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

Objectives

• Understand the anatomy and physiology differences between children and adults.
• Learn the appropriate assessment and care for pediatric illnesses and injuries across different age groups.
• Recognize indicators of abuse and neglect and understand EMT responsibilities.

Key Differences: Children vs. Adults

• Anatomical, physiological, and emotional differences affect responses to illness and injury.
• Fear, communication barriers, and stress in caregivers can complicate assessments.

Communication and Family Interaction

• Support caregivers and maintain a calm environment.
• Children respond better in the presence of calm caregivers.

Growth and Development Stages

1. Infancy (0-1 year): Rapid growth, reliance on crying, risk of hypothermia.
2. Toddler (1-3 years): Explorer nature, stranger anxiety, risk of choking.
3. Preschool (3-6 years): Rich imagination, modesty develops, specific pain descriptions.
4. School-age (6-12 years): Understanding of death, adult-like assessments.
5. Adolescents (13-18 years): Adult-like anatomy, risk-taking behavior, possible pregnancy.

Pediatric Anatomy and Physiology

• Respiratory System: Smaller airways, higher oxygen demand.
• Circulatory System: Higher heart rates, vasoconstriction signs.
• Nervous System: Immature and fragile, higher blood flow and oxygen demand.
• Musculoskeletal System: Softer bones, growth plates prone to injury.
• Integumentary System: Thinner skin, higher risk of burns and fluid loss.

Patient Assessment

• Scene Size-Up: Mentally prepare and plan for pediatric-specific needs.
• Pediatric Assessment Triangle (PAT): Appearance, Work of Breathing, Circulation.
• Hands-On Assessment: XABCs (Airway, Breathing, Circulation, Disability, Exposure).

Transport Decision

• Rapid transport for significant MOI, serious illnesses, signs of shock, or altered mental status.

History Taking

• Adjust approach based on age; use caregivers for infants and young children.

Secondary Assessment

• Full body assessments for hidden injuries and age-appropriate focused assessments.

Specific Pediatric Emergencies

• Respiratory Emergencies: Leading cause of cardiopulmonary arrest.
• Airway Obstruction: Foreign objects, infections cause obstruction.
• Asthma: Inflammation and mucus in bronchioles; treat with oxygen and bronchodilators.
• Pneumonia, Croup, Epiglottitis: Different presentations and specific treatments.
• Seizures: Common causes, postictal states, and management.
• Shock: Different signs and compensations compared to adults.

Special Considerations

• Child Abuse and Neglect: Recognize signs, report suspected abuse, and document objectively.
• Sudden Infant Death Syndrome (SIDS): Risk factors, scene assessment, and family support.

Conclusion

• Understanding pediatric emergencies requires knowledge of their unique anatomy and emotional needs.
• Proper communication, assessment techniques, and rapid intervention are key to effective management and recovery in pediatric emergencies.