Ch. 33 Pediatric Emergencies

Question 1

Infancy

Answer 1

is usually defined as the first year of life; the first month after birth is called the neonatal or newborn period

Question 2

What portion of the brain is larger in small children 3 and under?

Answer 2

The occiput

Question 3

Which fontanelles are open and why? At what age do they fully close?

Answer 3

The anterior and posterior fontanelle are still open to allow compression through the birth canal. At 18 months both fontanelles have fully been closed.

Question 4

What can bulging and sunken fontanelle indicate?

Answer 4

Bulging fontanelle can indicate Intracranial pressure (ICP) and a sunken fontanelle can be indicative of dehydration.

Question 5

List some differences in a child’s airway

Answer 5

1. The childs tongue is larger in proportion to the childs oropharynx and more anteriorly located
2. The epiglottis is floppy and narrow and larger than an adults
3. The larynx is higher at C3 and C4
4. The airway is much more narrower than and adults at all levels
5. The narrowest portion of the childs airway is at the cricoid cartilage.

Question 6

Tracheal Tugging

Answer 6

It is easily collapsable in young children therefore when they experience respiratory distress the trachea tends to draw into the neck

Question 7

What is the importance of keeping the nasal passage way clear in children 4 to 6 months?

Answer 7

They are predominately breath through their nose and may not have the intuition to open their mouths to breathe.

Question 8

Why do children breathe faster than adults?

Answer 8

Proportionally, their tidal volume is similar to adolescents and adults however their metabolic oxygen demand is doubled which means they will have less oxygen reserves.

Question 9

What is a normal respiratory rate for a newborn?

Answer 9

40 - 60 breaths/min

Question 10

Why is it important not to put pressure on a child’s abdomen due to their respiratory system?

Answer 10

Children are belly breathers and have very little use of their chest muscles while breathing so by allowing pressure in an infant or young child you can block the movement of the diaphragm and cause respiratory compromise

Question 11

Pediatric Respiratory Rates

Neonate: 0 - 1 month

Answer 11

30 - 60 breath/min

Question 12

Pediatric Respiratory Rates

Infant: 1 month to 1 year

Answer 12

25 - 50 breath/min

Question 13

Pediatric Respiratory Rates

Toddler: 1 - 3 years

Answer 13

20 - 30 breath/min

Question 14

Pediatric Respiratory Rates

Preschool age 3 - 6 years

Answer 14

20 - 25 breath/min

Question 15

Pediatric Respiratory Rates

School age 6 - 12 years

Answer 15

15 - 20 breath/min

Question 16

Pediatric Respiratory Rates

Adolescent 12 - 18 years

Answer 16

12-20 breath/min

Question 17

Pediatric Pulse Rate

Neonate - 1 month

Answer 17

100 - 180 beats/min

Question 18

Pediatric Pulse Rate

Infant: 1 month to 1 year

Answer 18

100 - 160 beats/min

Question 19

Pediatric Pulse Rate

Toddler: 1 - 3 years

Answer 19

90 - 150 beats/min

Question 20

Pediatric Pulse Rate

Preschool: 3 - 6 yrs

Answer 20

80 - 140 beats/min

Question 21

Pediatric Pulse Rate

School age 6 - 12 years

Answer 21

70 - 120 beats/min

Question 22

Pediatric Pulse Rate

Adolescent 12 - 18 years

Answer 22

60 - 100 beats/min

Question 23

Things to Note for a Pediatric Nervous System

Answer 23

Their nervous system isn’t fully developed yet there for this system is extremely fragile. It is not as well protected as adults therefore it will take less force to damage them.

The subarachnoid space in a child is smaller than an adult therefore provides less cushioning for the brain.

The pediatric brain also requires nearly 2x the cerebral blood flow as an adult brain making minor injuries significant. This requirement increase hypoxia and hypotension

Question 24

Things to Note for a Pediatric Musculoskeletal system

Answer 24

Bones in children and much more softer and porous therefore most fractures will be greenstick (Incomplete fractures)

Treat any sprain or strain as a fracture and splint accordingly

Injury to the epiphyseal pate may result in abnormalities in normal bone growth and development

Question 25

Things to Note for a Pediatric Chest and Lungs

Answer 25

There is less overlying muscle and fat to protect the ribs and vital organs. Therefore you should expect more injuries to the underlying organs and structures

The respiratory muscles in a child are more immature and fatigue more quickly than an adults therefore children tends to tire more easily as a result.

Question 26

Pediatric Assessment Triangle (PAT)

Answer 26

is a structured assessment tool that allows you to rapidly form a general impression of the infants or childs condition without touching him or her.

Question 27

What are the 3 components of PAT?

Answer 27

Appearance
Work of breathing
Circulation (Skin)