care of the family and child mike pyorala rcp, p.a.l.s, a.c.l.s., b.l.s., 12-lead ecg a.h.a....
TRANSCRIPT
Care of the Family and Care of the Family and ChildChild
MIKE PYORALARCP, P.A.L.S, A.C.L.S., B.L.S., 12-LEAD ECG
A.H.A. INSTRUCTOR
Care of the Family and ChildCare of the Family and Child
Psychological aspects
Developmental issues
Approach
Assessment
Objectives
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Why are psychological and emotionalneeds difficult to manage?
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Child’s viewpoint
Parent’s viewpoint
Health Care Provider’s viewpoint
Psychological Aspects
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CHALLENGES Individual Unit
Crisis
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Pain
Fear
Guilt
Child’s Viewpoint
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Frightened
Guilty
Exhausted
Parent’s Viewpoint
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Scared
Inexperienced
Empathetic
Health Care Provider’s Viewpoint
Care of the Family and ChildCare of the Family and ChildChild’s Responses
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Care of the Family and ChildCare of the Family and Child
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Be honest
Give real choices
Support family relationship
Maintain self-control
Respect right to privacy
Key Points
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Assume the child can hear you.
Do not introduce fear/anxiety.
Praise children.
Key Points
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Decreased ability to: accept and understand incoming information think clearly and to solve problems
Helplessness Anxiety Hysteria Anger Guilt
Parental Responses
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Perception of the event
Previous experience
Family relationships
Culture/religion
Support systems
Assessment
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Include the parents and child
Ask for the parent’s assistance
Acknowledge feelings
Be honest
Stay calm
Familiarize family with the environment
Give control
Prepare the family
Strategies
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The child’s chronological age may not always match the developmental age.
Developmental Issues
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Care of the Family and Care of the Family and ChildChild
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Does the child look sick?
Does the child sound sick?
Physical Examination
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Appearance
Airway and C-spine
Breathing
Primary Survey
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Many problems, especially respiratory distress, are made worse by agitation.
Remember:
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Varies with age
Approach
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Respond to Soothing voice Gentle hands Pacifier
Keep warm Exam chest and abdomen first
Less than 1 month of age
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Unafraid of strangers Responds to cooing and tickling Keep warm Exam chest and abdomen first
Infant (1-6 Months)
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Afraid of strangers Separation anxiety Examine in parent’s lap Examine trunk then proceed to head
Infant (6-12 Months)
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Independent Strong distrust of strangers Patient but firm approach Keep parents nearby Limit exam to bare essentials
Toddler (1-3 Years)
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Frightened of bodily injury Need explanations and reassurance May be more cooperative Modest Examine in presence of parents Examine chest and abdomen first
Preschooler (3-5 Years)
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Cooperative More aware of death Need reassurance Modest Examine with parents present Examine in an adult fashion
School-Age Child (6-12 Years)
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Expect to be treated as an adult
Many of the same fears as younger children
Body image Excessively modest Examine as an adult
Adolescent (12-18 Years)
The approach to the unconscious child of any age is the same as for the unconscious adult, with rapid
performance of the primary survey and institution of priority
treatments.
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Talk to all patients of all ages Give explanations in simple language Be honest Be sympathetic Offer reassurance Carefully document
Tips on Treatment
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Vary with age
Vital Signs
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Broselow® Resuscitation Tape
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Critical measurement (Age in years x 2) + 8 = weight in kilograms
Weight
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Count respirations before touching the child. Count for 1 full minute to assess:
quantity quality effort
Respirations
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Newborn Infant/young child Older child
Umbilical Cord
Brachial artery
Carotid artery
Heart Rate
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Heart rate rises long before blood pressure falls!!!!!!
In Shock,
Remember :
Bradycardia in an ill child indicates extreme distress, requiring URGENT intervention.
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Remember:
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Wide range of normals May see up to 25% decrease in blood volume before BP
decreases. Over one year may estimate minimum systolic:
(Age in years x 2 ) + 70 = minimum systolic blood pressure
Blood Pressure
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Never wait until the child is hypotensive to initiate volume resuscitation!!!!!!
Remember:
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Children cool quickly Exposure and low cardiac output lower core temperature
Temperature
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Anterior Fontanel Bulging or tense Sunken
Neurological
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Alertness Eye contact Recognition of parents Playing Withdrawal to pain
LOC
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Talk Reassure Be Honest Carefully document
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Discuss and review difficult pediatric cases Critical Stress Debriefings
Care for Yourself