identify the signs, symptoms

Identify the signs, symptoms and treatments of common pediatric emergencies.

The Pediatric PatientCommon Medical Conditions Traumatic InjuriesChild Abuse and Neglect

Transporting Infants and Children

EMS Response to Pediatric Emergencies

Pediatrics - medical care devoted to the young

Children to the age of 18

Infants◦ birth to 1 yearfirst 30 days referred to as neonate

Toddlers◦ ages 1-3 years

Preschool◦ ages 3-6 years

School-age◦ ages 6-12 years

Adolescents◦ ages 12-18 years

Major cause of death◦ Infants

related to birth◦ Developmental stages

Trauma (MVA)

Infants◦ Keep with parents◦ Keep warm◦ Assess general appearance and

breathing before touching◦ Make sure stethoscope and hands are

are warm before touching infant◦ Heart and lungs first, head last

Children Might◦ Be frightened◦ Dislike being touched by strangers◦ Be afraid of needles◦ Resist O2

Children (cont.)◦ Do not separate from parents◦ Reassure them they are not in trouble◦ Respect their modesty◦ Treat adolescents as if they were adults

Airway Obstruction◦ Partial Airway ObstructionStill able to breathePlace in position of comfortAdminister high-flow O2Remove foreign body (if visible in mouth,

NO blind finger sweeps)Limit assessment to ABCDDo not agitatePrompt transport

Complete Airway Obstruction◦ Chest does not rise and fall◦ Decreased LOC◦ Cyanosis◦ Inability to cry or speak◦ Perform thrust maneuvers to attempt to remove

object (Abdominal, Chest/Back – Age dependent, follow AHA Guidelines)◦ Attempt ventilation's with BVM (per AHA

Guidelines) ◦ Transport

Signs of Respiratory Problems◦ Early Distress◦ Severe Distress◦ Respiratory Arrest

Early Distress◦ Audible wheezing◦ Grunting◦ Stridor◦ Nasal Flaring◦ Use of accessory muscles

Severe distress ◦ Respiration's more than 60 breaths/min◦ Cyanosis◦ Drooling◦ Decreased muscle tone◦ Altered level of consciousness◦ Delayed capillary refill (>2 sec.)◦ Use of accessory muscles

Respiratory Arrest◦ Less than 10 breaths per minute◦ Agonal or no respirations◦ unconscious and unresponsive◦ Limp muscle tone◦ Heart rate less than 60 beats/min◦ Distal pulses weak or absent◦ Full ventilatory support with BVM & chest

compressions

Common among children Usually not life threatening Causes great anxiety Most episodes last 15 seconds or less May lose bladder control Common with high fever (febrile

seizure)

Other causes◦ Brain or CNS infections◦ Poisoning◦ Trauma◦ Inadequate O2◦ Hypoglycemia◦ Unknown reasons

Determine cause Mechanism of Injury / Illness Assist ventilation's as needed Transport Obtain history of episode

Hypoglycemia Poisoning Infection Treatment? Insufficient O2 Head injury Seizure episode

Gather information about poison • From the container• (Poison Control 1-800-222-1222)

Bring poison to hospital (if can safely be done)

No activated charcoal in pre-hospitalsetting

Prompt transport Monitor LOC Prepare to provide BLSinterventions as necessary

Croup - A viral illness that causes acute swelling of the lining of the larynx below its opening.

Epiglottitis - Bacterial infection that produces severe swelling of the epiglottis, the flap of tissue that protects the opening of the larynx.

Signs & Symptoms◦ Fever◦ Progressive respiratory difficulty◦ Barking, brassy cough and hoarseness◦ Progressive and excessive musculareffort with breathing

Never use tongue blade, finger, or Oropharyngeal airway

Avoid back-blows & abdominal-thrust maneuver

Sniffing position

O2◦ moist - epiglottis◦ cool mist for croup

Suction secretions and transport

◦ Meningitis◦ Heat-Related Emergencies◦ Febrile Convulsions

Extremely serious Hot and obviously sick Headache and stiff neck Sore throat and upper respiratory

infection prior Rapid transport Alert for seizures!

Heat related emergenciesMost dangerous is feversSame care for child as adultReduce body temperatureTransportMonitor carefully

Febrile Convulsions◦ Usually last less than 15 seconds◦ Rarely result in permanent injury◦ No special treatment other than airway

management and cooling

Appendicitis◦ Most serious cause of abdominal pain in

childhood◦ Most frequent ages of 10-25 years◦ Crampy pain◦ Pain starts over the umbilicus and rapidly

moves to the RLQ

◦ Pain becomes steady and severe◦ Nauseated, may vomit, irritable or fussy with no

appetite◦ Low grade fever is common◦ Transport all children with abdominal pain◦ Should not try to determine the cause

Dehydration ◦ Associated with abdominal pain◦ Common with infants and children◦ May cause shock

◦ Measles ◦ German Measles◦ Chicken pox◦ Mumps

Treatment?

Rarely result of Heart Condition Meningitis Blood Infection Dehydration* Abdominal injury Blood Loss*

Signs & Symptoms◦ Rapid heartbeat◦ Delayed capillary refill◦ Pale, cool, clammy skin◦ Weak or absent peripheral pulses◦ Altered level of consciousness

Late indicator - low systolic blood pressure◦ A pediatric 12 years old and under is considered

hypotensive when the systolic blood pressure is 70 + (age x 2)◦ Remember normal BP for a pediatric 12 years old

and under is 90+ (age x 2)◦ Once the pediatric reach age 13 years old the

normal BP and hypotension is equivalent to that of an adult

MOA C-spine Dress obvious

wounds Splint fractures

Elevate feet Keep warm Handle gently NPO

Ventilation is top priority Other considerations◦ Spinal injuries◦ Hypothermia◦ Alcohol or drug use in adolescents

Prompt transport

Cause unknown Occurs during sleep Primarily between the ages of 2-6

months Anguished, severely disturbed parents

BLS before and during transport Continue until baby is pronounced dead by a

physician Notify MCC Remain alert for signs of child abuse

The Basic Principles of Trauma Management◦ MOA◦ C-spine◦ Control bleeding◦ Splint musculoskeletal injuries

Usually caused by motor vehicle accidents, falls, or diving mishaps

Treatment◦ Do not bend neck or back◦ MOA◦ Assist ventilation's◦ Avoid urge to pick-up and cradle◦ Transfer child with head slightly elevated

Treatment (cont.)◦ Monitor level of consciousnessAVPURecord observations every 5 minutes

Penetrating abdominal or chest injuries are uncommon

Blunt injuries are far more common◦ Falls◦ Motor vehicle accidents

Blunt abdominal trauma may rupture:◦ Spleen◦ Liver◦ Kidney

Suspect shock if:◦ Sustained blunt abdominal injury◦ Complains of abdominal pain

Transport promptly Monitor vital signs Anticipate shock Be alert for vomiting

Extremity Injuries◦ Treatment? .. .. .. Control bleeding, bandage, splint

Severe Bleeding and use of a PASG◦ Do we use them? .. .. .. No

Burns◦ Treatment same as adults

Child Abuse - Deliberate, intentional injury of a child physically and emotionally.

Recognizing Child Abuse◦ History does not match injury◦ Multiple injuries at different stages of healing◦ HX of several accidents in the past

◦ Child may appearWithdrawnFearfulHostileUndernourished

Handling◦ Do not diagnose/accuse◦ Professional approach◦ Carefully record history◦ Can’t transport without parents permission◦ Consult law enforcement◦ Follow local protocol

Reporting◦ Report to Physician◦ What you saw, not what you think!

Most rape victims are over 10 years of age Should not examine genitalia unless:◦ Obvious bleeding◦ Injuries that must be treated

When abuse suspected:

◦ Ensure law enforcement is notified◦ Patient should not wash, urinate, or defecate◦ Same sex EMT if at all possible◦ Concerned caring approach is important◦ Allow law enforcement to collect evidence (If you

must collect evidence place in a paper sack)◦ Transport to a facility with a S.A.N.E. Nurse

Obtain history from child and witnesses◦ May be hysterical◦ May be unwilling, especially if abuser is:SiblingRelativeFamily friend

EMT is in best position to get information◦ Record information carefully and completely◦ Written in clear and accurate detail◦ Use ambulance report form

Transport

Neglect - Occurs when a parent or caregiver does not provide basic care to a child.◦ Provide food◦ Clothing◦ Shelter

Abandoning Follow local protocol

Susceptible of temperature changes◦ Lose body heat more rapidly◦ Wrap in blankets and keep warm◦ O2 should be warmed

Susceptible to infection◦ Avoid breathing or coughing on child◦ Universal precautions◦ Transport newborns in special incubators when it is

possible

Child should have a familiar person close◦ Parent◦ Relative◦ Close friends

Familiar objects may help◦ Dolls / Toys◦ Stuffed animal◦ Favorite blanket

The ECA/EMR, EMT, Paramedic should:◦ Maintain a caring professional approach◦ Stay at eye level when possible◦ Be honest◦ Verbally repeat procedures◦ Respect child’s modesty◦ Friendly tone of voice◦ Maintain eye contact

May experience wide range of emotions Prepare for pediatric cases◦ Practice with equipment◦ Review local protocol◦ Mentally prepare yourself

Debriefing is helpful Know when to seek help

Pediatric Patient Common Medical Conditions Traumatic Injuries Child Abuse and Neglect Transporting EMS Response