Chapter 35: Pediatric Emergencies - Emergency Care and Transportation of the Sick and Injured, 12th Edition

Learning Objectives

• Understand the anatomical and physiological differences between children and adults.
• Learn appropriate assessment and care for illnesses and injuries in children.
• Recognize patterns of injury based on age and size, and identify signs of abuse and neglect.
• Understand medical and legal responsibilities of EMTs.

Communication and Growth

• Communication: Calm parents result in calm children; engage caregivers in the process.
• Growth Stages:
  • Infancy (0-1 year): Newborns, 0-2 months, 2-6 months, 6-12 months.
  • Toddler (1-3 years): Rapid growth, increased injuries.
  • Preschool Age (3-6 years): Fear of pain, imagination-driven.
  • School Age (6-12 years): Understanding of death.
  • Adolescents (13-18 years): Emotionally and physically in transition.

Anatomy and Physiology Differences

• Respiratory System: Smaller airways, larger tongues, higher oxygen demand.
• Circulatory System: Higher heart rates, signs of vasoconstriction.
• Nervous System: Larger head-to-body ratio, fragile brain tissue.
• Musculoskeletal System: Softer bones, open growth plates.
• Integumentary System: Thinner skin, higher risk of dehydration.

Patient Assessment

• Scene Size-up: Gather as much information as possible.
• Pediatric Assessment Triangle (PAT): Evaluate appearance, breathing, and circulation.
• XABCs: Exsanguination, Airway, Breathing, Circulation, Disability, Exposure.
• History Taking: Tailor questions to the child's age and condition.

Specific Emergencies and Management

• Respiratory Emergencies: Leading cause of cardiopulmonary arrest in children.
• Asthma: Inflamed and swollen bronchioles.
• Pneumonia: Secondary lung infection.
• Croup: Viral infection below vocal cords.
• Epiglottitis: Bacterial infection above vocal cords.
• Bronchiolitis: Inflammation of bronchioles often from RSV.
• Pertussis: Bacterial infection causing severe coughing.

Airway and Breathing Management

• Use appropriate airway adjuncts (OPAs, NPAs).
• Oxygen delivery options: Blow-by, Nasal Cannula, Non-rebreather Mask, BVM.
• Shock: Monitor for signs of hypoperfusion and provide rapid transport.
• Anaphylaxis: Life-threatening allergic reaction.

Neurological Emergencies

• Seizures: Disorganized brain activity; manage airway and provide ventilation.
• Meningitis: Inflammation of brain and spinal cord membranes.

Gastrointestinal and Poisoning Emergencies

• Dehydration: Results from fluid loss, monitor for shock.
• Poisonings: Ingested, inhaled, injected, or absorbed substances.

Trauma and Burns

• Monitor for hidden injuries, manage burns as per severity.
• Fractures: Handle growth plate injuries with care.
• Pain Management: Positioning, ice, and elevation.

Child Abuse and Neglect

• Recognize signs of physical, sexual, and emotional abuse.
• Report suspected abuse as mandated by law.

Sudden Unexpected Infant Death Syndrome (SUIDS)

• Understand causes and risk factors.
• Support families dealing with infant loss.

Conclusion

• Understanding pediatric emergencies requires knowledge of childhood development, anatomical differences, and specific medical and legal responsibilities. Proper assessment and management are crucial for effective pediatric care.