chapter 35; Emergency Care and Transportation of the Sick and Injured - Pediatric Emergencies

CHAPTER 35: Emergency Care and Transportation of the Sick and Injured - Pediatric Emergencies

Overview of Pediatric Emergencies

• Pediatric emergencies require understanding the specific developmental, anatomical, and physiological differences between children and adults.

• Emergency Medical Services (EMS) must adapt assessments and interventions to cater to varying developmental stages—from infants to adolescents.

Special Patient Populations

• Fundamental Knowledge: Understanding growth, development, aging, and assessment findings is essential for providing emergency care to patients with special needs. This knowledge applies to:

  • Pediatric patients

  • Patients with disabilities and special challenges

National EMS Education Standard Competencies

1. Patients With Special Challenges:

   • Recognizing and reporting abuse and neglect.

2. Health Care Implications of Abuse:

   • Acknowledge health care impacts due to the abuse and neglect of pediatric patients.

3. Pediatrics:

   • Understand age-related assessment findings, emphasizing the assessment and treatment modifications needed for pediatric-specific major diseases/emergencies:

     • Upper airway obstruction

     • Lower airway reactive disease

     • Respiratory distress, failure, arrest

     • Shock

     • Seizures

     • Sudden infant death syndrome (SIDS)

4. Trauma:

   • Apply fundamental knowledge to assess and care for acutely injured pediatric patients.

5. Special Considerations in Trauma:

   • Recognize and manage trauma in pediatric patients, understanding their unique physiological responses.

Introduction to Pediatric Assessment and Care

• Anatomical and Emotional Differences:

  • Children differ from adults in anatomical, physical, and emotional aspects.

  • Their responses to illnesses and injuries vary based on age and developmental level.

  • Children should not be treated as "small adults".

  • Fear of EMS providers and pain complicates assessments; requiring providers to remain calm and professional helps ease anxiety.

Communication with the Patient and Family

• In pediatric care, it is crucial to also communicate and provide support to the parents or caregivers.

• Strategies to calm the child include:

  • Ensuring parental calmness impacts child calmness,

  • Being efficient, professional, and sensitive during interactions.

Growth and Development Stages

• Childhood development occurs in several stages:

  • Infancy (0-1 year): Significant physical changes; infants are responsive mainly to physical stimuli.

  • Toddler (1-3 years): Rapid growth; toddlers tend to explore, which increases injury risk.

  • Preschool-age (3-6 years): Imaginative thinking, fear about pain; understanding this age group's perceptions can facilitate care.

  • School-age (6-12 years): Learn to take care of themselves and understand more complex issues related to health and safety.

  • Adolescents (12-18 years): Exhibit adult-like physiology; privacy is important, and they engage in risk-taking behaviors.

Specific Assessment Strategies

1. Infants: Sorted by age ranges;

   • 0-2 months: Primarily asleep and eating, inconsolable infants may indicate illness.

   • 2-6 months: Increased activity and responsiveness; eye contact is essential.

   • 6-12 months: They become mobile and are more vulnerable to choking hazards.

   • Assessment strategies should involve a distance observation and a caregiver holding the infant.

2. Toddlers: Caregivers' involvement is crucial; a head-to-toe approach starts at the feet.

   • Assessment may require patience, as toddlers can be fearful and may have difficulty describing pain.

3. Preschool-Age: They can describe pain areas; assessment should be straightforward, never lying to children, and incorporating imagination may help ease fears.

4. School-Age: Enables the assessment of head-to-toe, engaging the child in conversation to ensure comfort and trust.

5. Adolescents: Should be allowed to partake in discussions about their health; consider gender-matching for examinations.

Anatomy and Physiology in Pediatric Care

• The anatomical differences greatly affect evaluation and treatment, focusing on:

  • Respiratory System: Smaller airways, increased oxygen demand, and different respiratory rates compared to adults. Pediatric respiratory rates are typically between 20-60 breaths/min in newborns.

  • Circulatory System: Awareness that heart rates significantly vary with age, with average rates for infants being approximately 160 beats/min. Signs of significant perfusion issues include delayed capillary refill time and weak distal pulses.

  • Nervous System: Children have an immature nervous system, making them vulnerable to trauma and increased chance of brain injury from shearing forces.

  • Gastrointestinal System: Less stable and less protected, with organs positioned in vulnerable ways, leading to a higher risk of injury.

  • Musculoskeletal System: Soft and flexible bones, open growth plates can lead to different types of fractures; pediatrics require specialized care for musculoskeletal injuries.

Scene Size-up, Primary Assessment, and History Taking

• Through the initial dispatch, the EMS should prepare for pediatric assessment by noting the age, gender, and chief complaint and ensuring scene safety.

• Primary Assessment: Use the Pediatric Assessment Triangle (PAT) to determine the child's appearance, work of breathing, and circulation.

• History Taking: Inquire deeply about injury or illness, also leveraging caregiver knowledge for information necessary for treatment. Use the SAMPLE and OPQRST methods, tailored to developmental stages.

Secondary Assessment and Management Protocols

• Conduct thorough physical examinations, mainly starting at the feet for younger children, examining all body systems, while noting any abnormalities such as bruising, color changes, or responses indicative of severe trauma.

• Vital signs should be taken with a careful eye on normal ranges varying with age. For children aged 1-10, the blood pressure can be calculated with:
  $BP<em>{systolic} = 70 + (2 imes age</em>{years})$.

Specific Emergencies in Pediatric Care

1. Respiratory Emergencies:

   • Prevalent causes of pediatric cardiopulmonary arrest, including asthma and pneumonia. Signs may include changes in behavior, distinctive breathing patterns, and physical distress.

2. Cardiac Emergencies:

   • Understanding shock types, signs of circulatory failure and unique pediatric responses to hypovolemia or infection.

3. Neurological Emergencies:

   • Addressing seizures, altered mental status, and symptoms reflecting significant head and neck trauma.

Child Abuse and Neglect Recognitions

• It is vital to recognize signs of abuse through careful documentation, understanding injury patterns, and having protocols in place to report suspicions.

• Abused children may demonstrate changes in behavior or seem fearful of caregivers. Utilize the mnemonic CHILD ABUSE during assessments to ensure thoroughness of investigation.

Transportation and Management Guidelines

• Ensure optimal transportation based on patient condition; for unstable patients, rapid transport is essential while managing critical assessments throughout the transfer process.

• Always monitor vital signs, and oxygenation, and provide warmth as children are susceptible to hypothermia.

Review and Conclusion

• Understanding the fundamentals of pediatric care, assessment techniques, and emergency response lays the foundation for effective treatment.

• Constant updates on best practices and techniques ensure that medical professionals remain prepared for pediatric emergencies and focus on both physical and emotional health aspects.

Important Takeaway

• Constant reassessment and validation of critical information along with a caring approach is a hallmark of successful pediatric emergency care.