Chapter 33: Pediatric Emergencies Flashcards
What are the pediatric age categories?
Newborns and Infants (Birth-1year); Toddlers (1-3 years); Preschool (3-5 years); School age (6-12 years); Adolescent (13-18 years)
True or False: Infants and children differ from adults in psychology, anatomy, and physiology
TRUE
What are characteristics of the HEAD in pediatrics?
proportionately larger and heavier than an adult’s until about age four; always suspect injury if serious mechanism of injury;
Define Fontanelles.
“Soft spots” at the top of infants’ heads
Define characteristics of pediatric mouth, nose and tongue.
Mouth and nose are smaller, more easily obstructed; tongue takes up more space proportionately; typically breath through their noses;
Define characteristics of pediatric trachea (windpipe)
trachea (windpipe) softer and more flexible, narrower, and is easily obstructed by swelling or foreign objects
Define characteristics of pediatric chest wall.
Chest wall is softer and diaphragm is more involved in breathing
Define characteristics of pediatric thorax.
Thorax is shorter and located adjacent to a very full abdominal cavity; abdominal contents can prevent the diaphragm from dropping far enough to promote increased lung capacities
What are characteristics of neonatal ribs?
Neonatal ribs are more boxlike; limited ability to take deeper breaths
True or False: Hyperextension or flexion of the neck cannot result in airway obstruction
FALSE
True or False: Because infants are nose breathers, be sure to suction secretions from the nose as needed to help the patient breath.
TRUE
What is the rule for “Blind” finger sweeps in children?
“Blind” finger sweeps are not performed when trying to clear an airway obstruction in an infant or child because your finger might force the obstruction back and wedge it in the narrow trachea
Name characteristics of pediatric chest and abdomen.
Less developed, more elastic in young patients; infants and children are abdominal breathers; abdominal organ less protected than in adults
Name characteristics of pediatric body surface.
Larger than adult’s in proportion to body mass; more prone to heat loss through skin; more vulnerable to hypothermia
Name characteristics of pediatric blood volume.
Less than blood volume of adult; blood loss that might be considered moderate in an adult can be life-threatening situation for a child
What are 5 things to do when interacting with a pediatric patient.
Identify yourself; let child know that someone has called or will call his parents; if no life-threatening problems, continue at a calm pace during the evaluation process; let child have a nearby toy; kneel at child’s eye level
Name 6 more things to do when interacting with a pediatric patient.
Smile; touch or hold child’s hand or foot; do not use equipment without first explaining what you will do with it; let child see your face; stop occasionally to find out if child understands; never lie to the child
True or False: Do not delay evaluation and care because you or the patient may be embarrassed.
TRUE
True or False: When possible, do not have the exam conducted by or in the presence of an EMT of the same sex as the patient
FALSE
What are possible reactions to child’s illness/injury by parent or care provider?
Denial, shock, crying, screaming, anger, self-blame, guilt; they may interfere with care of child
What is the pediatric assessment triangle (PAT)
Two viewpoints - from the doorway and remainder of primary assessment done next to patient; Elements - Appearance, work of breathing, circulation to skin
What do you identify when forming a general primary impression of a pediatric patient?
Rapidly identify critical patient; make observations of mental status, interaction with environment or others, emotional state, response to you, tone and body position; work of breathing, quality of cry or speech, and skin color
What do you look for to assess mental status of a pediatric patient?
Alert, verbal, painful, gently tap unresponsive infant or child
What do you look for to assess pediatric patient breathing?
Chest expansion, work of breathing, sounds of breathing, breathing rate, color
What do you look for when assessing circulation in pediatric patient?
Warm, pink, and dry skin; normal pulse; check capillary refill in infants and children fiver years or younger; check for and control any blood loss
How do you identify priority patients?
A patient who: gives a poor general impression, is unresponsive or listless, does not recognize the parent or primary caregiver, is not comforted when held by a parent but becomes calm and quiet when set down
More ways to identify priority patients?
A patient who: has a compromised airway, is in respiratory arrest or has inadequate breathing or respiratory distress, has a possibility of shock, has uncontrolled bleeding or has experienced significant blood loss
What is involved in a secondary pediatric assessment?
Ask simple questions that cannot be answered with “Yes” or “No”, perform a physical exam for a medical patient; take and record vital signs
What are the steps to a pediatric physical exam?
Start with toes/trunk and work way toward head; if no injuries, patient should be held in parent’s lab; protect child’s modesty; explain why each piece of clothing must be removed
What are factors to look for when examining the nose and ears of a pediatric patient?
Look for blood and clear fluids coming from the nose and ears; mucus or clot obstructions will make it hard for children to breathe
What do you do to maintain airway in pediatric patients?
Maintain neutral position for infants, neutral-plus (sniffing) position for children; if no suspicion of spinal injury, place a flat, folded towel under patient’s shoulders to get the appropriate airway alignment
What do you look for in a pediatric chest during assessment?
Be alert for wheezes and other noises; check for symmetry; check for bruising; check for paradoxical motion and retraction
What do you look for in the abdomen during assessment of pediatric patients?
Note if rigid; check for tender areas and dissension; abdominal injury may impede movement of the diaphragm
What do you look for in the pelvis during assessment of pediatric patients?
Check for stability of pelvic girdle
What do you look for in the extremities during assessment of pediatric patients?
Capillary refill, distal pulse, pulses, motor, sensory
How do you perform a reassessment for pediatric patients?
Reassess mental status; maintain open airway; monitor breathing; reassess pulse; monitor skin color, temperature, and moisture
How often do you reassess vital signs of pediatric patients?
Every 5 minutes for unstable patients; every 15 minutes for stable patients
How do you maintain an open airway for pediatric patients?
Align and open airway; use head-tilt, chin-lift if no trauma; use jaw-thrust with spinal immobilization if trauma is suspected; suction; check blockage of airway by tongue
How do you clear an airway partial obstruction?
Place patient in position of comfort, offer high-flow oxygen, transport
How do you clear an airway complete obstruction?
Perform airway clearance techniques; by using alternate back blows with chest thrusts if severe airway obstruction in infant
When should high-concentration oxygen be administered?
Should be administered to children in respiratory distress, those with inadequate respirations, or those in possible shock
What do you do if young child is afraid of oxygen mask?
Push oxygen tubing through a paper cup; nonrebreather mask preferable
What are the guidelines for providing supplemental oxygen?
Avoid breathing too hard through the pocket face mask or using excessive bag pressure and volume; use properly sized face masks to ensure a good mask seal
What are the guidelines for providing ventilations?
Flow-restricted, oxygen-powered ventilation devices are contraindicated for infants and children; if ventilation is not successful in raising the patient’s chest, perform procedures for clearing an obstructed airway. Then try to ventilate again
What are common causes of shock in infants and children?
Diarrhea and/or vomiting, infection, trauma, blood loss, allergic reactions, poisoning, cardiac events
What are signs and symptoms of shock in pediatric patients?
Apathy or lack of vitality; rapid respiratory rate; rapid or weak and thready pulse; altered mental status; pale, cool, clammy skin; absence of tears when crying; falling blood pressure; delayed capillary refill
How do you care for a pediatric patient in shock?
Ensure an open airway; manage severe external hemorrhage if present; provide high-concentration oxygen; lay patient flat; keep patient warm; transport immediately
How do you protect against hypothermia?
Cover patient’s head and body; keep the patient compartment warm; avoid rough handling; consult medical control about active rewarming of patient
What is the likeliest cause of cardiac arrest in a child, other than trauma?
Respiratory disorders
True or False: The role of the EMT is to recognize signs of early respiratory distress and treat it before it advances to a life-threatening stage.
TRUE
What are signs of upper airway disorder?
Affects mouth, throat, larynx; foreign body obstructions, trauma, swelling from burns and infections; commonly identified by difficulty breathing, stridor, or difficulty speaking
What are signs of lower airway disorder?
Affects large and small bronchiole tubes, and alveoli; asthma, pneumonia, other respiratory infections; commonly identified by difficulty breathing, wheezing lung sounds
What do you look for when doing a patient assessment for difficulty breathing?
Nasal flaring; retractions; use of abdominal muscles; stridor (high-pitched, harsh sound); audible wheeze; grunting; breathing rate greater than 60 breaths/min; altered mental status; slowing or irregular respiratory rate; cyanosis; decreased muscle tone; poor peripheral perfusion; decreased heart rate
What are symptoms of croup (respiratory disease)?
Mild fever and some hoarseness (daytime); Loud “seal-bark” cough; difficulty breathing; signs of respiratory breathing; restlessness; paleness with cyanosis
What are symptoms of epiglottitis?
Sudden onset of high fever; painful swallowing (child often drools); tripod position; patient sits very still; appears more ill than with croup
How do you care for a child with a fever?
Remove child’s clothing; cover in towel soaked in tepid water, if local protocols permit; monitor for shivering; follow protocols for water or ice chips
True or False: You should not submerge patient in cold water to reduce fever.
TRUE
True or False: You should not use rubbing alcohol to cool patient.
TRUE
How do care for a child with meningitis?
Monitor ABCs and vital signs; provide high-concentration oxygen by nonrebreather mask; ventilate with BVM or pocket mask if necessary; provide CPR; be alert for seizures; transport immediately
How do you care for a child with diarrhea and vomiting?
Maintain open airway; provide oxygen; contact medical control if signs of shock are present; if protocols allow, offer the child sips of clear liquids and chipped ice; immediate transport
How do you care for a child experienceing a seizure?
Maintain open airway (not oral); position on side if no spinal injury; be alert for vomiting; provide oxygen; transport; monitor for inadequate breathing and/or altered mental status
How do you care for a child with poisoning?
Contact medical direction or poison control center; consider activated charcoal, if protocol allows, provide oxygen; transport; continue to monitor responsiveness
How do you care for a downing patient?
Provide artificial ventilation or CPR; protect airway; consider spinal immobilization; protect against hypothermia; treat any trauma; transport
What is sudden infant death syndrome (SIDS) and how do you “treat” it?
No accepted reason exists for why these babies die; treat as any patient in cardiac or respiratory arrest; resuscitate unless there is rigor mortis; give emotional support for parents
What are some injury patterns during motor vehicle collisions?
Unrestrained- head and neck; Restrained -abdominal and lower spinal; When struck by vehicle-head injury, abdominal injury and possible internal bleeding, lower extremity injury and possible fractured femur
How do you examine a child’s head during motor vehicle collision?
Examine head; look for bruising or blood or clear fluid draining from the nose or ears; palpate gently for soft or spongy areas, skull irregularities, or crepitus; check the fontanelles in infants
What is crepitus?
Feeling of grinding bone fragments
What are the steps to examining child during vehicle accident?
Examine head, examine eyes, examine neck, examine chest, auscultate for breath sounds, examine abdomen, examine pelvis, examine arms, examine legs, then examine back and spine (in this order)
When checking the eyes, what should you look for?
The pupils should be equal in size and reactive to light.
When examining the neck, what should you look for?
Check for the position of the trachea, swollen neck veins, stiffness, tenderness or crepitus
When examine the chest, what should you look for?
Check for bruising, equal chest rise and fall, and crepitus; watch for signs of breathing difficulty
What should you look for when examining the abdomen?
Check for bruising, tenderness, or guarding; look for swelling that may indicate swallowed air
When examine the pelvis, what should you look for?
Examine the pelvis for tenderness, swelling, bruising, or crepitus; if patient complains of pain, injury or other problems in the genital area, assess for bruising swelling or tenderness in that area
What do you look for when examining the arms?
Examine the extremities. Evaluate pulses, sensation, and warmth; look for unequal movement
What do you look for when examining the legs?
If you have immobilized an extremity, check the patient’s capillary refill, peripheral pulses, and sensory status, and compare them with the other arm or leg
What do you look for when examining the back and spine?
Examine the back; assess for tenderness, bruising and crepitus; if the child requires immobilization, the back can be checked while the cild is being log-rolled onto the spine board
How do you immobilize a child with KED?
Open the KED and place baking on it to properly position and align the child’s head and body; log-roll the child onto the KED; Fold the side pieces inward to provide side padding and support and to allow visualization of the chest and abdomen; since the torso straps will be rolled to the inside, secure the torso with tape; fold the head flaps securely against the child’s head, and tape across the head and chin
How do you treat burn ins children?
Identify candidates for transportation to burn centers; cover burn with nonadherent sterile dressing; ensure open airway; suction as needed; immobilize spine; transport immediately
What are types of child abuse?
Psychological (emotional) abuse; neglect; physical abuse; equal abuse
How do you assess potential child abuse?
Signs of possible physical abuse: slap marks, bruises, abrasions, lacerations, incisions; broken bones; head injuries; abdominal injuries; bite marks; burn marks; indications of shaking an infant
What are signs of possible physical abuse?
Obvious signs of sexual assault; any unexplained genital injury; seminal fluid on body or clothes or other discharges associated with sexually transmitted diseases; if the child tells you he was sexually assaulted
What are possible indications for an adult being an abuser?
Inappropriate concern about child; trouble controlling anger; seems to be on a brink of an emotional explosion; appears to be in deep depression; indications of alcohol or drug abuse; suicidal thought
What is the role of the EMT in cases of suspected abuse or neglect?
Gather information from adults without expression of disbelieve or judgement; talk with child separately; plaining and clearly report to medical staff any finding or suspicion regarding physical or sexual abuse; use terms suspected and possible even when talking to partner, hospital staff, police and superiors; contact state child abuse reporting hotline
What are potential complications with tracheostomy tubes?
Obstruction; bleeding from or around tube; air leaking around tube; infection; dislodged tube
What are possible complications with central intravenous lines?
Infection, bleeding, clotting-off of the line, cracked line; apply pressure if there is bleeding and transport the patient
