Pediatric Emergencies

Question 1

Pediatric: Normal Respiratory Rate

Answer 1

Adolescent (13-18 y/o): 12-20

School-age (6-12 y/o): 18-25

Preschooler (4-5 y/o): 20-28

Toddler (1-3 y/o): 22-37

Infant (<1 y/o): 30-53

Question 2

Pediatric: Normal Pulse Rate

Answer 2

Adolescent: 60-100

School-age: 75-118

Preschooler: 80-120

Toddler: 98-140

Infant: 100-180

Pulses slower in sleeping child/athlete

Question 3

Pediatric: Lower Limit of Normal Systolic BP

Answer 3

Adolescent: > 110

School-age: > 97

Preschooler: > 89

Toddler: >86 (or strong pulses)

Infant: > 72 (or strong pulses)

Question 4

Pediatric Bradycardia

Answer 4

Airway/Breathing management:
Monitor SpO2 and administer 100% O2 via NRB

If signs of severe cardiopulmonary compromise are present: Ventilate w/BVM
If pt 8 y/o or less and has signs of poor perfusion (as described above) w/a HR < 60 despite 100% O2 and ventilation for 2 min, initiate chest compressions

Look for signs of airway obstruction:
No breath sounds
Tachypnea
Intercostal and suprasternal retractions
Stridor
Chocking
Cyanosis

BGL

Assess temperature:
Hypothermia - Rewarm pt, ensure pt compartment is warm and administer warm IV fluids

Question 5

Pediatric Tachycardia

Answer 5

Symptomatic pediatric tachycardia: cool mottled skin, diminished pulses, AMS, increased capillary refill time
Sinus Tachycardia = Infant < 220 or Child < 180 w/narrow QRS
Symptomatic Tachycardia = Infant greater than or equal to 220 or Child greater than or equal to 180 w/signs of poor perfusion

If pt is asymptomatic look for underlying causes (fever, dehydration, pain, etc)

Airway/Breathing management:
Monitor SpO2 and administer 100% via NRB

BGL

Assess temperature

Question 6

Pediatric Shock

Answer 6

Shock pt deteriorate rapidly. Signs of shock include hypotension, cool mottled skin, diminished pulses, AMS, increased capillary refill and tachycardia

Place pt in supine position

Maintain body warmth

Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher

BGL

Assess temperature

Question 7

Pediatric FBAO

Answer 7

Airway/breathing management:
Infant (Less than 1 y/o) - Conscious
Mild obstruction w/good air exchange:
Do not interfere w/pt's own attempts to clear airway
Monitor closely for signs of worsening 
Attempt to keep pt calm

Severe Obstruction:
If possible, bear the infant’s chest
Support infant in prone position, deliver up to 5 back blows in the middle upper back
Rotate to supine position w/head lower than trunk
Deliver up to 5 quick downward chest thrusts in the same location as chest compressions
Repeat sequence until obstruction is cleared of infant become unconscious

Unconscious:
Reposition airway and remove object by direct laryngoscopy w/Magill forceps
Begin CPR as indicated
Suction as needed

Child (1 y/o or older)
Conscious:
Mild Obstruction:
Encourage pt's own attempts to clear airway
Attempt to keep pt calm

Severe Obstruction:
Abdominal thrusts

Unconscious:
Reposition airway and remove object by direct laryngoscopy w/Magill forceps
Begin CPR as indicated
Suction as needed

Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher

Question 8

Pediatric Respiratory Distress

Answer 8

Respiratory Distress: increased respiratory rate, increased work of breathing, retractions, nasal flaring, SpO2 < 95%

Airway/breathing management:
Assess breath sounds
Administer O2 via NRB

Assess temperature

BGL

Question 9

Pediatric Asthma

Answer 9

Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher

BGL

Assess temperature

Question 10

Pediatric Allergic Reaction/Anaphylaxis

Answer 10

Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher

Assist w/administration of pt’s Auto-Injector Epi-pen if present

BGL

Assess temperature

Question 11

Pediatric Altered Consciousness

Answer 11

Maintain aspiration prophylaxis by placing pt in recovery position

BGL - refer to Diabetic Guidelines

Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher
If GCS equal to or less than 8 or inability to protect airway, refer to Advanced Airway Guidelines

Assess temperature

Tx based on underlying causes:
Narcotic use/exposure - refer to pediatric overdose/poisoning guidelines

Unknown Etiology:
Consider other treatable neurological or metabolic disorders and if identified follow appropriate guideline

Question 12

Pediatric Diabetic

Answer 12

Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher

BGL

Assess temperature

Look for underlying causes

Question 13

Pediatric Overdose/Poisoning

Answer 13

If substance is known, contact Poison Control

Airway/Breathing management:
Maintain aspiration prophylaxis by placing pt in recovery position
O2 via proper adjunct to maintain levels at 95% or higher

BGL

Wear appropriate PPE

Sz may develop in many overdose/poison/ingestion situations - refer to Pediatric Sz Guidelines

Do not delay tx or transport but if possible bring Rx or substance ingested

Question 14

Pediatric Seizures

Answer 14

Maintain aspiration prophylaxis by placing pt in recovery position

If trauma suspected, maintain c-spine

If pt is actively seizing, protect pt from further injury

Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher

BGL - refer to Pediatric Diabetic Guidelines

Assess temperature - if t is febrile (greater than or equal to 104), apply cooling methods

Question 15

Pediatric Fever

Answer 15

Airway/Breathing management:
O2 via proper adjunct to maintain levels at 95% or higher

BGL

Assess temperature - if temp is greater than or equal to 104, apply cooling measures (ice pack, wet towels to neck, axillae, groin, etc)