Anatomic and Physiologic Differences

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2. Anatomic and Physiologic Differences . There are fundamental anatomic and physiologic differences between children and adults that directly effect How assessment is performedHow children respond to illness and injuryHow treatment and transportation decisions are made. 3. Pediatric Airway Considerations.
Anatomic and Physiologic Differences

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1. 1 Anatomic and Physiologic Differences Lesson 2

2. 2 Anatomic and Physiologic Differences There are fundamental anatomic and physiologic differences between children and adults that directly effect How assessment is performed How children respond to illness and injury How treatment and transportation decisions are made This lesson is only a few slides. While there are significant differences between the anatomy and physiology of children and adults, the objective of this session is simply to introduce those differences. The key concept in Lesson 2 is that children differ from adults in structure and function, which in turn gives the basis for modifying the prehospital approach to children from that used for adults. This lesson is only a few slides. While there are significant differences between the anatomy and physiology of children and adults, the objective of this session is simply to introduce those differences. The key concept in Lesson 2 is that children differ from adults in structure and function, which in turn gives the basis for modifying the prehospital approach to children from that used for adults.

3. 3 Pediatric Airway Considerations More anterior than the adult less head tilt to open the airway Smaller diameter of airway than the adult easily blocked by secretions or blood Large tongue in relation to jaw size likely to cause obstruction when child is unconscious Airway differences are more pronounced in infants and become less pronounced as children grow toward adulthood.Airway differences are more pronounced in infants and become less pronounced as children grow toward adulthood.

4. 4 Pediatric Airway Considerations

5. 5 Infants prefer to breathe through the nose. Nasal obstructions can cause respiratory distress. Sometimes, what seems like a minor problem such as this may actually have major consequences. Airway assessment for children is the most essential life saving skill an EMT can have. Being attentive to all aspects of the airway is the primary responsibility of pediatric care.Sometimes, what seems like a minor problem such as this may actually have major consequences. Airway assessment for children is the most essential life saving skill an EMT can have. Being attentive to all aspects of the airway is the primary responsibility of pediatric care.

6. 6 Breathing Considerations Small children are dependent on contraction of the diaphragm to breathe. A child?s primary response to respiratory distress is to increase the rate and effort of breathing. Although both children and adult use their diaphragms to breathe, adults are able, by chest expansion alone, to cause air to rush in to the lungs. Children cannot create enough negative pressure in the chest because the chest wall is less developed. Children in respiratory distress compensate rapidly by increasing the respiratory rate then easily fatigue, signaling the onset of respiratory failure. Increased respiratory rate uses much more of the body?s energy supply so that the child will eventually be unable to maintain elevated respiratory rate. Once the child?s breathing slows, his oxygenation is severely impaired and hypoxemia results.Although both children and adult use their diaphragms to breathe, adults are able, by chest expansion alone, to cause air to rush in to the lungs. Children cannot create enough negative pressure in the chest because the chest wall is less developed. Children in respiratory distress compensate rapidly by increasing the respiratory rate then easily fatigue, signaling the onset of respiratory failure. Increased respiratory rate uses much more of the body?s energy supply so that the child will eventually be unable to maintain elevated respiratory rate. Once the child?s breathing slows, his oxygenation is severely impaired and hypoxemia results.

7. 7 A child may have pronounced retractions of the chest wall because the chest wall is less muscular and has more flexible bones. Extra effort of breathing may include the chest, abdomen, neck and head. Literally, the child uses his body to keep up the respiratory effort. Once the respiratory system begins to fail (respiratory failure), the heart is affected. Because oxygen is depleted, the heart is unable to maintain a rapid rate, and bradycardia results.Extra effort of breathing may include the chest, abdomen, neck and head. Literally, the child uses his body to keep up the respiratory effort. Once the respiratory system begins to fail (respiratory failure), the heart is affected. Because oxygen is depleted, the heart is unable to maintain a rapid rate, and bradycardia results.

8. 8 A silent chest is an ominous sign of low blood oxygen in the pediatric patient. Breathing Considerations

9. 9 Circulation Considerations Children compensate efficiently in shock by increasing heart rate and vasoconstriction but then decompensate rapidly. Mental state change is often an early indicator of shock. As a general rule, children do not have cardiovascular disease as adults do. As a result, children are more able than adults to constrict their peripheral blood flow when necessary to keep their central circulation perfused. The major compensatory mechanism of the child to increase cardiac output is through the elevation of the heart rate, which can race to over 200 beats per minute. Sustaining a high heart rate requires increased amounts of oxygen to be available. If there is respiratory insufficiency, the child will not be able to get the increased oxygen necessary for this sustained elevated heart rate, and other symptoms will begin to appear. Altered mental state in the presence of a very fast or slow heart rate indicates that the child is decompensating.As a general rule, children do not have cardiovascular disease as adults do. As a result, children are more able than adults to constrict their peripheral blood flow when necessary to keep their central circulation perfused. The major compensatory mechanism of the child to increase cardiac output is through the elevation of the heart rate, which can race to over 200 beats per minute. Sustaining a high heart rate requires increased amounts of oxygen to be available. If there is respiratory insufficiency, the child will not be able to get the increased oxygen necessary for this sustained elevated heart rate, and other symptoms will begin to appear. Altered mental state in the presence of a very fast or slow heart rate indicates that the child is decompensating.

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11. 11 Circulation Considerations Hypovolemia can develop from vomiting or diarrhea in children. Blood pressure is an unreliable indicator of perfusion in the pediatric patient. Very commonly, hypovolemia develops from medical rather than traumatic causes in children. Because children readily compensate for volume loss by increasing their heart rates, blood pressure does not fall until hypoperfusion is profound.Very commonly, hypovolemia develops from medical rather than traumatic causes in children. Because children readily compensate for volume loss by increasing their heart rates, blood pressure does not fall until hypoperfusion is profound.

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