Hello and welcome to Chapter 35, Pediatric Emergencies of the Emergency Care and Transportation of the Sick and Injured, 12th edition. After you complete this chapter and the related coursework, you will understand the anatomy and physiology of the child as compared to the adult. You will learn the appropriate assessment and care for all the types of illnesses and injuries affecting children of all ages, including patterns based on size, and special body systems injuries. You will also learn the indicators of abuse and neglect and the medical and legal responsibility of an EMT. So let's get started.
Children differ anatomically, physically, and emotionally from adults. The illness and injuries that children sustained and their responses to them vary based on age and developmental level. It's important to remember that children are not just small adults.
Depending on his or her age, the child may not be able to tell you what's wrong. Fear of EMS providers and pain can make the child difficult to assess. Parents or primary caregivers may be stressed, frightened, or behaving irrationally.
For these reasons, pediatrics, the specialized medical practice devoted to the care of young patients, can be challenging. Once you learn how to approach children of different ages and what to do, to expect when caring for them, you will find that treating children also offers some very special rewards. Their innocence and openness can be appealing.
Children often respond to treatment much more rapidly than adults do. So first, let's start with communicating with the patient and the family. Caring for an infant and child means that you must care for the patients and caregivers as well. Family members or caregivers often need emotional support. A calm parent usually results in a calm child.
The parent can often assist you with the child's care. An agitated parent means the child will act the same way, which may make the child's care more difficult. So remain calm, efficient, professional, and sensitive.
Growth and development. Many physical and emotional challenges and changes occur during childhood. Childhood extends from birth to age 18. The thoughts and behaviors of the children as a whole are often grouped into five different stages.
So first is the infancy, and this is the first year of life. Then there's the toddler, and that's ages one to three years. Then preschool age.
That is three to six. Then school age, that's age six to 12. And then adolescence from 13 to 18. So first, let's talk about the infant. The infancy is usually defined as the first year of life. First month after birth is called the neonatal or newborn period.
Okay, so then we're going to, let's break it down a little bit more. So zero to two months, infants. Less than two months spend most of their time sleeping and eating. And infants cannot tell the difference between parents and strangers. So crying is one of the main modes of expression.
An unconsolable infant, after all obvious needs have been addressed, could be a sign of a significant illness. Their heads have a relatively larger surface area between area, which predisposes them to hypothermia. All right, so ages 2 to 6 months, they can recognize their parents or caregivers and turn their head towards a loud sound or familiar voice. Persistent crying, irritability, or lack of contact can be an indicator of a serious illness, depressed mental status, or a delay in development. And then from 6 to 12 months, they become mobile, which predisposes them to physical danger.
They could place things in their mouth, which leads to choking or poisoning, and they may cry if separated from their parents or caregivers. Persistent crying or irritability can be a symptom of a serious illness. So when we're talking about assessing an infant, we begin assessment by observing the infant from a distance.
We let the caregiver continue to hold the baby during the physical assessment. Provide as much sensory comfort as possible. Do any painful procedures at the end of the assessment process. Complete each procedure efficiently and avoid interruptions.
Explain each procedure to the parent or caregiver before you perform it because the procedure and the infant's reaction may be upsetting. Alright, so now let's talk about the toddler. After infancy until 3 years, so 1 year to 3 years of age, a child is called a toddler.
Toddlers experience rapid changes in growth and development. From 12 to 18 months, because they are explorers by nature and not afraid, Injuries in this group increase because of the lack of molars. They may not be able to fully chew their food, and this leads to an increase in choking. When we talk about the assessment, they may have stranger anxiety. They may resist separation from caregiver and demonstrate the assessment on a doll or a stuffed animal first, if possible.
They may be unhappy about being restrained or held for procedures. and toddlers can have a hard time describing or localizing pain. So use visual cues, clues, such as the one Baker faces pain scale.
They may be distracted by a toy. Begin your assessment at the feet or away from the location of pain if possible. Persisting cries or irritability can be a symptom of a serious injury. Previous medical experiences may lead to hesitation towards you.
If a parent or caregiver is unavailable, reassure the child using simple words and a calm, soothing voice. Okay, now after the toddlers, we're into that preschool-aged child. And this is ages 3 to 6 years old.
They can have a rich imagination and can be fearful about pain. They may believe injury is a result of earlier bad behavior. So when I talk about the assessment, they can understand directions and be specific in describing their painful areas.
Despite increased ability to communicate, much of the history must still be obtained from the caregivers. Communicate simple and directly, appealing to the child's imagination may help facilitate the examination process. Do not lie to this patient because it'll be hard to regain lost trust.
The patient may be easily distracted by games or toys or conversation and begin the assessment at the feet and move towards the head. Use adhesive bandaging to cover the site of an injection or a small wound. And modesty is developing, so keep the child covered as much as possible.
Okay, so after the toddler and the school age. We're going to move to the school age, and this is 6 to 12. At this stage, children begin to understand death is final, but their understanding of death is and why it occurs is still unrealistic. Assessment begins to be more like an adult to help gain trust, talk to the child, not just the caregiver.
The child is probably familiar with the process of a physical exam. Start with the head and work towards the feet as in with an adult assessment. And if possible, give the child choices. For example, ask only the type of questions that let you control the answer. Allow the child to listen to his or her own heartbeat through the stethoscope.
These children can understand the difference between physical and emotional pain. So give them simple explanations. about what is causing their pain and what will be done about it. Ask the parents or caregivers advice about which distraction will work best.
Okay, and after that, we're going to get into the adolescents. And this is ages 13 to 18, physically similar to adults, but they are still children on an emotional level and time of... This time they're doing experimentation and taking risk behaviors.
So adolescents can often understand very complex, complex concepts and treatment options. So allow adolescents to be involved in their own care. An EMT of the same gender should perform the physical exam if possible to lessen the stress of the event.
Allow the adolescents to speak openly and ask questions. And risk-taking behaviors are common at this age. Female patients can be pregnant, so adolescents also have a clear understanding of the purpose and meaning of pain. So, let's start to talk about the anatomy and physiology.
Okay, so the body is growing and changing rapidly during childhood. You must understand the physical differences between children and adults and alter your patient care accordingly. First, we're going to talk about the respiratory system. So, the anatomy of a pediatric airway differs from adults.
Pediatric airway is smaller in diameter and shorter in length. and lungs are smaller. The heart is higher in the child's chest.
The neck opening is higher and positioned more anteriorly, and the neck appears to be non-existent. As children develop, the neck gets proportionately longer as the vocal cords and epiglottis achieve a correct adult position. The occiput is larger and rounder, which requires requires more careful positioning of the airway. The tongue is larger relative to the size of the mouth and in a more anterior location in the mouth. A child's tongue can easily block the airway.
A long, flappy U-shape epiglottis in infants and toddlers is larger than the adults, and the rings of cartilage in the trachea are less developed and may easily collapse if the neck is flexed or hyperextended. The upper airway has a narrowing funnel shape compared to the cylinder shape of the lower airway. So the diameter of the trachea in infants is about the same size as a drinking straw.
So this means that airways can easily become obstructed and also that the infants, they are nose breathers and they may require suctioning and airway maintenance. And the respiratory rate is from... 20 to 60 is normal for the newborn. So children also have an oxygen demand twice of that from the adult. The muscles of the diaphragm dictate the amount of air the child inspires.
Anything that places pressure on the abdomen of a young child can block the movement of the diaphragm and cause respiratory compromise. You must make and use caution when applying the straps of a spinal immobilization device because it may hinder the tidal volume. Gastric distension can interfere with movement of the diaphragm and lead to hypoventilation.
Breath sounds are more easily heard because of their thinner chest walls and less air is exchanged with each breath. So detection of poor air movement or complete absent of breath sounds. may be more difficult.
The circulatory system. It's important to know the normal pulse ranges when evaluating children. An infant's heart rate can beat 160 times or more in a minute, and children are able to compensate for decreased perfusion by constricting the vessels in the skin. Signs of vasoconstriction include pallor, and that's an early sign.
Weak distal pulses in the extremities, delayed cap refill, and cool hands or feet. The table on this slide lists responsive pediatric pulse rates. All right, so let's move on to the nervous system. And so the differences are the pediatric nervous system is immature, underdeveloped, and not well protected.
Head-to-body ratio of infant and young children is disproportionately larger. The occipital region of the head is larger, which increases the momentum of the head during the fall. The subarachnoid space is relatively smaller, leaving less cushioning for the brain, and the brain tissue and the cerebral vasculature are fragile and prone to bleeding from shearing forces.
The pediatric brain also requires a higher amount of cerebral blood flow, oxygen, and glucose than does the adult brain tissue. and it places them at risk for secondary brain damage from hypotension and hypoxic events. Spinal cord injuries are less common in pediatric patients. If cervical spine is injured, it is more likely to be an injury to the ligaments because of a fall. For suspected neck injuries, perform manual inline stabilization or follow local protocols.
The gastrointestinal system. Okay, so abdominal muscles are less developed in pediatric patients. This gives them less protection from trauma. liver spleen and kidneys are proportionately larger and situated more anteriorly so they are more prone to bleeding and injuries because of minimum direct impact the muscular skeletal system the child's bones are softer than those of an adult and open growth plates allow bones to grow during childhood so as a result of open growth plates Bones are softer and more flexible, making them prone to stress fractures, and bone length discrepancies can occur if there is an injury to the growth plate.
The bones of an infant's head are flexible and soft, and soft spots called fontanelles are located at the front and back of the head. The fontanelles can be used for an assessment tool For such issues as increased intracranial pressure or dehydration, the thoracic cage of children is highly elastic and pliable because it is primarily composed of cartilage connective tissue. The ribs and vital organs are also less protected by muscle and fat. Intimigatory system of the pediatric population differs in a few ways. The skin is thinner with less subcutaneous fat.
Composition of the skin is thinner and tends to burn more deeply and easily with less exposure. And the higher ratio of body surface area to body mass can lead to a larger fluid loss and heat losses. So let's get into our patient assessment.
And we're going to start with that scene size up. Okay, so assessment begins at the time of that dispatch, remember. So prepare mentally for approaching and treating an infant. or child. Plan for pediatric scene size-up, pediatric equipment, and age-appropriate patient physical assessments.
If possible, collect the age and gender of the child, location of the scene, mechanism of injury, or nature of illness, and chief complaint from dispatch. Note the position in which the patient is found. The patient may be a safety threat if he or she has an infectious disease. So complete an environmental assessment. Okay, so next we're going to talk about the PAT.
And the PAT is the Pediatric Assessment Triangle. And we're going to, the objective of this primary assessment is to identify and treat immediate and potential life threats. So we're going to use the pediatric assessment triangle to determine if the patient is sick or not sick.
And it can be performed in less than 30 seconds. Okay, so let's talk about it. The PAT consists of three elements and requires no equipment.
And so the first is going to be the appearance. And this is the muscle tone or mental status. Then the work of breathing. And then finally the circulation.
Okay. So the appearance. Note the level of consciousness or interactiveness in muscle tone. These will provide you with information about the adequacy of the patient's cerebral perfusion and overall function of the central nervous system. The mnemonic T-I-C-L-S, tickles, can also help to determine if the patient is sick or not.
Tickles includes tone, interactiveness, consult. console ability, look or gaze, and speak, speech or cry. Then is the work of breathing.
So signs of increased work of breathing often presents with abnormal airway noise, accessory muscle use, retractions, head bobbing, nasal flaring, tachypnea, and the tripod position. Okay, so the body will attempt to compensate for abnormalities in oxygen. and ventilation.
And then finally, the third is the circulation to the skin. So, pallor of the skin and mucous membranes may be seen in compensated shock. It may also be a sign of anemia or hypoxia.
Modeling is another sign of poor perfusion. And cyanosis reflects a decreased level of oxygen in the blood. From the PAT findings... you will decide if the pediatric patient is stable and requires urgent care. If the patient's unstable, assess the XABCs, treat any life threats, and transport immediately.
If the patient is stable, continue with the remainder of the patient's assessment process, perform necessary interventions, and discuss transport options with the parents and caregivers. Hands-on. So we're going to really look for, do a hands-on assessment.
And we're going to assess and treat those life threats as we identify them following the X ABCs. So the X is a signiation, airway, breathing, circulation, disability, and exposure. Now we're going to talk about those next, okay?
So if the airway is open and the patient can adequately keep it open, assess respiratory adequacy. If the patient is unresponsive or has difficulty keeping the airway clear, ensure that is... properly positioned and that it's clear of mucus, vomit, blood, and foreign bodies.
Always position airway in the neutral sniffing position and establish whether the patient can maintain his or her own airway. Then breathing. So look, listen, and feel technique.
We're going to place both hands on the patient's chest to feel for chest rise and fall of the chest wall. Belly breathing in infants is considered adequate because of the soft... pliable bones of the chest and the strong musculature diaphragm. When it comes to circulation, we must determine if the patient has a pulse, is bleeding, or is in shock. In infants, we're going to palpate the brachial pulse or femoral pulse.
In children older than one year, we're going to palpate the carotid pulse. Strong central pulses indicate that the child is not hypotensive, but it does not rule out the possibility of compensation. Weak or absent peripheral pulses indicates decreased perfusion. And tachycardia may be an early sign of hypoxia or shock or a less serious condition such as a fever, anxiety, pain, or excitement.
Interpret the pulse within the context of the overall patient history, the PAT, and the primary assessment. A trend of an increasing or decreasing pulse rate may suggest worsening hypoxia or shock. or improvement after treatment.
Feel the skin for temperature and moisture and estimate the cap refill time. D, when it comes to disability, we're going to use the AFPU score or the pediatric Gall-Ascal coma score to assess level of consciousness. We want to check the responsiveness of the pupils and look for symmetrical movement of the extremities. Pain is present with most types of injuries. So assessment of pain must take into consideration the developmental age of the patient.
And then E is exposure. So the hands-on ABCs require that the caregiver remove part of the patient's clothing to allow observation of the face, chest wall, and skin. The pediatric population is more prone to hypothermic events during the course of the treatment than the pediatric population.
due to immature thermoregulatory system, thinner skin, and lack of that subcutaneous fat. So infants and young children should be kept warm during the transport or when the patient is exposed to excessive or reassessing an injury. And then D is that transport decision, okay?
So if the pediatric patient is in stable condition, Obtain a patient history, perform a secondary assessment at the scene, transport, and provide additional treatment as needed. Okay, so rapid transport is indicated if any of the following conditions exist. So if there's a significant mechanism of injury, if there's a history of capable of or with a serious illness, if a physical abnormality is noted during the primary assessment, or if a potentially serious anatomic abnormality or significant pain or an abnormal level of consciousness, altered mental status, or any signs of or symptoms of shock. We want to also consider the following. So we want to know the type of clinical problem, the expected benefits of advanced life support treatment in the field.
and local EMA systems treatment and transport protocols, your comfort level, and also the transport time to the hospital. If the pediatric patient condition is urgent, then immediate transport to the closest facility should be initiated. Special facilities such as trauma centers or children's hospitals have the training, staff, and equipment to provide complete care for all levels of pediatric patients. So the most appropriate facility is not always the closest.
So you want to ask yourself, can I deliver this pediatric? patient to the most appropriate facility without the risk or delay to the pediatric patient? If the answer is no, you need to transport the patient to the closest facility. If patients weigh less than 40 pounds who do not require spinal immobilization, you should transport them in a car seat.
Mount a car seat to the stretcher and follow the seat manufacturer's instructions to Secure the car seat to the captain's chair. Patients younger than two years must be transported in a rear-facing position because of the lack of mature neck muscles. For pediatric patients who require spinal immobilization, the patient should be immobilized to a long backboard or other suitable spinal immobilization devices. Pediatric patients in cardiopulmonary arrest should be on a device that can be secured to the stretcher. You should not use the pediatric patient's car seat.
The goal is to secure and protect the patient for transport in the ambulance. Okay, so history taking. Your approach to the history will depend on the age of the pediatric patient.
Historical information for the infant, toddler, or preschool age child. will have to be obtained from the parent or caregiver when dealing with adolescent most information will be obtained from the patient sexual activity possibility of pregnancy and drugs or alcohol should be obtained from the patient in private questioning the parent or child about the immediate illness or injury should be based on the child's chief complaint when interviewing the parent caregiver or child about the chief complaint, obtain the following. You want to know the mechanism of injury or the nature of illness, how long the pediatric patient has been sick or injured, the key events that led to the injury or illness, the presence of fever, effects of the illness or injury on the pediatric patient's behavior, and the pediatric patient's activity level, recent eating, drinking, and urine output. change in bowel or bladder habits, or the presence of vomiting, diarrhea, abdominal pain, and the presence of rashes.
You want to obtain the name and phone number of the caregiver if they are not able to come to the hospital with you. And then let's talk about the history taking as far as the sample history. So it's the same as the adults.
But the questions should be based on the pediatric patient's age and development stage of life. The process for obtaining OPQRST is the same for the children as it is the adults. So questions should be based on the pediatric patient's age and developmental stage as well. Okay, and then your secondary assessment. So a secondary assessment of the entire body should be used.
When pediatric patients have the potential for hidden illness or injuries. Okay, so it may help identify problems that were not as obvious during the primary assessment, but over time, the presenting signs and symptoms have become more apparent. Use the DCAP-BTLS mnemonic.
A focused assessment should be performed on a pediatric patient without life-threatening illness or injuries. Infants, toddlers, and preschool-aged children who do not have life-threatening illness or injuries should be assessed starting at the feet and ending with the head. School-aged children and adolescents can be assessed using the head-to-toe approach, as with the adult patients.
So when it comes to that physical exam, we're going to look at the head, bruising, DCAP-BTLS, and of course assess the fontanelles and infants. And with the nose, nasal congestion needs to be cleared because it can cause respiratory distress. So you could use a bulb syringe or a suction cap, a soft suction cap.
Then the ears, you have to look for the drainage in the ears of this indicates the skull fracture, just with the same as adults. And the mouth, of course, we're looking for bleeding or anything that could cause an airway obstruction. And of course, the mouth, as with the adolescent onset or child onset of diabetes, we want to note the smell of the brain.
The neck, we're going to look for tracheal deviations, same as the adult in the chest. Decap B TLS, we're going to look, listen, and feel to the chest area and the clavicles. Then the back, we're going to look for decap B TLS. The abdomen, we're going to inspect for distension. We're going to palpate and note any guarding or pain or tenderness.
And then, of course, looking for the seat belt abrasions or bruising. And then the extremities, we're going to do PMS. looking for some symmetry and then just rotate to see if there's full range of motion in the extremities. Vital signs. So, of course, these are used to assess circulatory status, but there are some important limitations when it comes to pediatric patients.
So normal heart rates vary in age with those pediatric patients, and blood pressure is... Also, you usually not assess in pediatric patients younger than three years old. And then assessment of the skin is a better indication of the pediatric patient's circulatory status. So use appropriately sized equipment when assessing a pediatric patient's vital signs. You have to use a cuff that covers two-thirds of the pediatric patient's upper arm.
All right, so When we talk about how to formulate a blood pressure in children 1 through 10 years old, we're going to basically just take the child's age in years and multiply it by 2 and then add it to 70. So a systolic blood pressure is a, that's a useful tool in determining blood pressure in children. But the circle... Respiratory rates can also be difficult to interpret, so count the respiratory or the respirations for at least 30 seconds and then double it.
And in infants and children younger than three, evaluate respirations by assessing the rise and fall of the abdomen. We're going to assess the pulse rate by counting for at least a minute, noting quality and regularity. okay so normal vital signs in a pediatric patient of course are going to vary with age we want to assess respirations and then pulse and then blood pressure last and we're going to compare the size of the pupils with each other and pulse ox is a valuable tool to measure the oxygen saturation in a pediatric patient with respiratory distress and then of course we're going to reassess and uh 15 minutes if they're in stable condition and every five if they're in unstable and we of course continually monitor respiratory effort skin color condition and level of consciousness or their interactiveness parents and caregivers may be able to assist you by calming and reassuring that patient down and then of course we have to communicate and document all that info to the emergency department personnel okay now we're going to get into specific emergencies and management of those types of emergencies, okay? So specifically to respiratory emergencies, it's the leading cause of cardiopulmonary arrest in the pediatric population.
Failure to recognize and treat declining respiratory status will lead to death. During respiratory distress, the pediatric patient is working hard to get to the hospital. harder to breathe and will eventually go into respiratory failure if left untreated. In the early stages of respiratory distress, you may not note changes in the pediatric patient's behavior such as combativeness, restlessness, and anxiety. Signs and symptoms of increased workup breathing include nasal flaring, abnormal breath sounds, accessory muscle use, and they might be in the tripe.
position as the pediatric patient progresses to possibly respiratory failure efforts of to breathe decrease the chest rise less with inspiration and the body has used up all its available energy stores and cannot continue to support the extra work of breathing changes in behavior will also occur until the pediatric patient demonstrates an altered level of consciousness patients may also experience periods of apnea as the lack of oxygen becomes more serious The heart muscles become hypoxic and the heart rate slows down. Respiratory failure does not always indicate airway obstruction. It may indicate trauma, nervous system problems, dehydration, or metabolic disturbances.
A pediatric patient's condition can progress from respiratory distress to respiratory failure at any time. A child with an infant or respiratory distress needs supplemental oxygen. Assist ventilation with a bag valve mask and 100% oxygen if needed.
Allow the patient to remain in a comfortable position. Okay, so airway obstruction. Children can obstruct their airway with any object that can fit in their mouth.
In cases of trauma, teeth may have been dislodged into the airway. Blood. Vomit or other secretions can also cause mild or severe airway obstructions. Infections including pneumonia, croup, epiglottitis, and bacterial tracheitis can also cause airway obstructions. Infections should be considered if patient has congestion, fever, drooling, and cold symptoms.
The figure on this slide shows the effects of epiglottitis, and this is an infection that can cause an upper airway obstruction in the pediatric patients. Obstructions by a foreign object may involve the upper or lower airway. It may be partial or complete.
Signs and symptoms frequently associated with a partial upper airway obstruction include decreased or absent breath sounds and stridor. Signs and symptoms of a lower airway obstruction include wheezing and or crackles. The best way to auscultate breath sounds in a pediatric patient is to listen on both sides of the chest and at the armpit level.
Immediately begin treatment of a pediatric patient with an airway obstruction. If the patient is conscious and coughing forcefully and someone... saw him or her ingest a foreign object, encourage the child to cough to clear the airway. If you see signs of severe airway obstruction, attempt to clear the airway immediately. If an infant is conscious with a complete airway obstruction, we're going to perform up to five back blows and chest thrusts.
If the child is conscious with a complete airway obstruction, we're going to perform abdominal thrusts, and this is the Heimlich maneuver. We need to use a head tilt, chin lift, and a finger sweep to remove a visible foreign body in an unconscious pediatric patient. Chest compressions are recommended to relieve a severe airway obstruction in an unconscious pediatric patient. Okay, so... Let's talk about asthma specific.
This is a condition in which the smaller airway passages, the bronchioles, have become inflamed and they swell and produce excessive mucus, which leads to difficulty breathing. It's a true emergency if not promptly identified and treated. Common causes for an asthma attack include upper airway or respiratory infection, exercise, exposure to cold air or smoke. and emotional stress.
Signs and symptoms are wheezing, cyanosis, respiratory arrest, or the tripod position. What we want to do is treatment of that pediatric patient with asthma. We want to allow the patient to maintain a position of comfort.
We want to administer supplemental oxygen, albuterol alone with ibuprofene via MDI or nebulizer, and um contact advanced life support and assist ventilations if needed. Okay that was asthma. Now let's get into pneumonia. Pneumonia is a general term that refers to an infection of the lungs.
often a secondary infection. It occurs after a pre-existing infection such as a cold. It can also occur from chemical ingestion or direct lung injury or a submersion event. Children with diseases causing immunodeficiency are at an increased risk for developing pneumonia. Incidence is greatest during fall and winter months.
Presentation in a pediatric patient. Unusual rapid breathing, or they'll breathe with grunting or wheezing sounds. There's also nasal flaring, tachypnea, hypothermia or fever, or unilateral diminished breast sounds or crackles over the affected lung segments.
So treatment of pneumonia in the pediatric patient will be, primary treatment will be supportive. We want to administer supplemental oxygen if they need it and administer a bronchodilator. It's a chest or if the child's wheezing.
So diagnosis of pneumonia must be confirmed at the hospital. Okay, and then there's croup. So croup is an infection of the airway below the level of the vocal cords and usually caused by a virus. Typically seen in children between six months and three years. It's easily passed between children.
It starts with a cold cough and a low-grade fever. It develops over two days. The hallmark sign of croup is stridor and a seal bark cough. It responds well to oxygen or administration of humidified oxygen.
And bronchodilators are not indicated for croup and can actually make the child worse. And then there's epiglottitis. So that's an infection of the soft tissue in the area above the vocal cords. It's bacterial infection is the most common cause. And since the development of a vaccine against one organism that causes epiglottitis, the incident of this disease has dramatically decreased.
In preschool and school-aged children especially, the epiglottitis can swell. to two or three times its normal size. Children with this infection look ill and they report a very sore throat and high fever. They will often be found in the tripod position and drooling. And then bronchiolitis.
Okay, so specific viral infections of newborns and toddlers often caused by RSV. causes inflammation of the bronchioles. RSV is highly contagious and spread through coughing and sneezing, and viruses can survive on surfaces, and virus tends to spread rapidly through schools and child care centers. More common in premature infants and results in copious secretions that may require suctioning. Okay, so it occurs during the first two years of life.
and is more common in males. Most widespread in winter and early spring. And the bronchioles become inflamed, swell, and fill with mucus. Airway of the infants and young children can become easily blocked. So you want to look for signs of dehydration, shortness of breath, and fever.
How we're going to treat bronchiolitis in pediatric patients is we're going to allow the patient to remain in that position of comfort. We need to administer humidified oxygen and consider advanced life support backup. And then there's pertussis. It's a communicable disease caused by a bacterium that is spread through respiratory drop.
As a result of vaccinations, this potentially deadly disease is less common in the United States. The typical signs and symptoms are similar to that of a common cold. cold, sneezing, and a runny nose, and as the disease progresses, the coughing becomes more severe and characterized by a distinctive whoop sound heard during inspiration. Infants infecting with pertussis may develop pneumonia or respiratory failure.
To treat pediatric patients, make sure you keep the airway open and transport. Follow standard precautions, including including wearing a mask and eye protection. Let's talk about some airway adjuncts next.
And these devices that help maintain the airway or system providing artificial ventilation include, so they're OPs and NPs, bite blocks or bag valve mask devices. So the OP, it's designed to keep the tongue from blocking the airway and make suctioning easier. It should be used for pediatric patients who are unconscious and in possible respiratory failure. It should not be used in conscious patients or those who have a gag reflex or who have ingested caustic or petroleum-based products.
The nasal pharyngeal, it's usually well-tolerated and not as likely to cause vomiting. It's used in responsive pediatric patients, used in association with possible respiratory failure, and it's rarely used in infants younger than one year. Should not be used in pediatric patients with a nasal obstruction or head trauma.
When it comes to potential problems with airway adjuncts, the airway with a small diameter may easily become obstructed. with mucus, blood, vomit, or other soft tissues of the pharynx. If the airway is too long, it may stimulate the vagal nerve and slow the heart rate down or enter the esophagus, and that will cause gastric distension.
So it may cause a spasm of the larynx and result in vomiting if inserted into a responsive patient. Nasal pharyngeal airways should not be used when pediatric patients have facial trauma because the airway may be soft and the tissues will cause bleeding into the airway. So when it comes to oxygen delivery devices, treating infants and children who require more than the usual 21% of oxygen that's found in the air, there are several options.
The blow-by technique, and this is at six liters, provides more than 21% oxygen concentration. Nasal cannula at 1 to 6 liters provides 21 or 24 to 44. Non-rebreather at 10 to 15 is up to 95%. And bag valve mask device is 10 to 15 liters. It'll provide nearly 100% concentration.
Use of a non-rebreather mask, a nasal cannula, or a simple face mask sheet. is indicated only for pediatric patients who have adequate respirations or tidal volumes. Children with respirations fewer than 12 breaths a minute or more than 60, an altered level of consciousness, or an inadequate tidal volume, should receive assisted ventilations with a BVM device.
Okay, so now let's go through these oxygen delivery devices. And the blow-by method. This is not nearly as effective as a face mask or nasal cannula, and it also does not deliver that high concentration, but it's better than no oxygen.
Then there's the nasal cannula, and some pediatric patients prefer the nasal cannula, but others find it uncomfortable. Okay, so the figure on the slide shows the blow-by technique and the nasal cannula. And then there's that non-rebreather, and this delivers up to 90% oxygen to that pediatric patient, allows them to exhale all the carbon dioxide without rebreathing it. Then, of course, the bag valve device. This is indicated for pediatric patients who have respirations that are either too slow, too fast, who are unresponsive, or who do not respond in a purposeful way to painful stimulus.
Figures on this slide show a pediatric patient non-rebreather and a one-person bag valve mass ventilation. Remember, there's two-person bag valve mass ventilation, and this procedure is similar to that one-person, except that one rescuer holds the mask on the patient's face and the other maintains the head position while the other ventilates. Usually more effective in maintaining a tight seal as it provides an open airway due to a properly body position. Cardiopulmonary arrest. So most often associated with respiratory arrest, like we said, children are affected differently than adults when it comes to decreasing oxygen concentration.
We want to focus on effective CPR, early use. of an AED and transport. And then shock. So shock, it develops when the circulatory system is unable to deliver a significant amount of blood to those vital organs.
It results in organ failure and eventually cardiopulmonary arrest. Compensated shock in early stages is when the body can still compensate for that loss. And decompensated shock is a later stage, and this is when the blood pressure is falling. pediatric patients the most common cause of shock is includes traumatic injury dehydration severe infection or neurologic injury a severe allergic reaction anaphylaxis or disease of the heart tension pneumo or blood around the heart pediatric patients respond differently to adults than fluid with tooth fluid loss They may respond by increasing their heart rate, increasing respirations, and showing signs of pale or blue skin. Signs of shock in children are tachycardia, poor capillary refill time, so this is going to be greater than two seconds.
They could also have a mental status change. Begin treating shock by assessing the XABCs and intervene when required. So if there's an obvious life-threatening external hemorrhage, the order becomes CAB because bleeding control is the most critical step. And if cardiac arrest is suspected, the order also becomes CAB because chest compressions are essential. So pediatric patients in shock often have increased respirations, but do not demonstrate a fall in blood pressure until the shock is very severe.
We want to limit our management to these simple interventions. We have to ensure the airways open, prepare for artificial ventilation, control bleeding, and give that supplemental oxygen by mask or blow by. We want to keep the patient warm, provide rapid transport to the nearest appropriate facility, and contact advanced life support backup as needed. Okay, so now let's talk about anaphylaxis, so associated with shock. Anaphylaxis is always called anaphylactic shock, and it's a life-threatening allergic reaction that involves a generalized multi-system response to an antigen characterized by airway swelling and dilation of blood vessels, and common causes are insect stings, medications, or food.
Signs and symptoms are hypoperfusion, stridor and wheezing, increased work of breathing, the appearance of restlessness, agitation, and sometimes the sense of impending doom and hives. How we're going to treat it is we're going to try and keep the patient calm, administer oxygen, or assist the parent with administering that prescribed epi autoinjector, and provide rapid transport. Okay, so then there's some bleeding disorders.
And hemophilia is a congenital condition in which the patient lacks one or more of the normal clotting factors. Most forms are hereditary and are severe, predominantly found in the male population. Bleeding may occur spontaneously, and all injuries become serious because of blood loss.
The blood does not clot. We have to transport them immediately, and we're not going to delay. to apply tourniquets for life-threatening hemorrhaging. Neurologic emergencies is what we're going to talk about next.
And of course, we use that mnemonic AEIO tips, and this reflects the major causes of altered mental status. And we just want to understand normal development or age-related changes in behavior and listening carefully to the caregiver's opinion. Signs and symptoms vary from simple confusion to a coma, and we want to manage them focusing on that ABCs.
The first one we're going to talk about is seizures, and of course this is a disorganized electrical activity in the brain. It manifests in a variety of ways, depending on the age of the child. Seizures in infants are very subtle, consisting only of... of a gaze sometimes, sucking motion or bicycling movements. In older children, seizures are more obvious and typically consists of repetitive muscle contractions and unresponsiveness.
And this slide shows the common causes of seizures. Once the seizure stops, the patient's muscles relax, becoming more flaccid or floppy, and the breath becomes labored during the postictal state. Once the pediatric patient regains a normal level of consciousness, the postictal state is over.
Seizures that continue every four hours. a few minutes without regaining consciousness in between or lasting longer than 30 minutes is referred to status epileptics. This reoccurring or prolonged seizures should be considered potentially life-threatening.
If the patient does not regain consciousness or continues to seize, protect the patient from harming him or herself and call for advanced life support backup. How you manage seizures is You want to make sure that you protect the airway, and that's our top priority. You want to place the child in the recovery position if they are vomiting and have the suction available.
Provide 100% oxygen by non-rebreathing mask or blow-by method. And begin bag mask ventilations if there are no signs of improvement. Some caregivers will have given the child a rectal volume dose, okay? and this is prior to our arrival monitor breathing and the level of consciousness carefully and a transport to the appropriate facility meningitis meningitis is the inflammation of tissues or meninges that cover the spinal cord and brain they be being able to recognize a pediatric patient with meningitis is very important some are at a greater risk so we have males newborns Children with compromised immune systems, children who have a history of brain, spinal cord, or back surgery, or children who have head trauma, or children who have shunts, pins, or other foreign bodies within their brain or spinal cord.
Signs and symptoms of meningitis vary depending on the age of the patient. Fever and altered level of consciousness are common. common symptoms in all ages. Children may also experience a seizure, which may be the first sign of meningitis.
In infants younger than two to three months, they could have apnea, cyanosis, fever, a distinct high-pitched cry, or hypothermia. The meningeal irritation or meningeal signs are terms used by doctors to describe the pain that accompanies movement. It often results in characteristic stiff neck.
One sign of meningitis in an infant is increasing irritability and bulging fontanelle without crying. This bacterium that causes a rapid onset of meningitis symptoms often leads to shock and death. Okay, children with the bacterium typically have small pinpoint cherry red spots or a larger purple black rash on their face or body. So the figure on this slide shows the that type of of rash and typically with the small cherry point spots. All pediatric patients with suspected meningitis should be considered contagious.
You want to follow standard precautions with these patients and follow up to learn the diagnosis. Because if exposed to the saliva or respiratory secretions, you need to receive antibiotics. Treatment of patients with this suspected meningitis, you want to give them oxygen and assist ventilations if needed.
Reassess vital signs frequently. during transport to the highest level of service available. All right, so gastrointestinal emergencies.
Never take a complaint of abdominal pain lightly because a large amount of bleeding may occur within the abdominal cavity without any outward signs of shock. Monitor for signs and symptoms of shock. Complaints of gastrointestinal origin are common in pediatric patients. ingestion of certain foods or unknown substances. In some cases, the pediatric patient will be experiencing abdominal discomfort with nausea, vomiting, and diarrhea.
And remember that vomiting and diarrhea can cause dehydration. Appendicitis is also very common and if you suspect appendicitis, promptly transport to the hospital for further eval. And of course we have to obtain the history from the caregiver and in particular how many wet diapers, is the child tolerating liquids, how many times has a child had diarrhea, and when he or she cries are tears present.
All right, so next we're going to talk about poisoning emergencies. And poisonings, unfortunately, are common in children. They can occur by ingesting, inhaling, injecting, or absorbing a toxic substance.
Common sources of poisonings in children are alcohol, aspirin, cosmetics, household cleaning products such as bleach, household plants, iron, prescription medicines. illicit drugs, or vitamins. And the signs and symptoms of poisonings are going to vary widely.
It's going to depend on the substance and the age and weight of the child. They could look normal at first or be confused, sleepy, or unconsciousness. And some substances only take one pill to be lethal in a small child. Infants may be poisoned as a result of being fed harmful substances by a sibling, parent, or caregiver. So be alert to signs of abuse and may be exposed in a setting in which a harmful substance are being smoked.
So after you have completed the primary assessment, ask the patient or caregiver the following questions. What substance was involved? Approximately how much of it or how long ago?
And are there any changes in the behavior or level of consciousness? And was there any choking or coughing after the exposure? Contact medical control for assistance in identifying poisons. In treatment of the poison pediatric patient, of course, we're going to perform that external decon, assess the ABCs, and monitor breathing, provide oxygen and ventilations if necessary. And if the child demonstrates signs of shock, we want to position them supine.
Keep the child warm and transport promptly. In some cases, give activated charcoal according to medical control or local protocol. So dehydration emergencies and management.
Dehydration occurs when fluid loss is greater than fluid intake. Vomiting and diarrhea are also most common causes of dehydration. If left untreated, dehydration can lead to shock and death. Infants and children are at a greater risk than adults for dehydration because their fluid reserves are smaller than those of adults. Life-threatening dehydration can overcome an infant in a matter of hours.
Signs and symptoms of mild are dry lips, decreased saliva, or a few wet diapers. Signed in symptoms of moderate are sunken eyes, sleepiness, irritability, loose skin, sunken fontanelles, and then severe dehydration is mottled, cool, clammy skin, delayed cap refill, and increased respirations. Treating dehydration in pediatric patients.
So we need to assess those ABCs. If dehydration is severe, advanced life support. backup is necessary. Okay, all patients with moderate or severe dehydration have to be transported.
All right, so fever emergencies is what we're going to talk about next. An increase in body temp, usually in response to an infection. Temperatures of 100 degrees 0.4 or higher are considered abnormal. And fever is rarely life-threatening.
but fever with a rash can be a sign of a serious condition such as meningitis. Common causes of fever in pediatric patients include infection, status epilepsis, cancer, or drug ingestion such as aspirin, arthritis, and systemic lupus, high environmental temperatures, or fever. is a result of the internal body mechanism in which heat generation is increased and heat loss is decreased.
An accurate body temp is an important vital sign. A rectal temperature is the most accurate for infants and toddlers. Depending on the source of that infection, the pediatric patient may present with signs and symptoms of respiratory distress, shock, a stiff neck, rash, skin that is hot to the touch, flushed cheeks, seizures, and an infant's bulging fontanelles.
You want to assess for any other signs and symptoms, provide rapid transport and management, and follow standard precautions if you suspect a communicable disease is present. When it comes to febrile seizures, these are extremely common. And in children between six months to six years, most pediatric seizures are a result of the fever alone, which is why they are called febrile seizures. They typically occur in the first day of the febrile illness.
characterized by generalized tonic-clonic seizure activity. They last fewer than 15 minutes with no or little postictal state. And they may be a sign of a more serious problem, though, such as meningitis.
Of course, we're just going to assess the ABCs, provide those cooling measures, and all patients with febrile seizures need to be seen at the hospital. Okay. Next, we're going to talk about drowning emergencies. And this is the second most common cause of unintentional death in children age one to four in the U.S. Children often fall into the swimming pools and lakes, but may drown in the bathtubs and even puddles or buckets of water.
Older adolescent drown when swimming or boating and alcohol can be a cause. OK, so the principal condition. That results from drowning is lack of oxygen.
Even a few minutes without oxygen affects the heart, lungs, and brain. Submersion in icy water can lead to hypothermia. Diving into water increases the risk of neck and spinal cord injuries. So signs and symptoms are going to vary based on the length and time of submersion.
And they could be coughing or choking, difficulty breathing, altered seizure, or unresponsive. So you're going to manage them by requesting advanced life support, assess the management of ABCs, administer oxygen or BVM. And if trauma is suspected, have a cervical collar in place and put the patient on the backboard. So pediatric trauma emergencies, these are... Unintentional injuries are the number one killer of children in the U.S.
So quality of care in the first few minutes after they've been injured is going to have an enormous impact on that child's chances for complete recovery. The muscles and bones of children continue to grow well into adolescence. And adolescents are prone to fractures of the extremities. A fracture of the femur is very rare in pediatric patients, but when it occurs, it is a source of major blood loss. So children's bones and soft tissues are less well developed than those of an adult, and therefore the force of the injury affects these structures differently.
Because a child's head is portionately larger than the adult's, it exerts greater stress on the neck structures during a deceleration injury. Children are often injured because of their underdeveloped judgment and their lack of experience. So always assume that a child has serious neck or head injuries. When it comes to vehicle collisions, the exact area that is struck depends on the child's height and the position of the bumper at the time of impact.
High energy injuries to the head, spine, or abdomen, pelvis, or legs. When it comes to sport activities, children are often injured in organized sports activities. So head and neck injuries can occur after high-speed collisions.
Remember to mobilize the cervical spine when caring for children with sports-related injuries. When it comes to head injuries, these are common in children, once again, because of the child's head in relation to the body. An infant also has a softer, thinner skull, and it could result in injury to the brain tissues.
The scalp and facial vessels can bleed very easily and may cause a great deal of blood loss if not controlled. And then nausea and vomiting are common signs and symptoms of head injuries in children. When it comes to mobilization, it's necessary for all children who have a possible head injury or spine injury after a traumatic event.
It can be difficult because of the child's body portions. So we can mobilize a pediatric patient into a car seat to see the skill drill 35-6. When it comes to chest injuries, it could be a result of blunt rather than penetrating trauma.
And because the chest is flexible in children, it can produce a flailed chest. Although there are no external signs of injury, there may be significant injuries within the chest. Abdominal injuries are common.
We have to monitor for shock. And if the patient shows signs of shock, we need to prevent hypothermia by keeping them warm with blankets. and if the patient is has a low pulse we should ventilate and monitor during transport the figure on this slide illustrates the impact of blood loss on the potential for developing shock so all children with abdominal injuries should be monitored closely for signs and symptoms of shock burns So they're generally considered more serious than burns to adults.
Infants and children have more surface area to total body mass. So children are also more likely to go into shock, develop hypothermia, and experience airway problems. The most common ways that children are burned are exposure to hot substances, such as scalding water in the bathtub, hot items on the stove, Exposure to caustic substances such as cleaning solvents or paint thinners and older children are more likely to be burned by flames from the fire.
Infection is also common following a burn injury, so sterile techniques should be used in handling the skin of children with burn wounds if possible. We want to consider the possibility of abuse in any burn situation and we want to make sure we report. any information about suspicions to the appropriate authorities.
Severity of burns, there could be minor, moderate, or severe. So minor are partial thickness burns involving less than 10%, moderate are partial thickness burns involving 10 to 20, severe is any full thickness burn, a partial thickness burn involving more than 20%, or any burn involving the hands, feet, face, airway, or genitalia. When it comes to burns, the pediatric patients are going to be managed the same as adults.
Injuries to the extremities. So children have immature bones with active growth centers and growth of the long bones occur from the ends of the specialized growth plates. Now the growth plates are potential weak spots, incomplete or unprotected. green stick fractures can occur. Generally, extremity injuries in children are managed in the same way as adults.
Pain management. So the first step in pain management is recognizing the patients in pain. Since some pediatric patients use non-verbal or limited vocabulary, look for visual clues and use the Juan Baker Faces Pain Scale. You are limited to the following pain interventions, so positioning, ice packs, and extremity evaluation.
Those interventions will decrease the pain and swelling to the injury site, and then ALS interventions may be needed. Another important tool is kindness and providing emotional support. Okay, so next we're going to talk about disaster management.
Use the jump start. triage system instead of start triage it's jump start and this is intended for patients younger than eight or who appear to weigh less than a hundred pounds there are four triage categories with jumpstart and designated by colors corresponding to different levels of urgency so um we are going to have the green tag and the green is minor not an immediate treatment care of treatment. And these are people are able to walk except of course for the infants.
And then there's yellow that's delayed. And yellow is they have spontaneous breathing, they have peripheral pulses, and they're responsive to painful stimuli. When it comes to red tag, these are the immediate, and that is apnea and respiratory failure, breathing but without a pulse, or inappropriate painful response. So apnea.
and without a pulse or apnea and unresponsive to rescue breathing are black tagged. So the figure on the screen illustrates jumpstart triage system. All right, so child abuse and neglect.
Child abuse means an improper or excessive action that injures or otherwise harms a child or infant. This includes physical abuse, sexual abuse, neglect. war and emotional abuse. Over half a million children are victims of abuse annually. Many of these children suffer life-threatening conditions and some die.
If you suspect child abuse and you need to report it, this abuse is likely to happen again, perhaps causing permanent injury and even death. Signs are child abuse occurs in every socioeconomic status. So you must be aware of the patient's surroundings and document your findings objectively.
You may be called to testify in abuse cases, and it's essential that you record all findings. You have to ask yourself, is the injury typical for the developmental level of the child? Is the mechanism of injury reported consistent?
Is the parent or caregiver behaving appropriately? Is there evidence of drinking or abuse at the scene? Was there a delay in seeking help for the child?
And is there a good relationship between the caregiver and the child? Does the child have multiple injuries at different stages of healing? Does the child have an unusual mark or bruise that may be caused from cigarettes, heating, or branding injuries? Does the child have several types of injuries?
And does the child have any burns on the hands or feet that involve a glove distribution? Is there an unexpected decreased level of consciousness? Is the child clean and appropriate weight for their age? Is there any rectal or vaginal bleeding? And what does the home look like?
Is it clean or dirty? Is it warm or cold? And is there food? The mnemonic child abuse may help you remember the points to look for. So bruises.
You want to observe the color and location of the bruises. Bruises on the back, buttocks, or face are suspicious and are usually inflicted by a person. Then burns to a penis, testicles, or vagina or buttocks are usually also inflicted by someone.
Burns that encircle a hand or foot to look like a glove are usually also inflicted by someone. Suspect abuse if the child has cigarette burns or grid pattern burns. Then there's fractures. So fractures of the humerus or femur do not normally occur without major trauma.
Falls out of bed are usually not associated with fractures. Maintain an index of suspicion to an impactor. infant, or young child who sustains a femur fracture or a complete fracture of any bone. Shaken baby syndrome.
So infants may sustain life-threatening head trauma or by being shaken or struck in the head. There is bleeding within the head and damage to the cervical spine resulting from severe shaking. And then there's neglect. So you refusal or failure on the part of the caregiver to provide life necessities children who are neglected are often dirty thin or appear developmentally delayed because of the lack of stimulation symptoms and other indicators of abuse are abused children appear withdrawn fearful or hostile be concerned if a child does not want to discuss how the injury occurred occasionally a parent or caregiver will reveal a history of accidents.
Be alert for conflicting stories or lack of concern from the caregiver. The abuser may be a parent, caregiver, relative, or friend of the family. EMTs in all states must report suspected abuse.
Even states or most states have special forms to do so. Supervisors are generally forbidden to interfere with reporting of suspected abuse. Law enforcement and child protective surgeries will determine whether there is abuse. When it comes to sexual abuse, children of all or any age or gender can be victims. You want to maintain a high index of suspicion.
you should the assessment should be limited to determining what type of dressing any injuries need treat the bruises and fractures as well and do not determine if the genitalia of a young child unless there is evidence of bleeding do not allow the emt to or the child to wash urinate or defecate ensure the emt or police officer of the same age remains with the child and maintain professional composure the entire time Obtain as much information as possible. Transport all children who are victims. And sexual abuse is a crime.
Next, we're going to talk about SIDS. So Sudden Unexpected Infant Death Syndrome and Sudden Infant Death Syndrome. The Sudden Unexpected Infant Death refers to the sudden unexpected death. where the cause is not known until the investigation is conducted. And one of the causes of S-U-I-D is sudden infant death syndrome, which is SIDS, which results in death that cannot be explained by another cause.
About 3,500 infants die of SIDS annually. The American Academy of Pediatrics recommends that a baby be placed on his or her back in a crib that is free of bumpers, blankets, and toys. The CSC recommends having a baby sleep in the same room, but not the same bed. Breastfeeding and use of a pacifier are also associated with a lower risk of SIDS. Although it is impossible to predict SIDS risk factor, there are some that include a mother younger than 20, mothers who smoke, mothers who use alcohol or illicit drugs, and a low birth weight.
Death as a result of SIDS can occur at any time of the day, you will face with three tasks. So assessment of the scene, assessment and management of the patient, and then communication and support of the family. You will patient assessment. So an infant who has been a victim of SIDS will be blue and pale, not breathing and unresponsive. Other causes include overwhelming infection, child abuse, airway obstruction or meningitis, accidental poisoning, hypoglycemia, congenital metabolic defects, or begin with the assessment.
So XABCs, you're going to provide interventions as necessary. And depending on how much time has passed, the child may show signs of post-mortem changes. If the child... shows these signs, call medical control. If there is no sign of post-mortem change, you want to begin CPR immediately.
Pay special attention to any marks or bruises on the child before you perform these procedures. And note any intervention that was not done prior to your arrival. With the scene, you need to inspect the environment, noting any condition of the scene where the infant was found.
Assess the scene should concentrate on signs of illness, including medications, humidifiers, or thermometers, a general condition of the house, signs of poor hygiene, family interaction, and the site where the infant is discovered. You have to communicate and support the family after the death of a child. The sudden death of an infant is a devastating event for a family, and it tends to evoke strong emotional. responses among health care providers. Follow the family or allow them to express their grief.
Offer the family a high level of empathy and understanding. The family may want you to initiate resuscitation efforts, which may or may not conflict with your EMS protocols. Always introduce yourself to the child's parents and caregivers and ask about the child's date of birth and medical history. do not speculate on the child's cause of death the family should be asked whether you they want to hold the child and say goodbye the following interventions are helpful.
So learn and use the child's name rather than the impersonal your child. Speak to the family members at eye level and maintain good contact with them and use the word dead or died when informing the family of the child's death. Euphemisms such as passed away or gone are ineffective. Acknowledge the family's feelings.
Offer to call family members. Keep any instructions short, simple, and basic. and ask each family member individually whether he or she wants to hold the child. Wrap the child in a blanket and stay with the family members when they hold the child. Ask them to not remove tubes or other equipment that is used in an attempted resuscitation.
Each individually and each culture will express grief in a different way. Some will require intervention. Most caregivers feel directly responsible for the death of the child, and some EMS systems arrange for home visits after the child's death so the EMS providers and family members can come to some sort of closure.
You need special training for these visits. A child's death can be very stressful. Take time before going back to the job. Talk to other EMS colleagues.
Be alert for signs of... post-traumatic stress in yourself and others and consider the need for professional help if these signs occur. Apparent life-threatening events, so infants who are not breathing are cyanotic and responsive, unresponsive when found, sometimes resume breathing and color with stimulation.
This is called an apparent life-threatening event, ALTE. In addition to cyanosis and apnea, an ALTE or an ALTE. is characterized by a distinct change in muscle tone, choking or gagging. After the event, the child may appear healthy and show no signs of illness or distress.
Pay strict attention to airway management, assess the infant's history, allow caregivers to ride in the back, and physicians will have to determine the cause. Brief, resolved, unexplained event. So, Signs and symptoms include brief changes in color such as pale skin or cyanosis, choking, absence, low or irregular breathing, abnormal muscle tone, decreased level of consciousness, no abnormality found on assessment, and transport is required for evaluation. Okay, so this concludes chapter 35. Let's see.
what we've learned by doing the review questions. How does a pediatric anatomy differ from adult? All right, D. It's the head. That head is proportionately larger.
When a small child falls from a significant height, the blank most often strikes the ground first. And we know that's the head. It's proportionately larger. When assessing a conscious and alert nine-year-old, what should we do? We want to ask them the questions if they're capable of answering, right?
The purpose of a shunt is to, and we know that the purpose of the shunt, and a VP shunt is going to be to minimize pressure within the skull. Which of the following statements regarding febrile seizures is correct? All right, so we know that febrile seizures are going to be D, and that usually lasts only 15 minutes and often does not have that postictal state.
Okay, you respond to a sick child at night. The child appears very ill, has a high fever and strolling. sitting in that tripod positioning is struggling to breathe.
All right, so the patient's drooling, so we think epiglottitis because their epiglottis is swollen and they can't swallow. Treatment for a semi-conscious child who swallowed an unknown quality of pills is going to be, all right, if it's semi or unconscious, we're going to monitor for vomiting, give oxygen, and transport fast. When using the mnemonic child abuse, To assess the child for signs of abuse, the D is going to stand for, and that's going to stand for delay of seeking care, right?
So four-year-old fell from the second story balcony and landed on her head. She's unresponsive, slow, irregular breathing, has a large hematoma to the top of the head, and bleeding from her nose. Oh, goodness. All right. So when somebody has bleeding from their nose, we're going to suspect that she has some type of fracture, right?
So head fracture. So we got to stabilize our head. We're going to jaw thrust. put in an airway, a jug, and then BVM. AFPU, what does P stand for?
And we know that that is painful. P is painful. All right, thank you for joining us with the Chapter 35 lecture, and we hope you've enjoyed it.