Chapter 34 Flashcards
Thoughts and behaviors: ...: first year of life ...: 1 to 3 years ...-age: 3 to 6 years ...-age: 6 to 12 years ...: 13 to 18 years
infancy toddler preschool school adolescenet
Infancy is defined as first year of life.
First month after birth is neonatal or newborn period.
0 to 2 months
Spend most time … and …
Cannot tell the difference between …and …
…is one of the main modes of expression
Inconsolability could be a sign of …
sleeping; eating
parents; strangers
crying;
significant illness
infant contd:
2 to 6 months
Persistent …, …, or lack of … can be an indicator of serious illness, depressed mental status, or a delay in development.
6 to 12 months
May cry if separated from parents or caregivers
Persistent … or …can be symptoms of serious illness.
crying; irritability; eye contact
crying; irritability
infant contd:
Assessment
Observe infant from a …
Caregiver should hold baby during physical assessment.
Provide …comfort.
Do painful procedures at …of assessment.
Complete each procedure efficiently and avoid interruptions.
Explain each procedure to the parent or caregiver before you perform it.
distance
sensory
end
toddler:
12 to 18 months
Because they are …by nature and not afraid, injuries increase.
May not be able to fully …, leading to increased risk of choking
18 to 24 months
May cling to parents or comforting toy
explorers;
chew food;
toddler contd: Assessment May have ... May resist separation from caregiver May have a hard time ... Can be distracted Begin your assessment at the .... Persistent ...can be a symptom of serious illness or injury.
stranger anxiety
describing pain
feet
crying
preschool-age child:
Ages 3 to 6 years
… still high risk
Assessment
Can understand directions and be specific in describing painful areas
Much history must still be obtained from caregivers.
Communicate …and …
foreign body aspiration airway obstruction
simply; directly
preschool child contd:
Assessment (cont’d)
Appealing to child’s …may facilitate examination.
Never lie to the patient.
Patient may be easily distracted.
Begin assessment at …, moving to ….
Use adhesive bandages to cover the site of an injection or other small wound.
Modesty is developing; keep child covered as much as possible.
imagination; feet; head;
school-age years:
6 to 12 years
Children begin to understand …
Assessment
Begins to be more like the adult assessment
To help gain trust, … not just the caregiver.
Probably familiar with the process of a physical exam
Start with …and move to the …
death; talk to the child; head; feet
school-age years assessment contd:
Assessment
Give the child ….
Ask questions that let you control the answer.
Allow the child to listen to his or her heartbeat.
Understand the difference between physical and emotional pain.
Provide simple explanations about what is causing pain and what will be done.
Ask the parent’s or caregiver’s advice.
choices;
adolescents:
13 to 18 years
Physically similar to adults
Still children …
A time of experimentation and risk-taking behaviors
Assessment
Can often understand complex concepts and treatment options
Allow them to be involved in their own care.
EMT of … should do physical exam.
Allow them to speak openly and ask questions.
Female patients may be …
Have clear understanding of the purpose and meaning of pain
emotionally;
same gender
pregnant
Anatomy of airway differs from adults
Pediatric airway is …in diameter and … in length.
Lungs are smaller.
Heart is … in chest.
smaller; shorter; higher
Anatomy of airway differs from adults (cont’d)
Glottic opening is …and positioned more …, and neck appears to be nonexistent.
As child develops, the neck becomes proportionally longer as the vocal cords and epiglottis achieve anatomically correct adult position.
higher; anteriorly;
Anatomy of airway differs from adult (cont’d)
Larger, rounder …
Proportionally larger … Long, floppy, U-shaped epiglottis
Less-developed rings of cartilage in the ..
Narrowing, funnel-shaped upper airway
Diameter of trachea in infants is about the same as a ….
occiput;
tongue
trachea
drinking straw
Anatomy of airway differs from adult (cont’d)
Children have oxygen demand …that of an adult.
Diaphragm muscles dictate amount of oxygen inspired.
Gastric distention can interfere with movement of the diaphragm and lead to ….
Breath sounds are more easily heard because of …chest walls.
Detection of poor air movement or complete absence of breath sounds may be more difficult.
twice
hypoventilation
thinner
Important to know normal pulse ranges
Infant’s heart can beat …beats/min or more.
Children are able to compensate for decreased perfusion by … the vessels in the skin.
Signs of vasoconstriction include … (early sign), … in the extremities, delayed …, and …hands or feet.
160; constricting pallor weak distal pulses capillary refill cool
pulse rates by age: newborn-3 months: … to … 3 m- 2yrs: … to … 2 yrs- 10 yrs: … to …. >10 years: … to …
85; 205
100; 190
60; 140
60; 100
Pediatric nervous system is immature, underdeveloped, and not well protected.
Head-to-body ratio of infant and young child is disproportionately ….
Occipital region is larger, which increases the …of the head during a fall.
Subarachnoid space is relatively …, leaving less cushioning for brain.
Brain tissue and cerebral vasculature are fragile and prone to bleeding from …forces.
larger
momentum
smaller
shearing
Pediatric brain requires higher cerebral blood flow, oxygen, and glucose.
At risk for … from hypotension and hypoxic events
Spinal cord injuries are less common.
If injured, it is more likely to be an injury to the …because of a fall.
For suspected neck injury, perform manual in-line stabilization or follow local protocols.
secondary brain damage
ligaments
Abdominal muscles are less developed.
Less protection from trauma
Liver, spleen, and kidneys are proportionally …and situated more …and ….
Prone to bleeding and injury
larger; anteriorly; close to one another
Open… allow bones to grow.
As a result of growth plates, bones are softer and more flexible, making them prone to ….
…discrepancies can occur if injury to growth plate occurs.
Bones of an infant’s head are flexible and soft.
… is highly elastic and pliable.
growth plates
stress fractures
bone length
thoracic cage
Pediatric integumentary system differs in a few ways:
…skin and less …
Composition of skin is thinner and tends to …more deeply and easily with less exposure
Higher ratio of body surface area to body mass leads to larger …and …losses.
thinner; subcutaneous fat
burn
fluid; heat
Traumatic scene where the child is unresponsive or too young to communicate
Assume the injury was significant enough to cause … or …injuries.
Perform cervical spine immobilization if suspected MOI is severe.
head; neck
Form a general impression.
Use… (PAT) to determine if the patient is sick or not sick–> entails appearance, work of breathing, and circulation to skin
Can be performed in less than 30 seconds
For pediatric patient you will now perform a hands-on ABCs assessment.
Assess and treat any life threats as you identify them by following the …. format.
pediatric assessment triangle; ABCDE
Always position airway in … position for pediatric patients
Breathing
Use the look, listen, feel technique.
Place both hands on patient’s chest to feel for rise and fall of chest wall.
… in infants is considered adequate.
…is an ominous sign and indicates impending respiratory arrest.
neutral sniffing; Belly breathing; Bradypnea
Circulation
Determine if patient has a pulse, is bleeding, or is in shock.
In infant, palpate brachial or … pulse.
In children older than 1 year, palpate carotid pulse.
Strong central pulses usually indicate that the child is not … .
Weak or absent peripheral pulses indicate decreased …
femoral; hypotensive; perfusion
Circulation (cont’d)
Tachycardia may be early sign of ….
Interpret pulse within the context of overall history, the PAT, and primary assessment.
Evaluate trend of increasing or decreasing pulse rate.
Feel skin for temperature and moisture.
Estimate the capillary refill time.
hypoxia
Disability
Use AVPU scale or pediatric GCS.
Check … response.
Look for symmetric movement of …
Pain is present with most types of injuries.
Assessment of pain must consider developmental age of patient.
Hands-on ABCs require that the caregiver remove some of patient’s clothing for observation.
More prone to …events
Should be kept warm during transport
pupil
extremities
hypothermic
Transport decision (cont’d)
If less than 40 lb, transport in …
Mount a … to a stretcher.
Follow manufacturer’s instructions to secure car seat in captain’s chair.
Do not use the pediatric patient’s own car seat.
car seat; car seat
Questions to ask based on chief complaint:
NOI or MOI
Length of sickness or injury
Key events leading up to injury or illness
Presence of …
Effects of illness or injury on …
Patient’s …
Recent eating, drinking, and urine output
Changes in bowel or bladder habits
Presence of vomiting, diarrhea, abdominal pain
Presence of …
Obtain name and phone number of caregiver if they are not able to come to the hospital with you.
fever; behavior; activity level; rashes
blood pressure is usually not assessed in patients younger than … years
Use a cuff that covers … of the pediatric patient’s upper arm.
3; two thirds
Vital signs (cont’d)
Use this formula to determine blood pressure for children ages 1–10 years:
… = systolic blood pressure
Respiratory rates may be difficult to interpret.
Count respirations for at least 30 seconds and double that number.
In infants and those younger than 3 years, evaluate respirations by assessing the rise and fall of the …
70 + (2 x child’s age in years); abdomen
… problems are the leading cause of cardiopulmonary arrest in the pediatric population.
Failure to recognize and treat will lead to death.
Patient must work harder to breathe and will eventually go into respiratory failure if left untreated.
In the early stages, you may note changes in behavior, such as …, …, and …
respiratory; combativeness; restlessness; anxiety
As the patient progresses to possible respiratory failure
Efforts to breathe decrease.
Chest rises less with inspiration.
Changes in behavior and, eventually, altered level of consciousness
Patient may experience periods of …
… becomes hypoxic.
Respiratory failure does not always indicate airway obstruction.
May indicate trauma, … problems, …, or … disturbances
apnea; heart muscle; nervous system; dehydration; metabolic
Infections can cause obstruction.
Infection should be considered if patient has …, … , …, and ..symptoms.
Croup
Epiglottitis
congestion; fever; drooling; cold
Obstruction by foreign object may involve upper or lower airway.
Obstruction may be partial or complete.
Signs and symptoms associated with partial upper airway obstruction include decreased breath sounds and ….
Signs and symptoms of lower airway obstruction include … and/or …
Best way to auscultate breath sounds in the pediatric patient is to listen to both sides of the chest at armpit level.
stridor; wheezing; crackles
pneumonia:
…cause of death in children
Pneumonia is a general term that refers to an infection to the lungs.
Presentation in pediatric patient
Pediatric patient treatment
Diagnosis of pneumonia must be confirmed in the hospital.
Leading
…: An infection of the airway below the level of the vocal cords, usually caused by a virus
Typically seen in children between ages 6 months and 3 years
Easily passed between children
The hallmark signs of croup are … and a …cough.
Treatment
croup; stridor; seal-bark
…: Bacterial infection of the soft tissue in the area above the vocal cords
Incidence decreased since development of vaccine
Epiglottis can swell to two to three times normal size.
Children look ill, report a very sore throat, and have a high fever.
Tripod position and drooling
epiglottitis
…: Specific viral illness of newborns and toddlers, often caused by RSV
More common in premature infants and results in copious secretion
Look for signs of …, shortness of breath, and …
bronchiolitis; dehydration; fever
Pertussis (whooping cough) is caused by a … spread via respiratory droplets.
Signs and symptoms similar to a ..To treat pediatric patients, keep the airway patent (open) and transport.
Pertussis is contagious, so follow standard precautions, including wearing a mask and eye protection.
bacterium; cold
… are rarely used in infants younger than 1 year
NPAs
oxygen delivery devices:
Several options for pediatric patient
… technique at 6 L/min provides more than 21% oxygen concentration.
Nasal cannula at 1 to 6 L/min provides 24% to 44% oxygen concentration.
Nonrebreathing mask at 10 to 15 L/min provides up to 95% oxygen concentration.
BVM at 10 to 15 L/min provides nearly 100% oxygen concentration.
Blow-by;
Nonrebreathing mask, nasal cannula, or simple face mask are indicated for pediatric patients who have adequate respirations and/or tidal volumes.
BVM is used for those with respirations less than …breaths/min or more than …breaths/min, an altered LOC, or inadequate tidal volume.
12; 60
Pediatric patients respond differently than adults to fluid loss.
May respond by … heart rate, … respirations, and showing signs of … or … skin
increasing; increasing; pale; blue
Hemophilia is a congenital condition in which patients lack normal ….
Most forms are hereditary and severe.
Predominantly found in … population
Bleeding may occur spontaneously.
All injuries become serious because blood does not clot.
clotting factors; male
Result of disorganized electrical activity in the brain
Manifests in a variety of ways
Subtle in infants, with an abnormal … , …, and/or “…” motions
More obvious in older children with repetitive muscle contractions and unresponsiveness
Longer and more intense seizures take longer for the imbalance to ….
Recurring or prolonged seizures should be considered life threatening.
Protect from harm and call for ALS backup.
gaze; sucking; bicycling; correct itself
meningitis: inflammation of tissue that covers the spinal cord and brain Individuals at greater risk: … Newborn infants Compromised... by AIDS or cancer History of ..., ..., ...surgery Children who have had head trauma Children with ..., ..., or other foreign bodies in their brain or spinal cord
males
immune system
brain; spinal cord; back
shunts; pins;
Signs and symptoms vary with age.
Neisseria meningitidis is a bacterium that causes rapid onset of meningitis symptoms.
Often leads to …and death
Children present with small, pinpoint, cherry-red …or a larger ….
shock; spots; purple/black rash
poisoning emergencies and management:
Common among children
Common sources
Signs and symptoms vary, depending on substance, age, and weight.
May appear normal, …, …, or …
Some substances only take one pill to be lethal.
Be alert for signs of abuse.
confused; sleepy; unconscious
poisoning contd:
After primary assessment, ask caregiver the following:
What is the …involved?
Approximately how much was ingested?
What time did the incident occur?
Any changes in … or level of consciousness?
Any choking or …after the exposure?
substance; behavior; coughing
dehydration emergencies and management
Occurs when fluid …. is greater than fluid …. Vomiting and diarrhea are common causes.
Can lead to …. and death if left untreated
Infants and children are at greater risk.
Life-threatening dehydration can overcome an infant in a matter of …
Can be mild, moderate, or severe
loss; intake; shock; hours
fever emergencies and management: An increase in body temperature ...°F (38°C) or higher are abnormal. Rarely life threatening Common causes Result of internal body mechanism in which heat ...is increased and heat … is decreased
100.4; generation; loss
fever emergencies contd:
Accurate body temperature is important for pediatric patients.
Patient may present with signs of …, …, …, a …, hot skin, flushed cheeks, and, in infants, bulging ….
Transport and manage ABCs.
resp distress; shock; stiff neck; rash; fontanelles
febrile seizures: Common between 6 months and 6 years Caused by ...alone Typically occur on ...of febrile illness Characterized by ... activity Last less than ... with little or no postictal state May be sign of more serious problem Management
fever
first day
tonic-clonic
15 mins
drowning emergencies:
Take steps to ensure your own safety.
Second-most-common cause of unintentional death among children
Children younger than age 5 are most at risk
… frequently a factor with adolescents
Principal condition is lack of oxygen.
A few minutes without oxygen affects heart, lungs, and brain.
…from submersion in icy water
Diving increases risk of neck and spinal cord injuries.
Alcohol; hypothermia
trauma emergencies:
Number-one killer of children in the United States
Quality of care can impact recovery.
The muscles and bones of children continue to grow well into adolescence.
Fracture of the …is rare: Source of major blood loss
Older children and adolescents are prone to … fractures.
femur; long bone
Head injuries
Common in children because the size of the head in relation to the body
Infant has softer, thinner skull.
May result in brain injury
… and …. may cause great deal of blood loss if not controlled.
… and …are common signs and symptoms of a head injury in children.
scalp; facial vessels; nausea; vomiting
Chest injuries
Usually the result of blunt trauma
Chest wall flexibility in pediatric patients can produce a …
Abdominal injuries
Common in pediatric patients
Monitor all patients for signs of shock.
If signs of shock are evident, prevent …with blankets.
flail chest; hypothermia
Burns
Burns to children are considered more serious than burns to adults.
Have more surface area to relative total body mass, which means greater fluid and heat loss
Do not tolerate burns as well as adults
More likely to go into …, develop …, and experience …problems
shock; hypothermia; airway
Injuries to the extremities
Children have immature bones with active growth centers.
Growth of long bones occurs from the ends at specialized growth plates–>Potential weak spots
… or … fractures can occur.
Generally, extremity injuries in children are managed in the same manner as adults.
Painful deformed limbs with evidence of broken bones should be splinted.
Incomplete; greenstick
Injuries to specific body systems–>Pain management
First step is recognizing the patient is in pain.
Look for visual clues and use the W… pain scale.
Interventions are limited to …, …, and extremity …(to decrease pain and swelling to injury site).
ALS interventions may be needed.
Another important tool is kindness and providing emotional support.
Wong-Baker FACES; positioning; ice packs; elevation
JumpSTART triage system Intended for patients younger than age ... years and weighing less than .... lb Four triage categories … … … ...
8; 100 green yellow red black
JumpSTART triage system (cont’d)
…: minor not in need of immediate treatment
Able to walk (except in infants)
…: delayed treatment
Presence of spontaneous breathing with peripheral pulse, responsive to painful stimuli
…: immediate response
Apnea responsive to positioning or rescue breathing, respiratory failure, or inappropriate painful response
… : deceased or expectant deceased
Apneic without pulse, or apneic and unresponsive to rescue breathing
Green; Yellow; Red; Black
CHILD ABUSE mnemonic: C: … of injury with child's age H: … inconsistent with injury I: inappropriate … L: lack of … D: delay in … A: … B: … of varying ages U: unusual … patterns S: … circumstances E: environmental clues
consistency history parental concerns supervision seeking care affect bruises injury suspicious
Bruises
Observe color and location.
Burns
Burns to the penis, testicles, vagina, or buttocks are usually inflicted by ….
Burns that look like a …are usually inflicted by someone else.
You should suspect child abuse if the child has cigarettes burns or … pattern burns.
someone else; glove; grid
Fractures
Fractures of the …or …do not normally occur without major trauma.
Falls from bed are not usually associated with fractures.
Shaken baby syndrome:
Infants may sustain life-threatening head trauma by being shaken or struck.
Shaking tears …in the brain, resulting in bleeding around the brain.
humerus; femur; blood vessels
sexual abuse:
Any age and gender can be a victim of sexual abuse.
Maintain an index of suspicion.
Assessment
Limited to determining type of …required
Treat …and …as well.
Do not examine genitalia unless there is evidence of bleeding or other injury.
dressing; bruises; fractures
… (SIDS): Unexplained death after complete autopsy
About 3,500 infants die of SIDS annually.
Babies should be placed on their … on a firm mattress, in a crib free of bumpers, blankets, and toys.
Babies should sleep in the same room, but not the same bed, chair, or sofa, as an adult.
Impossible to predict
Sudden infant death syndrome; backs
SIDS contd: Risk factors Mother younger than age ... Mother … during pregnancy Low ... Can occur at any time of day You are faced with three tasks: Assessment of the scene Assessment and management of patient Communication with and support of the family Victim of SIDS will be pale or blue, not breathing, and unresponsive.
20 years; smoked; birth weight;
Infants who are not breathing, cyanotic, and unresponsive sometimes resume breathing and color with stimulation.
… (ALTE)
Classic ALTE is characterized by:
Distinct change in …
… or …
After ALTE, may appear healthy and show no signs of illness or distress.
Must complete careful assessment and provide rapid transport to the ED.
Pay strict attention to airway management.
Assess history and environment.
Allow caregivers to ride in the back of the ambulance.
Physicians will determine the cause.
Apparent life-threatening event; muscle tone; choking; gagging
