Pediatric Emergencies Flashcards
The specialized medical practice devoted to the care of young patients
Pediatrics
The first year of life
Infancy
The first month of life
Neonatal or newborn period
Infants younger than 2 months spend most of their time ___
Sleeping or eating
Infants respond mainly to ___
Physical stimuli such as light, warmth, hunger, and sound
Infants sleep for up to ___
16 hours a day
An infant should be ___ from a sleeping state
Aroused easily
If an infant cannot be aroused easily from a sleeping state ___
This is an emergency
Infants less than 2 months have a ___ for feeding
Sucking reflex
Separation anxiety may be present at ___
6 to 12 months
Toddler age
After infancy until 3 years
Preschool age
3 to 6
School age
6 to 12
Adolescent age
12 to 18
Stage of life with the most growth
Childhood
Anatomic differences between adult and pediatric airway
- Airway is smaller in diameter
- Airway is shorter
- Lungs are smaller
- Heart is higher in the chest
- Glottic opening is higher and positioned more anteriorly
- Neck appears nonexistent
- Larger, rounder occiput requiring more careful positioning of the airway
- Proportionally larger tongue and more anterior in the mouth
- Tongue larger relative to the mandible and can block airway
- Long, floppy epiglottis infants and toddlers proportionally larger in relation to the size of the airway
- Less-developed rings of cartilage in the trachea, may collapse if the neck is flexed or hyperextended
- Narrowing funnel-shaped upper airway to a cylinder-shaped lower airway
Diameter of infant trachea
Same as a drinking straw
Infant breathing
Obligate nose breathers
Infant respiration rate
30 to 60 /min
Toddler respiration rate
24 to 40 /min
Preschool respiration rate
22 to 34 /min
School age respiration rate
18 to 30 /min
Adolescent respiration rate
12 to 16 /min
Child oxygen demand is about ___ of an adult
Twice
The smaller lungs with higher oxygen demand increases the risk of ___
Hypoxia because of apnea or ineffective ventilation efforts
Anything that places pressure on the abdomen of a young child can ___
Block movement of the diaphragm and cause respiratory compromise
Auscultating breath sounds in children
Easier because of thinner chest walls, but detecting poor air movement or absent breath sounds is harder because less air is exchanged with each breath
Child’s primary method for compensating for decreased perfusion
Increase heart rate
Children are able to compensate for decreased perfusion by constricting ___
The vessels in the skin
Constriction of the blood vessels can be so profound that ___
Blood flow to the extremities can be diminished
Signs of vasoconstriction include ___
- Pallor (early sign)
- Weak distal pulses
- Delayed capillary refill time
- Cool hands or feet
Newborn to 3 months pulse rate
85 to 205 /min
3 months to 2 years pulse rate
100 to 190
2 to 10 years pulse rate
60 to 140
> 10 years pulse rate
60 to 100
The pediatric brain requires a higher amount of ___
Cerebral blood flow, oxygen, and glucose
Glucose stores in the pediatric patient
Limited
The pediatric brain is at risk for secondary brain damage from ___
Hypotension and hypoxic events
The pediatric brain tissue and cerebral vasculature is fragile and susceptible to bleeding from ___
Shearing forces
If a child’s cervical spine is injured, it is most likely to be an injury to the ___
Ligaments as the result of a fall
Pediatric GI differences
- Muscle structures less developed, less protection from trauma
- Liver and spleen are proportionally larger and situation more anteriorly
- Organs closer together, more prone to multi organ trauma
- Liver, spleen, and kidneys are injured more frequently
At the ends of the long bones, enable the bones to grow during childhood
Growth plates
The open growth plates are ___ than ligaments and tendons
Weaker
Immobilize extremities with suspected sprains or strains because they may be ___
Fractures through the growth plates
Soft spots on the newborn skull anterior and posterior
Fontanelles
The anterior fontanelle will close at ___
18 months
The posterior fontanelle will close at ___
6 months
Some bulging of the fontanelles is a normal assessment finding when the infant is ___
Either crying, coughing, or lying on the back or stomach
Fontanelles of an infant can be an important assessment tool for such issues as ___
- ICP (bulging in a non-crying infant)
- Dehydration (sunken appearance)
Structured assessment tool that allows you to rapidly form a general impression of the child’s condition without touching the child
Pediatric assessment triangle
PAT
Pediatric assessment triangle
When you assess an infant or child, use the PAT to determine if the patient is ___
Sick or not sick
The PAT can be performed in less than ___
30 seconds
Components of the PAT
- Appearance
- Circulation to skin
- Work of breathing
Appearance portion of the PAT
Muscle tone and mental status
Can also help to determine if the patient is sick or not sick
TICLS (or tickles)
TICLS
- Tone
- Interactiveness
- Consolability
- Look or gaze
- Speech or cry
Tone (TICLS)
- Is the child moving or resisting examination vigorously?
- Does the child have good muscle tone?
- Is the child limp, listless, or flaccid?
Interactiveness (TICLS)
- How alert is the child?
- How readily does a person, object, or sound distract or draw their attention?
- Will the child reach for, grasp, and play with a toy or examination instrument?
- Is the child uninterested in playing or interacting with anyone?
Consolability (TICLS)
- Can the child be consoled or comforted by anyone?
- Is the crying or agitation unrelieved by gentle reassurance?
Look or gaze (TICLS)
Does the child fix the gaze on a face, or is there a vacant, glassy-eyed stare?
Speech or cry (TICLS)
- Is the cry strong and spontaneous or weak or high-pitched?
- Is the content of speech age-appropriate or confused or garbled?
Increased work of breathing often manifests as ___
- Abnormal airway noise (grunting or wheezing)
- Accessory muscle use (contractions of the muscles above the clavicles)
- Retractions (drawing in of the muscles between the ribs or of the sternum during inspiration)
- Head bobbing (head lifting and tilting back during inspiration and forward during expiration)
- Nasal flaring (nares widening, usually during inspiration)
- Tachypnea
- Tripod position (Used by older children to maximize effectiveness of airway)
An “uh” sound heard during exhalation
Grunting
The grunting reflects the child’s ___
Attempt to keep the alveoli open
Above the clavicles
Supraclavicular
Drawing in of the muscles between the ribs
Intercostal retractions
Drawing in of the sternum
Substernal retractions
External opening of the nose
Nares
Pallor of the skin and mucous membranes may be seen in ___
Compensated shock or with anemia or hypoxia
Mottling is caused by ___
Constriction of peripheral blood vessels
Mottling is a sign of ___
Poor perfusion
Cyanosis reflects ___
A decreased level of oxygen in the blood
Cyanosis is a ___ sign of respiratory failure or shock
Late sign
XABCDE
- Exsanguination
- Airway
- Breathing
- Circulation
- Disability
- Exposure
Always position the pediatric airway in a ___
Neutral sniffing position
Keeping the airway in a neural sniffing position accomplishes two goals
- Keeping the trachea from kinking
- Maintaining proper alignment to restrict spinal motion
Bradypnea indicates ___
Impending respiratory arrest
Where to take infant pulse
Brachial or femoral
In children older than 1 year, where to take the pulse
Carotid
A strong central pulse does not rule out the possibility of ___
Compensated shock
Bradycardia in children
Less than 80 /min
Bradycardia in newborns
Less than 100 /min
Bradycardia in a pediatric patient indicates ___
Impending cardiopulmonary arrest
Tachycardia may indicate ___
Early sign of hypoxia or shock, but may also indicate fever, anxiety, pain, and excitement
Capillary refill is most reliable in ___
Children younger than 6
BLSCPR
Blood pressure
LOC
Skin: color, temp, moisture
Capillary refill time
Pulse: rate, rhythm, strength
Respiratory rate, effort, pattern
The Wong-Baker FACES Pain Rating Scale may help assess pain in children aged ___
3 and older
Why are children susceptible to hypothermia?
- Thermoregulatory system is immature
- Thin skin
- Lack of subcutaneous fat
- Larger skin surface area to mass ratio
- Infants younger than 6 cannot shiver
Newborns younger than ___ are the most susceptible to hypothermia
1 month
Infant GCS score
Eye opening
4 - Open spontaneously
3 - Open to speech or sound
2 - Open to pressure
1 - No response
Verbal
5 - Coos, babbles
4 - Irritable cry
3 - Cries to pain
2 - Moans to pain
1 - No response
Motor
6 - Normal spontaneous movement
5 - Localizes to pressure
4 - Withdraws from pressure
3 - Abnormal flexion (decorticate)
2 - Abnormal extension (decerebrate)
1 - No response (flaccid)
Child GCS score
Eye opening
4 - Open spontaneously
3 - Open to speech
2 - Open to pressure
1 - No response
Verbal
5 - Oriented conversation
4 - Confused conversation
3 - Cries
2 - Moans
1 - No response
Motor
6 - Obeys verbal commands
5 - Localizes to pressure
4 - Withdraws from pressure
3 - Abnormal flexion (decorticate)
2 - Abnormal extension (decerebrate)
1 - No response (flaccid)
Significant MOIs
Same as adult except:
1. Any fall higher than the child especially a head-first landing
2. Bicycle crash (when not wearing a helmet)
Rapid transport is indicated for ___
- Significant MOI
- History compatible with a serious illness
- Physical abnormality noted during primary assessment
- Potential serious anatomic abnormality
- Significant pain
- Abnormal LOC, altered mental status, or signs of shock
Considerations when making a transport decision
- Type of clinical problem
- Expected benefits of ALS treatment in the field
- Local EMS system protocols
- Your comfort level
- Transport time to the hospital
Children ___ should be transported in a car seat if the situation allows
Weighing less than 40 lbs who do not require spinal motion restriction
Children younger than ___ should be transported in a rear-facing position
2
Why do children under 2 need to be transported in a rear-facing position
Lack of mature neck muscles
Questions to ask during history taking
- NOI or MOI
- How long has it been happening
- Key events leading to it
- Presence of fever
- Effects on the child’s behavior
- Activity level
- Recent eating, drinking, and urine output
- Change in bowel or bladder habits
- Vomiting, diarrhea, abdominal pain
- Rashes
A ___ should be suspected in any child who refuses to bear weight
Lower extremity injury
When should the assessment begin at the feet and end at the head?
Infants, toddlers, and preschool age children who do not have apparent life-threatening injuries or illnesses
The presence of pus in the ear may indicate ___
An ear infection or perforation in the ear drum
Acidosis may impart a ___ odor on the breath
Fruity