Pediatric Emergencies - Chapter 35

Goals

• Understand anatomy and physiology differences between children and adults.
• Learn assessment and care for pediatric illnesses and injuries.
• Recognize indicators of abuse and neglect.
• Understand medical and legal responsibilities of EMTs.

Differences Between Children and Adults

• Anatomical, physical, and emotional differences affect illness, injury, and responses.
• Children may have difficulty communicating issues due to age or fear.
• Stress can affect both children and caregivers.

Communication and Care

• Care involves both patients and their caregivers.
• A calm parent helps soothe the child; stress in parents can complicate care.

Growth and Development Stages

1. Infancy (0-12 months)

   • 0-2 months: Sleeping, eating, unable to distinguish between parents and strangers.
   • 2-6 months: Recognizes parents, responds to sounds.
   • 6-12 months: Becomes mobile, risk of choking.
   • Assessment: Observe from a distance, let caregiver hold the infant.

2. Toddler (1-3 years)

   • Rapid growth and development, risk of choking.
   • Stranger anxiety, difficulty with pain communication.
   • Begin assessment at feet, use visual aids for pain.

3. Preschool Age (3-6 years)

   • Rich imagination, fear of pain, specific communication about pain.
   • Use games/toys for distraction, don't lie to maintain trust.
   • Modesty developing, keep child covered.

4. School Age (6-12 years)

   • Understanding of death begins, physical exam similar to adults.
   • Communicate directly with the child, offer choices.

5. Adolescence (13-18 years)

   • Physically similar to adults, emotionally still maturing.
   • Engage them in their care, consider risks of pregnancy.
   • Same-gender EMTs preferred for exams.

Anatomy and Physiology

• Respiratory System: Smaller airway, higher oxygen demand, risk of airway obstruction.
• Circulatory System: Higher pulse rate, compensates by constricting vessels.
• Nervous System: Higher cerebral blood flow requirement, fragile brain tissue.
• Gastrointestinal System: Larger and more anterior organs, risk of injury.
• Musculoskeletal System: Softer bones, vulnerable growth plates.
• Integumentary System: Thinner skin, higher risk for burns and fluid loss.

Pediatric Assessment Triangle (PAT)

• Appearance: Muscle tone, mental status.
• Work of Breathing: Abnormal sounds, respiratory effort.
• Circulation: Skin color, perfusion.

Assessment Process

1. Scene Size-Up: Gather initial information, observe the environment.
2. Primary Assessment: Use PAT, assess airway, breathing, and circulation (XABCs).
3. Transport Decision: Based on stability, transport to appropriate facility.
4. History Taking: Obtain information from caregivers or the child.
5. Secondary Assessment: Focus on body systems, use DCAP-BTLS.
6. Vital Signs: Adjust for age, monitor respiratory and circulatory status.

Specific Emergency Management

• Respiratory Emergencies: Major cause of arrest, monitor effort and distress signs.
• Airway Obstruction: Manage using back blows, chest thrusts, or the Heimlich maneuver.
• Asthma and Pneumonia: Provide oxygen, use bronchodilators as needed.
• Croup and Epiglottitis: Unique presentations, responsive to specific treatments.

Interventions

• Airway Adjuncts: OPAs and NPAs to maintain airway patency.
• Oxygen Delivery: Use appropriate devices based on needs and condition.
• Shock and Anaphylaxis: Rapid assessment and intervention, use of epinephrine.
• Seizures: Protect airway, manage postictal state, identify potential causes.

Trauma Management

• Head and Chest Injuries: High-risk due to size and development.
• Abdominal and Extremity Injuries: Monitor for shock, manage fractures.
• Burns: More serious due to surface area, treat accordingly.

Legal and Ethical Considerations

• Child Abuse and Neglect: Recognize signs, mandatory reporting.
• SIDS and ALTE: Understand protocols, manage family communication.

Final Review

• Differences in anatomy and physiology require targeted assessment and treatment strategies.
• Engage caregivers and manage both physical and emotional needs of pediatric patients.