2003oklahoma emsc resource center1 oklahoma prehospital pediatric supplement developed by the...

20032003 Oklahoma EMSC Resource CenterOklahoma EMSC Resource Center 11

OklahomaOklahomaPrehospital Pediatric Prehospital Pediatric

SupplementSupplementDeveloped by the Oklahoma EMSC Resource Center for the:Developed by the Oklahoma EMSC Resource Center for the:

““Infants and Children Module of the Infants and Children Module of the 1994 EMT-Basic Curriculum”1994 EMT-Basic Curriculum”

PART 2: RESPIRATORY +PART 2: RESPIRATORY +


PART 2PART 2: Respiratory +: Respiratory +

This section covers the following informational areas.This section covers the following informational areas.

- - Respiratory Distress / FailureRespiratory Distress / Failure

- - Respiratory EmergenciesRespiratory Emergencies

- Dehydration- Dehydration

- Altered Temperature Regulation- Altered Temperature Regulation


ObjectivesObjectives

• Evaluate the signs of respiratory insufficiency Evaluate the signs of respiratory insufficiency / failure in pediatric patients/ failure in pediatric patients..– Objective: 6-1.5 AObjective: 6-1.5 A

• Describe the four most common respiratory Describe the four most common respiratory emergencies in children, the signs and emergencies in children, the signs and symptoms, and management.symptoms, and management.– Objective: 6-1.7 AObjective: 6-1.7 A


Objectives Objectives ((ContinuedContinued))

• Differentiate among mild, moderate, and Differentiate among mild, moderate, and severe dehydration.severe dehydration.– Objective: 6- 1.8 AObjective: 6- 1.8 A

• Describe the management of Infants and Describe the management of Infants and Children with Altered Temperature Control.Children with Altered Temperature Control.– Objective: 6-1.11 AObjective: 6-1.11 A


Respiratory Distress/FailureRespiratory Distress/Failure

OBJECTIVE: 6-1.5 AOBJECTIVE: 6-1.5 A• DefinitionDefinition

– HypoventilationHypoventilation– HypoxemiaHypoxemia

• Early Signs and SymptomsEarly Signs and Symptoms– Respiratory Rate Respiratory Rate ((Age DependentAge Dependent)) and Work and Work

• TachypneaTachypnea• BradypneaBradypnea• Nasal FlaringNasal Flaring• Accessory Muscle UseAccessory Muscle Use


Distress/Failure Distress/Failure ((ContinuedContinued))

– Heart Rate Heart Rate ((Age DependentAge Dependent))

• TachycardiaTachycardia

– BehavioralBehavioral• CombativeCombative• RestlessRestless• AnxiousAnxious• FearfulFearful• ConfusedConfused



• Late SignsLate Signs– ApneaApnea– CyanosisCyanosis– Altered Mental Status Altered Mental Status ((AMSAMS))

– BradycardiaBradycardia• Birth to 12 months = HR <80 bpmBirth to 12 months = HR <80 bpm• > 1 year age = HR < 60 bpm> 1 year age = HR < 60 bpm

– Cardiopulmonary ArrestCardiopulmonary Arrest



• Predisposing FactorsPredisposing Factors– Upper Airway ObstructionUpper Airway Obstruction

• Severe Partial or CompleteSevere Partial or Complete• CausesCauses

– CroupCroup

– EpiglottitisEpiglottitis

– FBAOFBAO

• SignsSigns– Severe StridorSevere Stridor

– Totally Absent Breath SoundsTotally Absent Breath Sounds



– Lower Airway ObstructionLower Airway Obstruction• Severe Partial or CompleteSevere Partial or Complete• CausesCauses

– AsthmaAsthma

– BronchiolitisBronchiolitis

– FBAO AspirationFBAO Aspiration

– Toxic Gas InhalationToxic Gas Inhalation

• SignsSigns– TachypneaTachypnea

– RalesRales

– WheezesWheezes



– Lung DiseaseLung Disease• CausesCauses

– PneumoniaPneumonia

– CHFCHF

– Near DrowningNear Drowning

• SignsSigns– RalesRales

– HypopneaHypopnea

– Other CausesOther Causes• TraumaTrauma• Neurologic InsultNeurologic Insult• DehydrationDehydration• Metabolic InsultMetabolic Insult


Respiratory EmergenciesRespiratory Emergencies

OBJECTIVE: 6-1.7 AOBJECTIVE: 6-1.7 A• Most Encountered ConditionsMost Encountered Conditions

– AsthmaAsthma– BronchiolitisBronchiolitis– Laryngotracheobronchitis Laryngotracheobronchitis ((CROUPCROUP))

– EpiglottitisEpiglottitis– Foreign Body Airway Obstruction Foreign Body Airway Obstruction ((FBAOFBAO))


AsthmaAsthma

• DefinitionDefinition– Chronic recurrent lower airway disease with Chronic recurrent lower airway disease with

episodic attacks of bronchial constriction.episodic attacks of bronchial constriction.• EdemaEdema• Increased Thick Mucus SecretionIncreased Thick Mucus Secretion• Bronchi and Bronchiole Constriction from SpasmsBronchi and Bronchiole Constriction from Spasms

• Historical DataHistorical Data– Same as for adults plusSame as for adults plus

• Exhibited concern of caregiver regarding this attack Exhibited concern of caregiver regarding this attack relative to other attacksrelative to other attacks


Asthma Asthma ((ContinuedContinued))

• AssessmentAssessment– RespiratoryRespiratory

• TachypneaTachypnea• HypopneaHypopnea• S O BS O B• Intercostal RetractionsIntercostal Retractions• Episodic Coughing Episodic Coughing ((May Induce VomitingMay Induce Vomiting))

• Prolonged Expiratory PhaseProlonged Expiratory Phase• Generalized Inspiratory and Expiratory WheezingGeneralized Inspiratory and Expiratory Wheezing



– CirculationCirculation• Pale or MottledPale or Mottled• Lips may appear deep, dark red initiallyLips may appear deep, dark red initially

– Progresses to CyanoticProgresses to Cyanotic

– Hypoxemia IncreasesHypoxemia Increases

– Mental StatusMental Status• ApprehensionApprehension• ConfusionConfusion



• ManagementManagement– A-B-C’sA-B-C’s

• Assess and Continued MonitoringAssess and Continued Monitoring• Maintain Airway PatencyMaintain Airway Patency

– Heightened Awareness Possible Emetic EpisodeHeightened Awareness Possible Emetic Episode• High Flow, High Concentration OHigh Flow, High Concentration O2 2 ((Humidified PreferredHumidified Preferred))

• Assist Ventilations as NeededAssist Ventilations as Needed

– Medication TherapyMedication Therapy• Prescribed MedicationsPrescribed Medications

– Ensure Prescribed to Patient and Not ExpiredEnsure Prescribed to Patient and Not Expired– Max Dose Not Exceeded and Protocols Allow to AssistMax Dose Not Exceeded and Protocols Allow to Assist

– Immediate Transport to Appropriate FacilityImmediate Transport to Appropriate Facility• Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable


BronchiolitisBronchiolitis

• DefinitionDefinition– Infection of the lower respiratory tract.Infection of the lower respiratory tract.

• AssessmentAssessment– Fever and CoughFever and Cough– Inspiratory and Expiratory WheezingInspiratory and Expiratory Wheezing– Acute Respiratory Distress Acute Respiratory Distress with with Difficulty BreathingDifficulty Breathing

• TachypneaTachypnea• Mild to Moderate HypopneaMild to Moderate Hypopnea• Costal RetractionsCostal Retractions• CyanosisCyanosis


Bronchiolitis Bronchiolitis ((ContinuedContinued))



– NaresNares

– OralOral

• High Flow, High Concentration OHigh Flow, High Concentration O2 2 ((Humidified PreferredHumidified Preferred))


– Immediate Transport to Appropriate FacilityImmediate Transport to Appropriate Facility• Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable


LaryngotracheobronchitisLaryngotracheobronchitis

• DefinitionDefinition– Upper respiratory viral infection. Swelling and Upper respiratory viral infection. Swelling and

inflammation of larynx, subglottic tissue, and inflammation of larynx, subglottic tissue, and occasionally the trachea and bronchi.occasionally the trachea and bronchi.

• Historical DataHistorical Data– EtiologyEtiology

• 6 months to 3 years age6 months to 3 years age• Spring and Fall monthsSpring and Fall months• Following cold symptoms by 2-3 daysFollowing cold symptoms by 2-3 days

– Questions to AnswerQuestions to Answer• Difficulty Swallowing Fluids?Difficulty Swallowing Fluids?• Evident Drooling?Evident Drooling?


Croup Croup ((ContinuedContinued))

• AssessmentAssessment– Hoarse Cry/VoiceHoarse Cry/Voice– Seal-Like Barking CoughSeal-Like Barking Cough– Low-Grade FeverLow-Grade Fever– Inspiratory StridorInspiratory Stridor

• Expiratory in Severe CasesExpiratory in Severe Cases

– Respiratory DistressRespiratory Distress• Nasal FlaringNasal Flaring• Costal RetractionsCostal Retractions• TachypneaTachypnea• TachycardiaTachycardia• Pallor/CyanosisPallor/Cyanosis


Croup Croup ((ContinuedContinued))



– DO NOT Agitate with Excessive Exam or HandlingDO NOT Agitate with Excessive Exam or Handling

– DO NOT Attempt Any VisualizationDO NOT Attempt Any Visualization


– Non-Rebreather Mask if ToleratedNon-Rebreather Mask if Tolerated

– Flow-By if Mask NOT ToleratedFlow-By if Mask NOT Tolerated


– Urgent Transport to Appropriate FacilityUrgent Transport to Appropriate Facility• Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable


EpiglottitisEpiglottitis

• DefinitionDefinition– Bacterial infection localized in the epiglottis, Bacterial infection localized in the epiglottis,

usually caused by Hemophilus Influenza Type B usually caused by Hemophilus Influenza Type B ((H-FluH-Flu))..

• Historical DataHistorical Data– Questions to AnswerQuestions to Answer

• Fever Present?Fever Present?– Sudden or Gradual Onset?Sudden or Gradual Onset?

– How High Temperature?How High Temperature?

• Sore Throat and NOT Swallowing?Sore Throat and NOT Swallowing?


Epiglottitis Epiglottitis ((ContinuedContinued))

– EtiologyEtiology• TRUETRUE MEDICALMEDICAL EMERGENCYEMERGENCY• Acute Edema above GlottisAcute Edema above Glottis

– May Result Complete Airway ObstructionMay Result Complete Airway Obstruction

• Ages 3-6 years most commonAges 3-6 years most common– Can occur in younger or olderCan occur in younger or older

• Sudden OnsetSudden Onset• Rapid Progression Respiratory Distress & Airway Rapid Progression Respiratory Distress & Airway

ObstructionObstruction• Heightened Danger during SleepHeightened Danger during Sleep

– Awaken with High TemperatureAwaken with High Temperature

– Sore ThroatSore Throat

– Difficulty Breathing and SwallowingDifficulty Breathing and Swallowing



• AssessmentAssessment– High TemperatureHigh Temperature– Tripod PositionTripod Position

• TachypneaTachypnea• HypopneaHypopnea

– Open Mouth with Slightly Protruding TongueOpen Mouth with Slightly Protruding Tongue– Extremely Sore ThroatExtremely Sore Throat

• Refusal to SwallowRefusal to Swallow• Excessive SalivationExcessive Salivation




• Assess and Continued MonitoringAssess and Continued Monitoring– DO NOT Manipulate AirwayDO NOT Manipulate Airway– DO NOT Insert Anything in MouthDO NOT Insert Anything in Mouth– DO NOT Make Child Lie DownDO NOT Make Child Lie Down– DO NOT Agitate & Minimize HandlingDO NOT Agitate & Minimize Handling


– Non-Rebreather Mask if ToleratedNon-Rebreather Mask if Tolerated– Flow-By if Mask NOT ToleratedFlow-By if Mask NOT Tolerated– Positive Pressure B-V-M Ventilations: Obstruction OccursPositive Pressure B-V-M Ventilations: Obstruction Occurs

– Immediately Urgent TransportImmediately Urgent Transport• Appropriate Facility for Condition of PatientAppropriate Facility for Condition of Patient• Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable


DehydrationDehydration

OBJECTIVE: 6-1.8 AOBJECTIVE: 6-1.8 A• DefinitionDefinition

– Overtly excessive displacement of bodily fluids Overtly excessive displacement of bodily fluids due to any one or more of various insults to due to any one or more of various insults to homeostasis.homeostasis.

• Historical DataHistorical Data– PhysiologyPhysiology

• Majority of Total Body Weight = HMajority of Total Body Weight = H22OO– Birth to 12 months = 75%Birth to 12 months = 75%

» Infants Infants MOST SUSCEPTIBLEMOST SUSCEPTIBLE to Dehydration than any other to Dehydration than any other age group.age group.

– >> 1 year of age = 60% 1 year of age = 60%


Dehydration Dehydration ((ContinuedContinued))

– EtiologyEtiology• Excessive Body TemperaturesExcessive Body Temperatures• Excessive Sweating, Vomiting, and/or DiarrheaExcessive Sweating, Vomiting, and/or Diarrhea• Traumatic InsultTraumatic Insult• Medical Emergencies such as DKAMedical Emergencies such as DKA

– Questions to AnswerQuestions to Answer• Number Diaper Changes Last 4-6 hours?Number Diaper Changes Last 4-6 hours?• Quantity & Consistency (smell) of Urine Last 2 hours?Quantity & Consistency (smell) of Urine Last 2 hours?• Amount of Fluid Intake Last 4-6 hours?Amount of Fluid Intake Last 4-6 hours?• Infant - 18 mos: Fontanelle Appearance (Depressed)?Infant - 18 mos: Fontanelle Appearance (Depressed)?



• AssessmentAssessment– Mild DehydrationMild Dehydration

• Physical signs barely identifiablePhysical signs barely identifiable• History provides more than physically assessableHistory provides more than physically assessable

– Moderate DehydrationModerate Dehydration• Poor Skin Color and Turgor > 3 secondsPoor Skin Color and Turgor > 3 seconds• Mucous Membranes Dry and NO TEARSMucous Membranes Dry and NO TEARS• Decreased Urine Output with Increased ThirstDecreased Urine Output with Increased Thirst• Increasing Tachypnea without Accessory Muscle UseIncreasing Tachypnea without Accessory Muscle Use• Increasing Tachycardia with Diminishing Peripheral Increasing Tachycardia with Diminishing Peripheral

Pulses PalpablePulses Palpable

– Severe DehydrationSevere Dehydration• Life-Threatening Hypovolemic Shock Imminent w/o TxLife-Threatening Hypovolemic Shock Imminent w/o Tx



• ManagementManagement– Mild or Moderate DehydrationMild or Moderate Dehydration

• A-B-C’sA-B-C’s– Assess and Continued MonitoringAssess and Continued Monitoring

– Maintain Airway PatencyMaintain Airway Patency– High Flow, High Concentration OHigh Flow, High Concentration O2 2 ((Humidified PreferredHumidified Preferred))

• Urgent Transport to Appropriate FacilityUrgent Transport to Appropriate Facility• Position of Comfort if Clinically AcceptablePosition of Comfort if Clinically Acceptable

– Severe DehydrationSevere Dehydration• Same As Stated for Mild or ModerateSame As Stated for Mild or Moderate• Be Prepared to Initiate CPR for Circulatory Collapse and Be Prepared to Initiate CPR for Circulatory Collapse and

Respiratory ArrestRespiratory Arrest


Body’s Thermal RegulationBody’s Thermal Regulation

OBJECTIVE: 6-1.11 AOBJECTIVE: 6-1.11 A• HYPERTHERMIAHYPERTHERMIA

– DefinitionDefinition• Fever: Body’s response to infection or from alteration in Fever: Body’s response to infection or from alteration in

CNS regulation of body temperatureCNS regulation of body temperature– Protective ResponseProtective Response

– Drug Toxicity InducedDrug Toxicity Induced» AntihistaminesAntihistamines» ASAASA» Belladonna AgentsBelladonna Agents

– Environmental or Man-Made ResponseEnvironmental or Man-Made Response

• Heightened Concern for Rectal Temperature Heightened Concern for Rectal Temperature >> 39.6 39.6ºº C C (103(103ºº F) F)


Thermal Regulation Thermal Regulation ((ContinuedContinued))

– Historical DataHistorical Data• Rise in Body’s Core TemperatureRise in Body’s Core Temperature

– Increases OIncreases O22 Demand Demand

– Increases Metabolic AcidosisIncreases Metabolic Acidosis

– Increases Risk of Febrile SeizureIncreases Risk of Febrile Seizure» 6 months to 5 years age6 months to 5 years age» Temperatures Temperatures >> 39.6 39.6º Cº C

• Stresses Cardiac and Respiratory SystemsStresses Cardiac and Respiratory Systems– Respiratory Fatigue to FailureRespiratory Fatigue to Failure

– AssessmentAssessment• A-B-C-D-EA-B-C-D-E• Response to Fever Indicates Seriousness of ConditionResponse to Fever Indicates Seriousness of Condition



– ManagementManagement• FeverFever

– OO22 as Clinically Indicated as Clinically Indicated

– Monitor A-B-C’s and VS repeatedlyMonitor A-B-C’s and VS repeatedly

– Remove Heavy ClothingRemove Heavy Clothing

– Cooling TechniquesCooling Techniques

– Comfort and PositioningComfort and Positioning

– TransportTransport

• HyperthermiaHyperthermia– Monitor A-B-C’s and VS FrequentlyMonitor A-B-C’s and VS Frequently– Administer High Flow, High Concentration OAdminister High Flow, High Concentration O22

– Promote Rapid CoolingPromote Rapid Cooling» Remove Clothing and Place in Cool EnvironmentRemove Clothing and Place in Cool Environment

– Transport to Appropriate FacilityTransport to Appropriate Facility



• HYPOTHERMIAHYPOTHERMIA– DefinitionDefinition

• Body Core Temperature Body Core Temperature << 35 35ºº C C (95(95ºº F) F)

– Historical DataHistorical Data• Regulatory Mechanism Lacks Complete DevelopmentRegulatory Mechanism Lacks Complete Development• Larger Ratio of BSA than AdultsLarger Ratio of BSA than Adults• Newborns Have Less Body Fat to InsulateNewborns Have Less Body Fat to Insulate• Abdomen Abdomen LAST AREALAST AREA to Get Cold to Get Cold• CausesCauses

– Prolonged Exposure Below Norm Environmental TempsProlonged Exposure Below Norm Environmental Temps– Metabolic Anomalies Induced by Hypoglycemia, Drugs, Metabolic Anomalies Induced by Hypoglycemia, Drugs,

EtOH, etcEtOH, etc– CNS Trauma / SepsisCNS Trauma / Sepsis



• Physiologic ResponsePhysiologic Response– Increased Muscle Rigidity and Higher Metabolic RateIncreased Muscle Rigidity and Higher Metabolic Rate

– ShiveringShivering

– Slowing CNS ResponseSlowing CNS Response

– Decreased Respiratory / Cardiovascular ResponseDecreased Respiratory / Cardiovascular Response

– AssessmentAssessment• S-A-M-P-L-ES-A-M-P-L-E• A-B-C-D-EA-B-C-D-E• Length of ExposureLength of Exposure• Ingestion/Absorption of Drugs or EtOHIngestion/Absorption of Drugs or EtOH• EnvironmentEnvironment



– ManagementManagement• Mild HypothermiaMild Hypothermia

– Move to Warmer EnvironmentMove to Warmer Environment

– Remove Wet ClothingRemove Wet Clothing

– Give Warm Fluids Orally if AlertGive Warm Fluids Orally if Alert» Non-CaffeinatedNon-Caffeinated» Non-AlcoholicNon-Alcoholic

• Moderate to Severe HypothermiaModerate to Severe Hypothermia– Monitor A-B-C’s and VS FrequentlyMonitor A-B-C’s and VS Frequently– Administer High Flow, High Concentration,Warmed, and Administer High Flow, High Concentration,Warmed, and

Humidified OHumidified O22

– Assist with Ventilatory Support as IndicatedAssist with Ventilatory Support as Indicated

– Perform CPR as IndicatedPerform CPR as Indicated

– Transport to Appropriate FacilityTransport to Appropriate Facility


Summary Summary ((ContinuedContinued))

• Signs of Respiratory Distress/FailureSigns of Respiratory Distress/Failure• Most Common Respiratory EmergenciesMost Common Respiratory Emergencies

– RecognitionRecognition– AssessmentAssessment– ManagementManagement

• Dehydration Recognition and DifferentiationDehydration Recognition and Differentiation– MildMild– ModerateModerate– SevereSevere


SummarySummary

• Insult to the Body’s Thermal Regulation Insult to the Body’s Thermal Regulation MechanismMechanism– RecognitionRecognition– AssessmentAssessment– ManagementManagement

2003oklahoma emsc resource center1 oklahoma prehospital pediatric supplement developed by the...

Documents

respiratory slide

common respiratory emergencies

severe dehydration

symptomsearly signs

management of infants

dkamedical emergencies

altered temperature

children module