Pediatrics Flashcards
Pediatric Age Categories
- Newborns and infants: birth to 1 year
- Toddlers: 1–3 years
- Preschool: 3–6 years
- School age: 6–12 years
- Adolescent: 12–18 years
Anatomic and Physiologic Differences
- Infants and children differ from adults in psychology, anatomy, and physiology
- Understanding differences will help you assess and care for young patients
Airway & Respiratory System
Child has smaller nose
Child more space is taken up by tongue
Child’s trachea is narrower
Cricoid cartilage is less rigid & less developed
Airway structures are more easily obstructed
Chest and Abdomen
- Less developed, more elastic in young patients
- Infants and children: abdominal breathers
- Abdominal organs less protected than in adults
Body Surface***
A child’s body surface is larger in proportion to the body mass - not smaller - than an adults**
- More prone to heat loss through skin
- More vulnerable to hypothermia
Blood Volume
9 pnd newborn <12 ounces
60 pnd Child 2L
125 pnd adult 4L
Think About It
• What techniques would you utilize when attempting to assess a crying infant?
Interacting with the Pediatric Patient - pg 883-885
- Identify yourself
- Let child know that someone has called or will call parents
- If no life threats, continue at a calm pace during the evaluation process
- Let child have a nearby toy
- Kneel at child’s eye level
- 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 child
- Keep them warm
- Work toe to head*
Supporting the Parents or Other Care Providers
- Possible reactions to child’s illness/injury: denial, shock, crying, screaming, anger, self-blame, guilt
- May interfere with care of child
- Ask to help by holding/comforting child and giving medical history
Pediatric Assessment Triangle
Appearance
- Mental Status - Alert Verbal
- muscle tone
- interacting
- look & gaze
Work of Breathing
- abnormal sounds
- abnormal body position
- accessory muscle use
Circulation to Skin
-pallor, mottling, cyanosis
First done with a general impression as you enter the room and then hands on
Hands on
Appearance
-PU part of AVPU
Breathing
-is the airway open
Circulation
-cap refill
Pay special attention to mental status - is this normal for the child?
1 fail - respiratory distress
2 fail - resp failure
Primary Assessment: Pediatric Care
- Rapidly identifies critical patient
* Essential component of pediatric assessment
Population with the greatest rise in HIV / Hepatitis
adolescents - 12-18 because they think they are invincible
Interviewing the child - presence of adults
may have to ask all but one parent to leave at the room so the child can calm down
Findings from the Pediatric Assessment Triangle
How serious is the child
Most of the time issues with kids are breathing or circulation problems
retrations / nasal flaring
appearance side is bad work is bad - respiratory failure
good appearance / bad breathing
respiratory distress
poor circulation high RH - cir distress
PAT - 1 a problem -resp distress
PAT - 2 a problem - resp failure
babies are obligate nose breathers
.
Forming a general impression with the pediatric pt
kid crying afraid of you - not critical
lifeless - critical pt
Mental Status Interaction Emotional State Response to You Tone & Body Position Effort of Breathing Quality of Cry or Speech Skin Color
You don’t take a BP on a child…
younger than 3**
take BP only in children older than 3 pg 891
cap refill - pinch the child’s hand
blanch
Cap refill is a good indicator of perfusion in children…
younger than 6
book says younger than 5 pg 890
What order to you do the rapid exam in for a child
do to toe to head exam instead of a head to toe…
how long does it take the bones of the skull to fuse
12-18 months**
Posterior fontanelle closes first (2-4mo) and then the anterior (19mo)
what does a bulging fontanelle and a sunken fontanelle mean
Bulging - increased ICP meningitis, trauma
Sunken - dehydrated
How do you put an OPA in for a child
opa sweep the tounge to one side
OPA curved side down
How do you estimate the size of an NPA for a child
npa about the size of the pinky finger
measure from nostril to the tragus (cartilage at the front of the ear)
Clearing an obstructed airway in an infant
infant - <1yr old
5 back blows & 5 chest thrusts
becomes unconscious
30 compressions visualize the airway and clear if you can see the object
Attempt artificial ventilation
infant obstructed airway stuff
Circulation Problems
Common Causes of Shock in Pediatric Patients
- Diarrhea and/or vomiting
- Infection
- Trauma (especially abdominal injuries)
- Blood loss
Less Common
• Allergic reactions
• Poisoning
• Cardiac events (rare)
Unlike adults cardiac events are not common causes of shock in a child
foramen ovale
In the fetal heart, the foramen ovale , also foramen Botalli, ostium secundum of Born or falx septi, allows blood to enter the left atrium from the right atrium. It is one of two fetal cardiac shunts, the other being the ductus arteriosus (which allows blood that still escapes to the right ventricle to bypass the pulmonary circulation). Another similar adaptation in the fetus is the ductus venosus. In most individuals, the foramen ovale closes at birth. It later forms the fossa ovalis.
when it comes to infants and children which are most affected by hypothermia
premature
premature is equal to
Most common cause of cardiac arrest in child
respiratory problems - pg 909
on exam
differentiating upper airway problems vs lower airway problems
.
croup
longer onset
Viral Illness
occurs 6mo & 4yr of age
Upper airway tissues swell
larynyx, trachea & bronchi
Cooler months of the year
- Seal Bark cough
- Sick but not overly sick
- taking in cool air helps them breath better
Mild fever some hoarseness worsens at night Difficulty Breathing nasal flaring, retraction, tugging at throat
on the quiz will provide symptoms
Position of Comfort - Sitting
admin high flow humidified O2
Epiglottitis
sudden onset
Bacterial infection
older kids 4 to 7 yrs
Swelling of the Epiglottis / partial airway obstruction
stridor sudden onset of high fever cherry red swollen epiglottis - don't visualize tripod position can't swallow drools a lot kids are very sick more ill than the kids with coup pt will sit still but still works hard to breath
ALS call
High flow O2 from humidified source
Should you visualize the mouth of a child with coup or epiglottitis
don’t look in mouth with these kids as it could cause lyrngospasm
febrile seizure
and tx for Fever
seizure due to high body temp
remove childs clothing
put on tepid water
monitor to shivering
follow protocols for fluid admin
year 6mo to 6 yrs
Meningitis - pg 913
bacterial - worsens in hours
viral - worsens in days
potentially life threatening infection of the lining of the brain & spinal for caused by a bacteria or virus and commonly occurs between the ages of 1mo & 5yr.
dura mater
arachnoid layer
pia mater
inflamed meningies
The Centers for Disease Control and Prevention says that symptoms for viral meningitis either appear quickly or manifest over several days – usually following a cold, runny nose, diarrhea, vomiting or other signs of infection. Illness from viral meningitis generally lasts seven to 10 days, and the patient typically sees a full recovery.
Symptoms are the same for bacterial but worsen in hours not days.
Tx: O2
meningitis (bacterial)
fever altered mental status sunglasses on lights hurt her eyes
can you move your head forward
Diarrhea and Vomiting
• Maintain open airway • Provide oxygen • Contact medical control if signs of shock are present • Immediate transport
dehydration
Seizures
- Maintain open airway (not oral airway)
- Position on side if no spinal injury
- Be alert for vomiting
- Provide oxygen
- Transport
Altered Mental Status
- Be alert for MOI
- Be alert for signs of shock
- Look for evidence of poisoning
- Attempt to get history of diabetes and seizure disorder
Poisoning
- Contact poison control center
- Consider activated charcoal
- Provide oxygen
- Transport
- Continue to monitor responsiveness
Care for Unresponsive
Poisoning Patient
- Ensure open airway
- Provide oxygen
- Be prepared to provide artificial ventilation
- Transport
- Rule out trauma
Drowning
- Provide artificial ventilation or CPR
- Protect airway
- Consider spinal immobilization
- Protect against hypothermia
- Treat any trauma
- Transport
Sudden Infant Death Syndrome
- No accepted reason why these babies die
- Treat as any patient in cardiac or respiratory arrest
- Resuscitate unless there is rigor mortis
- Give emotional support for parents
know whats in the abdominal quadrants
can use a spine board if pad with kids
1-800-96a-buse
obligation to report abuse
Child abuse:
when did they call 911
did they call right away?
the abusers later say how am I going to explain this - why did you wait…..? give away
Infants and children with special challenges
be able to use the parents knowledge
trach tubes artificial ventilators Central IV linse Gastrostomy and Gastric Feeding Shunts
tx - airway, ventillation, O2, transport
suctioning with trach tubes
tell the parents that you need their help and show the EMT how it is done
walk into a complex child case
ask the parent what can I do for you
pediatric calls are stressful because the injuries to the kids are the fault of the parent
.
SUIDS
kinds less than 1 year
Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant younger than 1 year of age that remains unexplained after a thorough case investigation, including:
Performance of a complete autopsy
Examination of the death scene
Review of the infant’s and family’s clinical histories
many of the kids have a upper respiratory infection a couple of weeks prior
.
true unexplained vs sleep death
.
SUID
SIDS Accidental suffocation Unknown Poisoning Metabolic disorders Hypotherima / Hyperthermia Neglect or homicide
Highest Risk for SUIDS*****
Risk exists from birth up to one year of age with highest incidence between 2-6 months of age
What is the most primary cause of cardiac arrest in children
respiratory disease
What are the three components of the pediatric assessment triangle** on quiz
Appearance
Work of Breathing
Circulation to the Skin
rate of PPV infant and child
infant: 12-20 (3 to 5 seconds)
older: 10-12 (5 to 6 seconds)
causes of shock in children
Diarrhea and/or vomiting
Infection
Trauma
Blood Loss
Premature infant
weighs < 5 1/2 ponds or is born before 37 weeks
what is the number one cause of death in infants and children
trauma - blunt - accidental falls, burns, entrapment, crushing
head is proportionally lgr & heavier in a child
the chest is less developed and the ribs are more elastic
infants and young children ante abdominal breathers - rely on diaphragm more than adults
bones are more flexible
what adult piece of equipment can be used to immobilize a child
KED
respiratory distress - inside and outside - child
HR increases, blood vessels constrict
DIB, RR, PR increase
respiratory failure - inside and outside - child
can’t compensate, hypoxic, tires
cyanotic, slow irregular resp, AMS
blood loss - inside & outside child
HR, RR increases, blood vessels constrict
skin pale, delayed cap refill, AMS
