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Pediatric Patients - PowerPoint PPT Presentation

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Pediatric Patients
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  1. Pediatric Patients & Emergencies

  2. Family Matters • When a child is ill or injured, you may have several patients, not just one. • Children mimic caregiver behavior • Be calm, professional, and sensitive.

  3. Anatomic Differences • Less circulating blood • Lose body heat more easily • Bones are more flexible • Less fat surrounding organs • Could be much internal damage with little external visible trauma

  4. Skeletal Differences • Bones are prone to fracture with stress. • Infants have two openings in the skull called fontanels. • close by 18 months.

  5. 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.

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

  7. Circulation Differences • The heart rate increases for illness and injury • Very effective vasoconstriction keeps vital organs nourished • Pale, extremities, decreased cap refill are early signs of perfusion problems

  8. Approach to Assessment • level of activity, work of breathing, and skin color • cap refill • ALS backup or immediate transport? • Pediatric patients crash harder than adults • Transport to peds facilities when possible

  9. Capillary Refill

  10. Treatment Considerations • Oxygen - treat same as adult – Use “blow-by” administration if needed • Patient position - same as adult • *Remember* airway and breathing are focus

  11. Growth and Development • Usually grouped into stages • Infant • Toddler • Preschool • School-age • Adolescent

  12. Infant • first year of life • respond physical stimuli • crying is main means of expression • have caregiver hold pt

  13. Toddler • 1 to 3 years of age • mobile • may resist separation • don’t like being restrained • can be distracted

  14. Preschool • 3 to 6 years of age • can understand directions • can identify painful areas • fearful of pain • allow them to handle equipment • explain what you are going to do

  15. School-Age Child • 6 to 12 years of age • begin to think like adults • can be included when taking medical history • should be familiar with physical exam • allow them to make choices when possible

  16. The Adolescent • 12 to 18 years of age • concerned about body image • may have strong feelings about being observed • respect their privacy • they understand pain • explain any procedure

  17. Notes • never lie to a child

  18. Vital Signs

  19. Respirations Abnormal respirations are a common sign of illness or injury Less than 3, count rise and fall of abdomen Note effort of breathing/noises Note if they are crying

  20. Respiration Notes • Less than 12 breaths/min • More than 60 breaths/min, • ALOC and/or an inadequate tidal volume = ventilation with a BVM device

  21. Pulse Infants -brachial or femoral Child- use carotid Count at least 1 minute Note strength

  22. Blood Pressure • Use right size cuff • Difficult scene? Don’t waste time • Under 3? No BP

  23. Skin Signs • important sign • feel for temperature and moisture • always check capillary refill

  24. Pediatric Problems

  25. Fever • Common Causes • Infections • Neoplasm (cancer) • Drug ingestion • Collagen vascular disease • High environmental temperatures

  26. Emergency Care for Fever • Ensure BSI • Begin passive cooling • Remove clothing/coverings • Damp towels • No ice • No alcohol • No cold water baths

  27. Febrile Seizures • common in children 6 months to 6 years • most caused by high fever • hx of infection • generalized grand mal seizure • less than 15 minutes

  28. Treatment • ABC’s • protect patient • recovery position • high flow oxygen • suction prn • passive cooling measures • transport

  29. Dehydration • Dry lips and gums • Fewer wet diapers • Sunken eyes • Poor skin turgor • Sleepy or irritable • Sunken fontanels

  30. Care for Dehydration • Assess the ABCs • Obtain baseline vital signs • ALS backup may be needed for IV administration

  31. Airway Obstruction • Croup • An infection of the airway below the level of the vocal cords, caused by a virus • Epiglottitis • Infection of the soft tissue in the area above the vocal cords • Foreign body Aspiration

  32. Croup • barking cough • stridor • wheezing • rales • accessory muscle use • nasal flaring • grunting

  33. Epiglottitis • severe dyspnea • stridor • inability to swallow - DROOLING • fever • tripod position

  34. Foreign body aspiration • Partial Blockage • coughing • accessory muscle use • nasal flaring • wheezing • Complete Blockage • no sound • no cry • stridor • cyanosis • loss of consciousness

  35. treatment • ABC’s • high flow oxygen • position of comfort do not attempt to visualize the throat! do not put anything into patient’s mouth.

  36. Asthma • dyspnea • wheezing • accessory muscle use • nasal flaring • respiratory rate - observe

  37. Treatment • ABC’s • high flow oxygen • position of comfort • transport

  38. What is the most frequent cause of cardiac arrest in pediatrics?

  39. Respiratoryarrest!

  40. want to save a pediatric patient? aggressive ventilation & high flow oxygen

  41. USC video! Pediatric respiratory distress

  42. Meningitis • Inflammation of meninges • Bacterial or viral • Permanent brain damage/death

  43. Signs and Symptoms of Meningitis • Fever • ALOC • Headache • Seizure • Stiff neck • Vomiting • Photophobia • Irritability • Bulging fontanel

  44. Neisseria meningitidis • rapid onset • pinpoint cherry-red spots or larger purple/black rash • sepsis, shock, and death • all suspected cases considered contagious

  45. Treatment • BSI • ABC’s • protect patient • high flow oxygen • passive cooling for fever • monitor for shock • Transport • Call ALS for backup if unstable

  46. Submersion Injury • Drowning or near drowning • Second most common cause of unintentional death • ABC’s • May be in respiratory or cardiac arrest • C-spine precautions? • Be ready to suction • Keep warm

  47. Poisoning • Poisoning is common in children • Ask specific questions of caregivers • Focus on the ABCs • Give oxygen • Provide transport • Child’s condition could change at any time

  48. Pediatric Resuscitation Tape Measure (Aka: Broslow tape) • Used to determine height, weight, and proper equipment.