Chapter 35: Pediatric Emergencies

Overview

• Understand the differences in child anatomy and physiology compared to adults.
• Learn assessment and care for pediatric illnesses and injuries.
• Recognize indicators of abuse and neglect.

Communicating with Pediatric Patients

• Children differ anatomically, physically, and emotionally from adults.
• Pediatric assessment challenges due to fear, inability to communicate, and caregiver anxiety.
• Pediatrics can offer special rewards like seeing rapid recovery.

Growth and Development Stages

1. Infancy (0-1 year):

   • Neonatal: First month
   • 0-2 months: Mostly sleep, can’t differentiate people, cry as expression.
   • 2-6 months: Recognize caregivers, more interaction.
   • 6-12 months: Mobile, risk of choking.

2. Toddler (1-3 years):

   • Rapid growth, increasing injuries due to exploration.
   • Stranger anxiety, resist separation.
   • Assessment: Start away from painful areas.

3. Preschool (3-6 years):

   • Imaginative and fearful of pain.
   • Can describe pain, trust issues.
   • Use simple explanations.

4. School Age (6-12 years):

   • Understand more about illness and death.
   • Adult-like assessment.
   • Involve child in choices.

5. Adolescents (13-18 years):

   • Physically similar to adults but emotionally still children.
   • Risk-taking behaviors.
   • Involve in care decisions, respect privacy.

Anatomy and Physiology Differences

• Respiratory System: Smaller airways, higher oxygen demand.
• Circulatory System: Faster heart rates.
• Nervous System: Immature and fragile.
• Gastrointestinal System: Larger organs, less protection.
• Musculoskeletal System: Softer bones, growth plates.
• Integumentary System: Thinner skin, more heat/fluid loss.

Patient Assessment

• Pediatric Assessment Triangle (PAT):
  • Appearance, Work of Breathing, Circulation to Skin
• Hands-on ABCs: XABCs
  • X: Exsanguination
  • A: Airway
  • B: Breathing
  • C: Circulation
  • D: Disability
  • E: Exposure

Transport Decision

• Rapid transport if serious conditions or mechanisms of injury.
• Consider ALS and specialty facilities.

Specific Emergencies Management

Respiratory Emergencies

• Airway Obstruction: Coughing and obstructions require different interventions based on age.
• Asthma: Wheezing, treat with oxygen and medications.
• Pneumonia: Supportive treatment, bronchodilators if wheezing.
• Croup & Epiglottitis: Infection caused, requires different approaches.
• Bronchiolitis & Pertussis: Viral infections needing supportive care.

Shock

• Types: Dehydration, infection, etc.
• Symptoms: Tachycardia, poor capillary refill, altered mental status.
• Management: Ensure open airway, provide oxygen, control bleeding.

Neurologic Emergencies

• Seizures: Manage airway, provide oxygen.
• Meningitis: Recognition and protective measures.

Gastrointestinal and Poisoning Emergencies

• Dehydration: Recognize signs, ensure transport.
• Poisoning: Identify substance, manage airway and shock.

Trauma Emergencies

• Head and Spine Injuries: Special considerations due to head size.
• Burns: Higher risk due to skin characteristics.
• Extremity Injuries: Growth plates vulnerable.

Child Abuse and Neglect

• Recognize signs and document objectively.
• Report all suspicions.

SIDS and ALTE

• SIDS: Sudden death, manage family support.
• Apparent Life-Threatening Events: Requires evaluation and transport.

Conclusion

• Review understanding of pediatric anatomy.
• Assessment questions and typical scenarios.

This chapter emphasizes understanding pediatric anatomical and physiological distinctions, appropriate assessment and emergency response, and recognizing signs of abuse and neglect.