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PEDIATRIC EMERGENCIES

PEDIATRIC EMERGENCIES. Pediatric Emergencies. Basic Approach to Pediatric Emergencies Approaches to patient vary with age and nature of incident Practice quick and specific questioning of the child Key on your visual assessment Begin your exam without instruments

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PEDIATRIC EMERGENCIES

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  1. PEDIATRIC EMERGENCIES

  2. Pediatric Emergencies • Basic Approach to Pediatric Emergencies • Approaches to patient vary with age and nature of incident • Practice quick and specific questioning of the child • Key on your visual assessment • Begin your exam without instruments • Approach the child slowly and gently

  3. Pediatric Emergencies • Basic Approach (cont..) • Do not separate the child from the mother unnecessarily • Be honest and allow the child to determine the order of the exam • Avoid touching painful areas until the child’s confidence has been gained

  4. Pediatric Emergencies • Child’s response to emergencies • Primary response is fear • Fear of being separated from parents • Fear of being removed from home • Fear of being hurt • Fear of mutilation • Fear of the unknown • Combat the fear with calm, honest approach • Be honest - tell them it will hurt if it will • Use approach language

  5. Development Stages -Keys to Assessment • Neonatal stage - birth to 1 month • Congenital problems and other illnesses often n noted • Personality development begins • Stares at faces and smiles • Easily comforted by mother and sometimes father • Rarely febrile, but if so, be cautious of meningitis

  6. Development Stages -Keys to Assessment • Approach to Neonates • Keep child warm • Observe skin color, tone and respiratory activity • Absence of tears when crying indicates dehydration • Auscultate the lungs early when child is quiet • Have the child suck on a pacifier • Have child remain on the mother’s lap

  7. Development Stages -Keys to Assessment • Ages 1-5 months - Characteristics • Birth weight doubles • Can follow movements with their eyes • Muscle control develops • History must be obtained from parents • Approach • Keep child warm and comfortable • Have child remain in mother’s lap • Use a pacifier or a bottle

  8. Development Stages -Keys to Assessment • Ages 1-5 months - Common problems • SIDS • Vomiting and diarrhea/dehydration • Meningitis • Child abuse • Household accidents

  9. Development Stages -Keys to Assessment • Ages 6-2 months - Characteristics • Ability to stand or walk with assistance • Very active and explore the world with their mouths • Stranger anxiety • Do not like lying supine • Cling to their mothers

  10. Development Stages -Keys to Assessment • Ages 6-12 months - Common problems • Febrile seizures • Vomiting and diarrhea/dehydration • Bronchiolitis or croup • Car accidents and falls • Child abuse • Ingestions and foreign body obstructions • Meningitis

  11. Development Stages -Keys to Assessment • Ages 6-12 months - Approach • Examine the child in the mothers lap • Progress from toe to head • Allow the child to get used to you

  12. Development Stages -Keys to Assessment • Ages 1-3 years - Characteristics • Motor development, always on the move • Language development • Child begins to stray from mother • Child can be asked certain questions • Accidents prevail

  13. Development Stages -Keys to Assessment • Ages 1-3 yrs - Common problems • Auto accidents • Vomiting and diarrhea • Febrile seizures • Croup, meningitis • Foreign body obstruction

  14. Development Stages -Keys to Assessment • Ages 1-3 yrs - Approach • Cautious approach to gain confidence • Child may resist physical exam • Avoid “no” answers • Tell the child if something will hurt

  15. Development Stages -Keys to Assessment • Ages 3-5 years - Characteristics • Tremendous increase in motor development • Language is almost perfect but patients may not wish to talk • Afraid of monsters, strangers; fear of mutilation • Look to parent for comfort and protection

  16. Development Stages -Keys to Assessment • Ages 3-5 yrs - Common problems • Croup, asthma, epiglottitis • Ingestions, foreign bodies • Auto accidents, burns • Child abuse • Drowning • Meningitis, febrile seizures

  17. Development Stages -Keys to Assessment • Ages 3-5 yrs - Approach • Interview child first, have parents fill in gaps • Use doll or stuffed animal to assist in assessment • Allow child to hold & use equipment • Allow them to sit on your lap • Always explain what you are going to do

  18. Development Stages -Keys to Assessment • Ages 6-12 years - Characteristics • Active and carefree • Great growth, clumsiness • Personality changes • Strive for their parent’s attention • Common problems • Drowning • Auto accidents, bicycle accidents • Fractures, falls, sporting injuries

  19. Development Stages -Keys to Assessment • Age 6-12 yrs - approach • Interview the child first • Protect their privacy • Be honest and tell them what is wrong • They may cover up information if they were disobeying

  20. Development Stages -Keys to Assessment • Ages 12-15 - Characteristics • Varied development • Concerned with body image and very independent • Peers are highly important, as is interest in opposite sex

  21. Development Stages -Keys to Assessment • Ages 12-15 - Common problems • Mononucleosis • Auto accidents, sports injuries • Asthma • Drug and alcohol abuse • Sexual abuse, pregnancy • Suicide gestures

  22. Development Stages -Keys to Assessment • Ages 12-15 - Approach • Interview the child away from parent • Pay attention to what they are not saying

  23. Development Stages -Keys to Assessment • Characteristics of Parents response to emergencies • Expect a grief reaction • Initial guilt, fear, anger, denial, shock and loss of control • Behavior likely to change during course of emergency

  24. Development Stages -Keys to Assessment • Parent Management • Tell them your name and qualifications • Acknowledge their fears and concerns • Reassure them it is all right to feel as they do • Redirect their energies - help you care for child • Remain calm and in control • Keep them informed as to what you are doing • Don’t “talk down” to parents • Assure parents that everything is being done

  25. General Approach to Pediatric Assessment • History • Be direct and specific with child • Focus on observed behavior • Focus on what child and parents say • Approach child gently, encourage cooperation • Get down to visual level of child • Use a soft voice and simple words

  26. Physical Exam • Avoid touching painful areas until confidence has been gained • Begin exam without instruments • Allow child to determine order of exam if practical • Use the same format as adult physical exam

  27. General Approach to Pediatric Assessment • Physical Exam (cont.) • Special concerns • Fontanels should be inspected in infants • Normal fontanels should be level with surface of the skull or slightly sunken and it may pulsate • Abnormal fontanels • Tight and bulging (increased ICP from trauma or meningitis) • Diminished or absent pulsation • Sunken if dehydrated

  28. General Approach to Pediatric Assessment • Special concerns (cont..) • GI Problems • Disturbances are common • Determine number of episodes of vomiting, amount and color of emesis

  29. Pediatric Vital Signs • Blood Pressure • Use right size cuff, one that is two-thirds the width of the upper arm • Pulse • Brachial, carotid or radial depending on child • Monitor for 30 seconds

  30. Pediatric Vital Signs • Respirations • Observe the rate before the child starts to cry • Upper limit is 40 minus child’s age • Identify respiratory pattern • Look for retractions, nasal flaring, paradoxical chest movement • Level of consciousness • Observe and record

  31. Noninvasive Monitoring • Prepare the child before using devices • Explain the device • Show the display and lights • Let child hear noises if devices makes them • Pulse oximetry-particularly useful since so many childhood emergencies are respiratory

  32. Pediatric Trauma • Basics • Trauma is leading cause of death in children • Most common mechanisms-MVA, burns, drowning, falls, and firearms • Most commonly injured body areas-head, trunk, extremities • Steps much like those in adult trauma • Complete ABCDE’s of primary assessment • Correct life threatening conditions • Proceed to secondary assessment

  33. National MVA 43% Burns 14.9% Drowning 14.6% Aspiration 3.4% Firearms 3.0% Falls 2.0% Oklahoma MVA 35% Drowning 14.5% Burns 14.0% Firearms 9.9% Aspiration 5.7% Stab/cut ? Causes of Death

  34. Frequency of Injured Body Parts • Head 48% • Extremities 32% • Abdomen 11% • Chest 9%

  35. Pediatric Trauma • Head, face, and neck injuries • Children prone to head injuries • Be alert for signs of child abuse • Facial injuries common secondary to falls • Always assume a spinal injury with head injury

  36. Pediatric Trauma • Chest and abdominal injuries • Second most common cause of pediatric trauma deaths • Most result from blunt trauma • Spleen is most commonly injured organ • Treat aggressively for shock in blunt abdominal injury

  37. Pediatric Trauma • Extremity injuries • Usually limited to fractures and lacerations • Most fractures are incomplete - bend, buckle,, and greenstick fractures • Watch for growth plate injuries

  38. Pediatric Trauma • Burns • Second leading cause of pediatric deaths • Scald burns are most common • Rule of nine is different for children • Each leg worth 13.5% • Head worth 18%

  39. Pediatric Trauma • Child abuse and neglect - Basics • Suspect if injuries inconsistent with history • Children at greater risk often seen as “special” and different • Premature or twins • Handicapped • Uncommunicative (autistic) • Boys or child of the “wrong” sex

  40. Pediatric Trauma • Child abuse and neglect - The child abuser • Usually a parent or someone in the role of parent • Usually spends much time with child • Usually abused as a child

  41. Pediatric Trauma • Sexual Abuse - Basics • Can occur at any age • Abuser is usually someone in family • Can be someone the child trusts • Stepchildren or adopted children at higher risk • Paramedic actions • Examine genitalia for serious injury only • Avoid touching the child or disturbing clothing • Provide caring support

  42. Pediatric Trauma • Triggers to high index of suspicion for child neglect • Extreme malnutrition • Multiple insect bites • Long-standing skin infections • Extreme lack of cleanliness

  43. Pediatric Trauma • Triggers to high index of suspicion for child abuse • Obvious fracture in child under 2 yrs old • Injuries in various stages of healing • More injuries than usually seen in children of same age • Injuries scattered on many areas of body • Bruises that suggest intentional infliction • Increased ICP in infant

  44. Pediatric Trauma • Triggers to high index of suspicion for child abuse (cont.) • Suspected intra-abdominal trauma in child • Injuries inconsistent with history • Parent’s account vague or changes during interview • Accusations that child injured himself intentionally • Delay in seeking help • Child dresses inappropriately for situation

  45. Pediatric Trauma • Management of potentially abused child • Treat all injuries appropriately • Protect the child from further abuse • Notify the proper authorities • Be objective while gaining information • Be supportive and nonjudgmental of parents • Don’t allow abuser to transport child to hospital • Inform ED staff of suspicions of child abuse • Document completely and thoroughly

  46. Pediatric Medical Emergencies - Neurological • Pediatric seizures - Common causes • Fever, infections • Hypoxia • Idiopathic epilepsy • Electrolyte disturbances • Head trauma • Hypoglycemia • Toxic ingestion or exposure • Tumors or CNS malformations

  47. Pediatric Medical Emergencies - Neurological • Febrile Seizures • Result from a sudden increase in body temperature • Most common between 6 months and 6 years • Related to rate of increase, not degree of fever • Recent onset of cold or fever often reported • Patients must be transported to hospital

  48. Pediatric Medical Emergencies - Neurological • Assessment • Temperature - suspect febrile seizure if temp over 103 degrees F • History of seizure • Description of seizure activity • Position and condition of child when found • Head injury, Respirations • History of diabetes, family history • Signs of dehydration

  49. Pediatric Medical Emergencies - Neurological • Management - Basic Steps • Protect seizing child • Manage the ABC’s, provide supplemental oxygen • Remove excess layers of clothing • IV of NS or LR TKO rate • Transport all seizure patients, support the parents

  50. Pediatric Medical Emergencies - Neurological • Management - If status epilepticus • IV of NS or LR TKO rate • Perform a Dextrostix <80 mg/dl give D25 2 ml/kg IV/IO if child is less than 12 • 12 or older give D50 1ml/kg IV • Contact Medical Control if long transport

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