PREVIEW OF

EMT/EMR PEDIATRIC EMERGENCIESPOWERPOINT TRAINING

PRESENTATION

GENERAL CONSIDERATIONSMany components of the initial evaluation can be

done by careful observation without touching the patientWhen appropriate, utilize the parent/guardian to help the infant or child be more comfortable with your exam & treatmentCommunicating with scared, concerned parents &

family is important when caring for an ill infant or child

Continue assessment until care is transferred

Subarachnoidspace

AIRWAY COMPAIRED TO AN ADULTS

Smaller in diameter & shorter in lengthJaw is smaller with infant’s tongue taking up

more room in the oropharynxInfants are nasal breathersTracheal cartilage is softer & more collapsibleEpiglottis of infants & toddlers is long, floppy,

narrow & extends at a 450 angle into airway

ABDOMINAL DIFFERENCE

Less-developed abdominal muscles & organs situated more anteriorly, therefore less protection of rib cageLiver & spleen are proportionally largerImplications for the health care provider

Seemingly insignificant forces can cause serious internal injuryLiver, spleen, and kidneys are more frequently injuredMultiple organ injury common

EXTREMITIES AS COMPAIRED TO AN ADULTS

Bones are softerOpen growth plates are weaker

than ligaments & tendons, so injury to growth plate can result in length discrepancies

Drawing byBruce Blaus

NERVOUS SYSTEM AND SPINAL COLUMN COMPARED TO AN ADULT’S

Brain tissue & vascular system is more fragile & prone to bleeding from injury

Subarachnoid space is relatively smaller, with less cushioning effect for brain

Pediatric brain requires nearly twice the cerebral blood flow as does an adult’sBrain & spinal cord less well protected

IMPLICATIONS FOR THE HEALTHCARE PROVIDER

The large cerebral blood flow requirement increases risk of hypoxia; hypoxia and hypotension in a child with a head injury can cause ongoing damageHead momentum may result in bruising and damage to the brain Spinal cord injuries less commonCervical spine injuries more commonly ligamentous injuries

GROWTH & DEVELOPMENT IN INFANCY BIRTH TO TWO MONTHS

Cognitive developmentCrying form of communicationInfants cry for obvious reasons such as

hunger and needing to be changedWhen obvious reasons for crying have been

addressed, persistent crying can be a sign of significant illness

IMPLICATIONS FOR THE HEALTH CARE PROVIDER

Persistent crying or irritability in a 0 to 2month-old can be a symptom of serious illnessInfants sleep a lot, however should arouse easily; inability to arouse a baby should be considered an emergencyHead control is limited

IMPLICATIONS FOR THE HEALTHCARE PROVIDER

They not like to be separated from parentsThey do not want an oxygen mask (do NOT

blow in face) Need to be kept warm - make sure hands

and stethoscope are warmed before touching child

GROWTH & DEVELOPMENTEIGHTEEN TO TWENTY-FOUR MONTHS

Physical developmentImproved gait and balanceBegin to run and climb

Cognitive developmentBegin to understand cause and effectBegin to label objectsTen to 15 words becomes 100 by 24 months

Emotional developmentClinginess with parentsAttachment to a special object, like a blanket

IMPLICATIONS FOR THE HEALTH CARE PROVIDER

Persistent crying or irritability can be a symptom of serious illness

Allow a child to hold objects of importance to them (e.g., blanket)

Children no longer require shoulder rolls to limit flexion of the neck when bag-valve-mask ventilating or intubating

Painful procedures make lasting impressions

GENERAL CONSIDERATIONS OF ASSESSMENT

Many components of the initial evaluation can be done by careful observation without touching the patient

When appropriate, utilize the parent/guardian to help the infant or child be more

comfortable with your exam and therapies

PREPARING FOR ARRIVAL

Assembling age-appropriate equipmentReviewing age-appropriate vital signs and anticipated development

PATIENT ASSESSMENT

“Pediatric Assessment Triangle” consists ofGeneralComponentsPossible physiologic state

GENERAL

Provides a 15- to 30-second assessment of theseverity of the patient’s illness or injury

Use prior to addressing “the ABCs”Does not require touching the

patient, just looking and listening

FOCUSED HISTORY

Symptoms and durationFeverActivity levelRecent eating, drinking, and urine output historyHistory of vomiting, diarrhea, or abdominal painNote any rashes

Medications taking and medication allergiesPast medical problems or chronic illnessesKey events leading to the injury or illness

ASSESSMENT

HistoryPhysical findings

Are respirations within normal limitsLabored breathingAbnormal chest rise & fallTripod positioning

SPECIFIC CONDITIONS

MeningitisAltered mental statusClosed head injury

Bleeding inside skullFractures

ALTERED MENTAL STATUS

Primarily caused by Hypoglycemia PoisoningSeizure InfectionHead trauma HypoxiaShock Fatigue

Cause should be determined for appropriate care

Have understanding of normal mental status

MANAGEMENT

Altered mental statusAssess for need to protect airwayAssess and intervene for increased

intracranialSupplemental oxygen as necessary

MOTOR VEHICLE PASSENGERS

Unrestrained passengers have head and neck injuries

Restrained passengers have abdominal and lower spine injuriesStruck while riding bicycle - head injury, spinal

injury, abdominal injuryPedestrian struck by vehicle - abdominal injury

with internal bleeding, possible painful, swollen, deformed thigh, head injury

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