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PEDIATRICS… ... more than just little people

PEDIATRICS… ... more than just little people. Airway Differences. Larger tongue relative to the mouth Less well-developed rings of cartilage in the trachea Head tilt-chin lift may occlude the airway. Breathing Differences. Infants breathe faster than children or adults.

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PEDIATRICS… ... more than just little people

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  1. PEDIATRICS… ...more than just little people

  2. Airway Differences • Larger tongue relative to the mouth • Less well-developed rings of cartilage in the trachea • Head tilt-chin lift may occlude the airway.

  3. Breathing Differences • Infants breathe faster than children or adults. • Infants use the diaphragm when they breathe. • Sustained, labored breathing may lead to respiratory failure.

  4. Circulation Differences • The heart rate increases for illness and injury. • Vasoconstriction keeps vital organs nourished. • Constriction of the blood vessels can affect blood flow to the extremities.

  5. Skeletal Differences • Bones are weaker and more flexible. • They are prone to fracture with stress. • Infants have two small openings in the skull called fontanels. • Fontanels close by 18 months.

  6. Growth and Development • Thoughts and behaviors of children usually grouped into stages • Infancy • Toddler years • Preschool age • School age • Adolescence

  7. Infant • First year of life • They respond mainly to physical stimuli. • Crying is their main avenue of expression. • They may prefer to be with caregiver. • If possible, have caregiver hold the infant as you start your examination.

  8. Toddler • 1 to 3 years of age • They begin to walk and explore the environment. • They may resist separation from caregivers. • Make any observations you can before touching a toddler. • They are curious and adventuresome.

  9. Preschool • 3 to 6 years of age • They can use simple language effectively. • They can understand directions. • They can identify painful areas when questioned. • They can understand what you are going to do using simple descriptions. • They can be distracted by using toys.

  10. School-Age Child • 6 to 12 years of age • They begin to think like adults. • They can be included with the parent when taking medical history. • They may be familiar with physical exam. • They may be able to make choices.

  11. The Adolescent • 12 to 18 years of age • They are very concerned about body image. • They may have strong feelings about being observed. • Respect an adolescent’s privacy. • They understand pain. • Explain any procedure that you are doing.

  12. Approach to Assessment • Obtain a complete set of baseline vitals. • Assess the need for ALS backup or immediate transport. • A child’s condition may deteriorate rapidly during transport. • Have pediatric resuscitation equipment ready.

  13. Vital Signs by Age

  14. Appearance Breathing Pediatric Triangle The Pediatric Triangle Circulation/Skin Color

  15. Appearance Look at the patient from across the room… …this is an important indicator of oxygenation, brain perfusion, and overall CNS function

  16. Appearance • Alertness • Eye contact • Distractibility • Consolability • Speech/Cry • Spontaneous motor activity

  17. Sick or Not Sick!

  18. Breathing • Abnormal body position • Audible or abnormal airway sounds • Retractions • Effort/work of breathing

  19. Breathing • A child with abnormal breath sounds needs high flow oxygen and immediate ALS intervention!

  20. Sick or Not Sick?

  21. Circulation & Skin Signs • Color • Temperature • Capillary refill time • Pulse quality

  22. Skin Signs • Feel for temperature and moisture. • Estimate capillary refill.

  23. Pulse In infants, feel over the brachial or femoral area. In older children use the carotid artery. Count for at least 1 minute. Note strength of the pulse.

  24. Blood Pressure • Use a cuff that covers two thirds of the arm. • If scene conditions make it difficult to measure blood pressure accurately, do not waste time trying.

  25. Circulation & Skin Signs Poor color equals… poor circulation… equals… SICK!

  26. NOT SICK SICK Short Report to ALS Medical Patients Appearance Breathing Pediatric Triangle Circulation/Skin Color DECIDE Short Report to ALS Low/Moderate Flow O2 100% O2 NRM or BVM *Focused medical assessment *Baseline vitals *SAMPLE history *OPQRST *Rapid medical assessment *Baseline vitals *SAMPLE history Focused Hx/ Physical Exam Focused Hx/ Physical Exam Detailed Physical Exam Appropriate Position Appropriate Treatment Rapid Trans- port/ALS Appropriate Transport Detailed Physical Exam Ongoing Assess Keep Warm Ongoing Assess Keep Warm

  27. NOT SICK SICK Short Report to ALS Medical Patients Appearance Breathing Pediatric Triangle Circulation/Skin Color DECIDE Short Report to ALS Low/Moderate Flow O2 100% O2 NRM or BVM *Focused medical assessment *Baseline vitals *SAMPLE history *OPQRST *Rapid medical assessment *Baseline vitals *SAMPLE history Focused Hx/ Physical Exam Focused Hx/ Physical Exam Detailed Physical Exam Appropriate Position Appropriate Treatment Rapid Trans- port/ALS Appropriate Transport Detailed Physical Exam Ongoing Assess Keep Warm Ongoing Assess Keep Warm

  28. NOT SICK SICK Short Report to ALS Trauma Patients Appearance Breathing Pediatric Triangle Circulation/Skin Color DECIDE Short Report to ALS Low/Moderate Flow O2 Spinal Stabilization Rapid Extrication 100% O2 NRM or BVM *Focused trauma assessment *Baseline vitals *SAMPLE history *Rapid trauma assessment *Baseline vitals *SAMPLE history Focused Hx/ Physical Exam Focused Hx/ Physical Exam Extricate/ Immobilize Spinal Immobilization Detailed Physical Exam Rapid Trans- port/ALS Appropriate Transport Detailed Physical Exam Ongoing Assess Keep Warm Ongoing Assess Keep Warm

  29. Appearance Breathing Pediatric Triangle Circulation/Skin Color NOT SICK SICK DECIDE Short Report to ALS Trauma Patients Short Report to ALS Low/Moderate Flow O2 Spinal Stabilization Rapid Extrication 100% O2 NRM or BVM *Focused trauma assessment *Baseline vitals *SAMPLE history *Rapid trauma assessment *Baseline vitals *SAMPLE history Focused Hx/ Physical Exam Focused Hx/ Physical Exam Extricate/ Immobilize Spinal Immobilization Detailed Physical Exam Rapid Trans- port/ALS Appropriate Transport Detailed Physical Exam Ongoing Assess Keep Warm Ongoing Assess Keep Warm

  30. Sick or Not Sick? Make a decision within 60 seconds!

  31. Children With Special Needs • Children born prematurely who have associated lung problems • Small children or infants with congenital heart disease • Children with neurologic diseases • Children with chronic diseases or with functions that have been altered since birth

  32. Tracheostomy Tube

  33. Artificial Ventilators • Provide respirations for children unable to breathe on their own • If ventilator malfunctions, remove child from the ventilator and begin ventilations with a BVM device. • Ventilate during transport.

  34. Central IV Lines

  35. Gastrostomy Tubes

  36. Shunts • Tubes that drain excess fluid from around brain • If shunt becomes clogged, changes in mental status may occur. • Patient may go into respiratory arrest.

  37. Remember, family does matter… • When a child is ill or injured, you may have several patients, not just one. • Children often mimic the behavior of their caregivers. • Be calm, professional, and sensitive.

  38. Thanks for all that you do!

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