Chapter 33 Pediatric Emergencies

Question 1

Key Terms

soft spots on an infant’s scalp formed by the joining of not-yet-fused bones of the skull

Answer 1

Fontanelles

Question 2

Key Terms

of or pertaining to a patient who has yet to reach puberty

Answer 2

Pediatric

Question 3

Key Terms

pulling in of the skin and soft tissue between the ribs when breathing. This is typically a sign of respiratory distress in children

Answer 3

Retraction

Question 4

Critical Decision Making

Pediatric patients cause stress because the stakes are high and we (fortunately) don’t get a lot of pediatric calls. The decision making in this section will involve your from-the-doorway pediatric or a less serious condition.

You are met at the door by an upset mother who is holding a limp thirteen-month-old child in her arms.

Answer 4

Serious. The patient’s limpness is an immediate flag that something is wrong. This is called poor muscle tone and is a serious finding. The upset mother is also a piece in the puzzle.

Question 5

Critical Decision Making

Pediatric patients cause stress because the stakes are high and we (fortunately) don’t get a lot of pediatric calls. The decision making in this section will involve your from-the-doorway pediatric or a less serious condition.

A three-year-old child is reported as having a croupy cough and difficulty breathing. She is screaming and clinging to her mother as you approach.

Answer 5

Less serious. The fact that the little girl is “screaming” means that she can move air in and out. Clinging to her mother indicates muscle tone and an appropriate mental status.

Question 6

Critical Decision Making

Pediatric patients cause stress because the stakes are high and we (fortunately) don’t get a lot of pediatric calls. The decision making in this section will involve your from-the-doorway pediatric or a less serious condition.

A child has fallen from a high sliding board. You arrive to find the child holding his left forearm against his body while quietly clinging to his mother.

Answer 6

Serious (until more information can be obtained). The fact that the child is holding his injured arm and clinging to his mother is good. Look for his mental status and why he is quiet before making a final determination. If you approach him and he turns shyly into his mother, you may upgrade this to less serious.

Question 7

Short Answer

Name one psychological/social characteristic that you would be likely to find in a patient of each of the following ages, and explain how you would tailor your actions as an EMT to accommodate this characteristic two-year-old, six-year-old, and fifteen-year-old.

Answer 7

Psychological/social characteristics found with each of the following ages might include:

  - Two-year-old:  Stranger anxiety and separation anxiety may suggest you allow the parent to hold the child during the exam when possible.  Fear and increasing independence require that you explain procedures in simple terms.
 - Six-year-old:  Separation anxiety suggests you keep a parent present.  Fear of punishment and pain requires a simple explanation of the procedures.  Allow simple decision making.
 - Fifteen-year-old:  Peer pressure suggests you respect modesty and separate from crowds.  Independence allows for an adultlike exam, but expect the patient to regress to earlier stages under duress.  Allow for decision making.

Question 8

Short Answer

Describe ways of calming and interacting effectively with the infant or child patient and with the parent or caregiver.

Answer 8

When trying to calm a child during assessment and treatment, always try to identify yourself simply; let the child know that someone has called his parents; let the child have any nearby toy that he may want; kneel or sit at the child’s eye level; smile; touch the child; do not use any equipment on the child without first explaining what you will do with it; stop occasionally to find out if the child understands; and never lie. Parents can be calmed by simply explaining what is going on. Take time to update them on their child’s status. When possible, involve them in assessment and treatment.

Question 9

Short Answer

Explain some of the elements of a general impression of the infant or child patient that you can obtain “from the doorway”—before you approach the patient.

Answer 9

The pediatric general assessment is organized as in the pediatric assessment triangle. It includes observation of appearance, work of breathing, and skin color.

Question 10

Short Answer

Explain how to differentiate between an upper airway obstruction and a lower airway disease or disorder. Explain how and why the two should be treated differently.

Answer 10

Upper airway disorders are typically characterized by stridor, difficulty speaking, and barking coughs. Lower airway disorders typically are characterized by wheezing. It is important to distinguish between these disorders as treatments are very different. For example, lower airway disorders can be treated with inhaled bronchodilators (where protocols allow). This type of medication is typically ineffective in treating upper airway disorders.

Question 11

Short Answer

Explain the main steps of emergency treatment for any infant or child trauma patient.

Answer 11

Pediatric trauma patients should essentially be treated like any other trauma patient. Treatment of primary assessment problems will always take priority. However, anatomical and physiological differences must be accounted for. For example, the large head may require padding under the body to achieve neutral position during spinal immobilization. Since pediatric bones flex more than they break, fractures are less common. Nonetheless, internal injuries may be present.