas where the neonate’s or infant’s skull has not fused together; usually disappear at the approximately 18 months of age.

generalized (tonic-clonic) seizure

a seizure that features rhythmic back-and-forth motion of an extremity and body stiffness

grunting

an “uh” sound heard during exhalation; reflects the child’s attempt to keep the alveoli open; a sign of increased work of breathing

infancy

the first year of life

length-based resuscitation tape

a tape used to estimate an infant’s or child’s weight on the basis of body length; appropriate drug doses and equipment sizes are listed on the tape.

meningitis

an inflammation of the meningeal coverings of the brain and spinal cord; it is usually caused by a virus or a bacterium

nares

the external openings of the nostrils. a single nostril opening is called a naris.

neglect

refusal or failure on the part of the parent or caregiver to provide life necessities.

Neisseria meningitides

a form of bacterial meningitis characterized by rapid onset of symptoms often leading to shock and death.

pediatric assessment triangle (PAT)

a structured assessment tool used to rapidly form a general impression of the infant or child without tuoching him or her; consists of assessing appearance work of breathing, and circulation to the skin.

pediatrics

a specialized medical practice devoted to the care of the young

pertussis (whooping cough)

an airborne bacterial infection that affects mostly children younger than 6 years, in which the patient is feverish and exhibits a “whoop” sound on inspiration after a coughing attack; highly contagious through droplet infection.

pre-school age

children between ages 3 and 6 years old

school-age

children between ages 6 and 12

shaken baby syndrome.

a syndrome seen in abused infants and children; the patient has been subjected to violent, whiplash-type shaking injuries inflicted by the abusing individual that may cause coma, seizures, and increased intracranial pressure due to tearing of the cerebral veins with consequent bleeding into the brain.

sniffing position

an upright position in which the patient’s head and chin are thrust slightly forward to keep the airway open

sudden infant death syndrome (SIDS)

death of an infant or young child that remains unexplained after a complete autopsy

tachypnea

rapid respirations

toddler

a child aged 1 to 3 years

tracheitis

inflammation of the trachea

tripod position

an upright position in which the patient leans forward onto outstretched arms with the head and chin thrust slightly forward.

work of breathing

an indicator of oxygenation and ventilation; reflects the child’s attempt to compensate for hypoxia.

0-2 months

* spend most time sleeping and eating.
* respond mainly to physical stimuli.
* cannot tell the difference parents and strangers.
* crying is one of the main modes of expression.

2 to 6 months

* More active at this stage
* may follow objects with eyes
* persistent cry, irritability, or lack of eye contact can be an indicator of serious illness, depressed mental status, or delay in development.

6 to 12 months

* 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
* persistent crying or irritability can be a symptom of serious illness.

12 to 18 months

* explorers by nature and not afraid
* they lack molars and may not be able to chew food fully increasing the risk of choking

Assessment Toddler

* May have stranger/separation anxiety.
* Hard time describing pain.
* begin assessment at the feet.
* Persistent crying can be a symptom of serious illness or injury.

3 to 6 years

* Have a rich imagination and can be fearful about pain.
* foreign body aspiration airway obstruction continues to be a high risk.

Preschool-Age Child Assessment

* Can understand directions and be specific to painful areas.
* Much history must still be obtained from caregivers.
* communicate simply and directly.
* appealing to a child’s imagination may facilitate examination.
* Never lie to the patient
* Modesty is developing
* Begin assessment at the feet

6 to 12

* beginning to act more likely adults.
* can think, respond, and help take care of themselves.
* School is important.
* Children begin to understand death.

Assessment of school-age years

* assessment more like adults
* talk to the child not just the caregiver.
* start with head and move to the feet.
* give the child choices.
* ask only the type of questions that let you control the answer.
* Do not bargain or debate with patient.
* allow the child to listen to his or her heartbeat
* Can differ the difference physical and emotional pain.
* provide simple explanations.

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13 to 18 years

* physically similar adults (puberty begins)
* Time of experimentation and risk-taking.

Assessment of adolescents

* can often understand complex concepts and treatment options, allow them to be involved in their own care, provide choices.
* EMT of the gender should do physical examination.
* Female patient may be pregnancy.
* Assess all an adult head to toe.

Newborn to 3 months pulse rate

85 to 205

3 months to 2 years pulse rate

100 to 190

2 to 10 years pulse rate

60 to 140

10 + years pulse rate

60 to 100

Normal of level of consciousness:

act appropriately for age, exhibit good muscle tone, and maintain good eye contact

TICLS mnemonic

helps determine if patient is sick or not sick: tone, interactives, consolably, look or gaze, speech or cry

mottling

occurs when blood flow to tiny vessels under your skin is disrupted. This results in a fine, bluish-red, lace-like pattern

XABCDE

* exsanguination
* airway
* breathing
* circulation
* disability
* exposure

Rapid transport:

* Significant MOI
* History compatible with serious illness
* physical abnormality noted.
* potentially serious anatomic abnormality
* significant pain
* abnormal level of consciousness

Early Respiratory Emergencies

changes in behavior, combativeness, restlessness, and anxiety

Respiratory Emergencies

* Nasal flaring
* abnormal breath sounds
* Accessory muscle use tripod position
* retractions - muscles between the ribs
* head bobing
* tachypnea

brachial pulse or femoral pulse

In infants, palpate the _______ when assessing a pulse.

carotid

in children older than 1 year palpate the _____ when assessing a pulse

crackles

a cracking or bubbling sound typically heard on inspiration indicates inflammation or infection (such as in pneumonia)

stridor

high-pitched inspiratory sound: indicates a partial upper obstruction (such as in croup or from a go reign body)

wheezing

high-or low-pitched sound heard usually during expiration; indicates a partial lower airway obstruction (such as in asthma, bronchiolitis, or foreign body aspiration)

absent breath sounds (silent chest)

combined with increased work of breathing, absent breath sounds indicate a complete upper or lower airway obstruction.

\[respiratory rate\] Infant 1 month to 1-year

30 to 60

\[respiratory rate\] toddler

24 to 40

\[respiratory rate\] preschool age

22 to 34

\[respiratory rate\] school age

18 to 30

\[respiratory rate\] adolescent

12 - 16

Treatment

Treat of Airway obstruction

Used head tilt chin lift and finger sweep to remove a visible foreign body in ana unconscious pediatric patient. Used chest compression to relive a sever airway obstruction in an unconscious pediatric patient.

Asthma

a condition in which the bronchioles become inflamed, swell, and produce excessive mucus, leading to difficulty breathing.

* Signs and symptoms: wheezing on exhale, airway completely block \[no air movement is heard\], cyanosis, respiratory arrest, tripod position.

Treatment Asthma

* Allow patient to assume a position of comfort.
* administer supplemental oxygen.
* Bronchodilator via metered dose inhaler with a spacer mask dvice
* Assist ventilation, contact ALS.

pneumonia

general term that refers to an infection to the lungs

* Signs and symptom: nasal flaring, tachypnea, hypothermia, fever, diminished breath sounds, crackles

Treatment Pneumonia

* primary treatment will be supportive.
* Monitor airway and breathing statis.
* Administer supplemental oxygen if needed.
* IF WHEEZING is present administer a bronchodilator

Treatment Croup

Humidified oxygen and DO NOT USE a bronchodilator.

Treatment Bronchiolitis

* use calm demeanor when approaching.
* Allow patient to remain in position of comfort.
* treating airway and breathing problems.
* Humidified oxygen, consider ALS.

Treatment Pertussis

keep the airway open and transport

Devices to maintain airway.

* oropharyngeal and nasopharyngeal airways
* bite blocks
* bag-mask devices

Oropharyngeal airway

* keep tongue from blocking airway and makes suctioning easier.
* Should be used for pediatric patients who are unconscious and in respiratory failure.
* Should not be used in conscious patients or those who have a gag reflex or who have ingested a caustic or petroleum-based product.

Nasopharyngeal airway

* Usually well tolerated.
* Used for responsive pediatric patients.
* Used in association with possible respiratory failure
* Rarely used in infants younger than 1 year
* should not be used if there is nasal obstruction or head trauma.

Indicated for pediatric patient who have adequate respirations and/or tidal volume.

Nonrebreathing mask, nasal cannula, or simple face mask

Bag mask device

used for those with respirations less than 12 breaths/min or more than 60 breaths/min, altered LOC, or inadequate tidal volume.

* Select appropriately sized equipment, maintain a good seal, ventilate at the appropriate rate and volume, using a slow gentle squeeze

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Blow-by method

* Less effective than face mask or nasal cannula for oxygen delivery
* Does not provide high oxygen concentrations.
* Administration

Nasal cannula

Choose appropriately sized nasal cannula, connect tubing to an oxygen source at 1 to 6 L/min.

Nonrebreathing mask

Delivers up to 90% oxygen, allow pateint to exhale all carbon dioxide without rebreathing it.

* Select appropriately sized mask, connect tubing to oxygen source at 10 to 15 L/min. adjust oxygen flow as needed.

Hypoxic

Levels of oxygen in the blood are lower than normal.

Shock

Develop when the circulatory system is unable to deliver a sufficient amount of blood to the organs

Signs and symptoms: tachycardia, poor capillary refill time, mental status changes

Compensated shock

early stage of shock

decompensated shock

later stage of shock

pericarditis

swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium)

cardiac tamponade

compression of the heart due to fluid buildup in the sac surrounding the heart.

Treatment of shock

Assess XABCS, manage symptom by symptom, keep warm and elevate. ENSURE AIRWAY AND CONTROL BLEEDING.

* Give supplemental oxygen by mask or blow-by, continue to monitor airway, position of comfort, keep warm, provide transport, contact ALS backup

Anaphylaxis

life-threatening allergic reaction that involves generally, multisystem response

* signs and symptoms: hypoperfusion, stridor and/wheezing, restlessness, agitation, and sometimes a sense of impending doom, hives.

Treatment Anaphylaxis

Main airway and administer oxygen, assist with epinephrine, provide rapid transport.

Hemophilia

congenital condition in which patients lack normal clotting factors

AEIOU-TIPPS

reflects major causes of Altered mental status

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Treatment Altered Mental Status

Management focus on ABCs and transport

Status epilepticus

Seizures that continue every few minutes without regain consciousness in between or last longer 30.

Seizures Management

securing and protecting airway are priority, provide 100% oxygen by nonrebreathing mask or blow-by method. transport

Treatment Meningitis

provide supplemental oxygen and assist with ventilations, reassess vital signs frequently.

appendicitis

a finger-shaped pouch present at the lower right side of the abdomen. Starts with a dull pain in the middle or right side of the abdomen and moves down to the lower right abdomen.

Treatment Poisoning Emergencies and Managment

Perform external decontamination, assess and maintain ABCs and monitor breathing, if shock is present, treat and transport, give activated charcoal according to medical control or local protocol.

Treatment dehydration

Assess ABCs and obtain baseline vital signs, severe: ALS, transport to ED

Febrile seizures

Seizures Caused by fever alone, lasting less than 15 minutes with little or no postictal state, may be a sign of a more serious problem.