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Ch. 22-Pediatric and GeriatricCh. 22-Pediatric and GeriatricEmergenciesEmergencies

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22.1 Assessing the Child22.1 Assessing the Child

Special Assessment TechniquesSpecial Assessment Techniques Does the child look sick?Does the child look sick? Is the child in shock?Is the child in shock? Is the child in extreme pain?Is the child in extreme pain? How is the child breathing?How is the child breathing?

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Obtaining a HistoryObtaining a History

Do not let upset parents and a screaming child Do not let upset parents and a screaming child unnerve you; take the time you need to get the unnerve you; take the time you need to get the information you need.information you need.

Get information from parents or other witnesses, not Get information from parents or other witnesses, not the child.the child.

Ask when symptoms developed, how they Ask when symptoms developed, how they progressed, and what care has already been given.progressed, and what care has already been given.

If there was an accident, determine the details of the If there was an accident, determine the details of the accident, the mechanism of injury, and what first aid accident, the mechanism of injury, and what first aid care has already been given.care has already been given.

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Taking Vital SignsTaking Vital Signs

RespirationsRespirations PulsePulse TemperatureTemperature Neurological assessmentNeurological assessment

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PROGRESS CHECKPROGRESS CHECK

1. When assessing a child, you should position yourself 1. When assessing a child, you should position yourself ____________.____________.

(above the child/below the child/at the child’s eye level)(above the child/below the child/at the child’s eye level)2. During assessment, check the most painful part 2. During assessment, check the most painful part

____________.____________.(quickly/last/first)(quickly/last/first)3. You should check a child’s vital signs more ____________ 3. You should check a child’s vital signs more ____________

than you do an adult’s. than you do an adult’s. (frequently/thoroughly/quickly)(frequently/thoroughly/quickly)4. A child breathes ____________ than an adult. 4. A child breathes ____________ than an adult.

(slower/faster/more deeply)(slower/faster/more deeply)5. Check a child’s respiratory rate by placing your hand on 5. Check a child’s respiratory rate by placing your hand on

the child’s ____________. the child’s ____________. (chest/stomach/back)(chest/stomach/back)6. Take an infant’s pulse at the ____________ pulse. 6. Take an infant’s pulse at the ____________ pulse.

(carotid/radial/brachial)(carotid/radial/brachial)

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VocabularyVocabulary

CroupCroup- A viral infection that causes swelling - A viral infection that causes swelling beneath the glottis and progressive narrowing of the beneath the glottis and progressive narrowing of the airwayairway

EpiglottitisEpiglottitis- A bacterial infection that causes - A bacterial infection that causes swelling of the epiglottis and blocking of the airwayswelling of the epiglottis and blocking of the airway

Sudden infant death syndrome (SIDS)- Sudden infant death syndrome (SIDS)- Sudden Sudden death of an apparently healthy infant, usually while death of an apparently healthy infant, usually while asleepasleep

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Asthma care includes:Asthma care includes:

1. Allow the child to assume the position of greatest 1. Allow the child to assume the position of greatest comfort—almost always sitting or semisitting. comfort—almost always sitting or semisitting. Additionally, give an asthma victim plenty of fluids, Additionally, give an asthma victim plenty of fluids, which help loosen and thin mucus in the air which help loosen and thin mucus in the air passages.passages.

2. Be calm and reassuring.2. Be calm and reassuring.

3. Activate the EMS system or take the child to a 3. Activate the EMS system or take the child to a medical facility.medical facility.

4. If allowed as part of your training, assist the patient 4. If allowed as part of your training, assist the patient with his/her inhaler. Even retrieving an inhaler and with his/her inhaler. Even retrieving an inhaler and bringing it to the patient is valuable. bringing it to the patient is valuable.

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Cardiac ArrestCardiac Arrest

The signs and symptoms of cardiac arrest in a The signs and symptoms of cardiac arrest in a child include:child include:

UnresponsivenessUnresponsiveness Seizure (early in onset of arrest due to Seizure (early in onset of arrest due to

hypoxia)hypoxia) Gasping or absent respiratory soundsGasping or absent respiratory sounds Absence of chest movementAbsence of chest movement Pale or blue skinPale or blue skin Absent pulseAbsent pulse

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SeizuresSeizures

1. Turn the child onto his or her side to prevent 1. Turn the child onto his or her side to prevent the tongue from relaxing and shifting the tongue from relaxing and shifting backward, blocking the air passage.backward, blocking the air passage.

2. Do not hold the child down, but place the 2. Do not hold the child down, but place the child where he or she will not fall or strike child where he or she will not fall or strike something. A rug on the floor is excellent; so something. A rug on the floor is excellent; so is a crib with padded sides.is a crib with padded sides.

3. Loosen tight or restrictive clothing.3. Loosen tight or restrictive clothing.

4. Sponge a feverish child with lukewarm 4. Sponge a feverish child with lukewarm water.water.

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ShockShock

The signs and symptoms of shock in a child include:The signs and symptoms of shock in a child include: PalenessPaleness Cold, moist skinCold, moist skin Low blood pressureLow blood pressure A rapid, thready pulseA rapid, thready pulse Lack of vitalityLack of vitality Extreme anxietyExtreme anxiety UnconsciousnessUnconsciousness

*To care for shock, activate the EMS system, have*To care for shock, activate the EMS system, havethe child lie flat, keep the child warm and as calm asthe child lie flat, keep the child warm and as calm aspossible, and monitor vital signs frequently.possible, and monitor vital signs frequently.

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PROGRESS CHECKPROGRESS CHECK

1. Injuries of the extremities in a child can also damage the 1. Injuries of the extremities in a child can also damage the ____________.____________.

(bone marrow/growth plates/large ball-and-socket joints)(bone marrow/growth plates/large ball-and-socket joints)2. An infant has a proportionally large ____________, which can 2. An infant has a proportionally large ____________, which can

block the airway. block the airway. (tongue/epiglottis/larynx)(tongue/epiglottis/larynx)3. Most children involved in trauma have an enlarged ___________, 3. Most children involved in trauma have an enlarged ___________,

which can interfere with breathing. which can interfere with breathing. (tongue/larynx/stomach)(tongue/larynx/stomach)4. A characteristic “seal bark” cough is a sign of ____________.4. A characteristic “seal bark” cough is a sign of ____________.(asthma/croup/epiglottitis)(asthma/croup/epiglottitis)5. A child who is drooling, having difficulty speaking, and having 5. A child who is drooling, having difficulty speaking, and having

difficulty swallowing probably has _________. difficulty swallowing probably has _________. (asthma/croup/epiglottitis)(asthma/croup/epiglottitis)

6. Seizures in a child can be caused by _________, which rarely 6. Seizures in a child can be caused by _________, which rarely causes seizures in an adult. causes seizures in an adult. (head injury/oxygen (head injury/oxygen deficiency/fever)deficiency/fever)

7. ____________, which does not usually cause shock in older 7. ____________, which does not usually cause shock in older victims, can cause shock in an infant. victims, can cause shock in an infant.

(Blood loss/Loss of body heat/Major trauma)(Blood loss/Loss of body heat/Major trauma)

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Sudden Infant Death SyndromeSudden Infant Death Syndrome

1. 1. Even if the child is obviously dead, have someone Even if the child is obviously dead, have someone activate the EMS system and immediately begin activate the EMS system and immediately begin infant CPR.infant CPR.

2. Be aware of the parents’ extreme distress; the best 2. Be aware of the parents’ extreme distress; the best first aid is to make them feel that everything first aid is to make them feel that everything possible has been done for their child. Leave no possible has been done for their child. Leave no room for “ifs” and “maybes.” Parents will often feel room for “ifs” and “maybes.” Parents will often feel guilt. Be careful not to make judgmental statements guilt. Be careful not to make judgmental statements that add to guilt.that add to guilt.

3. After the ambulance arrives, encourage the parents 3. After the ambulance arrives, encourage the parents to accompany their baby in the ambulance and to accompany their baby in the ambulance and arrange for someone to stay with other children at arrange for someone to stay with other children at the home.the home.

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Identifying Child Abuse Identifying Child Abuse

The child is fretful, frightened of parents, afraid to go The child is fretful, frightened of parents, afraid to go home, wary of adults, or apathetic (a child who does not home, wary of adults, or apathetic (a child who does not cry, despite injuries)cry, despite injuries)

Abrasions, lacerations, incisions, bruises, broken bones, Abrasions, lacerations, incisions, bruises, broken bones, or multiple injuries in various stages of healingor multiple injuries in various stages of healing

Injuries on both the front and the back or on both sidesInjuries on both the front and the back or on both sides Unusual wounds, such as circular burnsUnusual wounds, such as circular burns Injuries to the head, back, and abdomen, including the Injuries to the head, back, and abdomen, including the

genitalsgenitals Pain, itching, bruises, or bleeding in the genital, vaginal, Pain, itching, bruises, or bleeding in the genital, vaginal,

or anal areasor anal areas Injuries that do not match the mechanisms of injury Injuries that do not match the mechanisms of injury

described by the parents or caregiversdescribed by the parents or caregivers

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First Aid Care for Child AbuseFirst Aid Care for Child Abuse

1. Calm the parents; let them know by your actions that you 1. Calm the parents; let them know by your actions that you are there to help and render first aid care. Speak in a low, are there to help and render first aid care. Speak in a low, firm voice.firm voice.

2. Focus attention on the child; speak softly to the child, 2. Focus attention on the child; speak softly to the child, using the first name. Never ask the child to recreate the using the first name. Never ask the child to recreate the situation while in the crisis environment or with the situation while in the crisis environment or with the suspected abuser still present.suspected abuser still present.

3. Conduct a thorough, head-to-toe exam; care for injuries 3. Conduct a thorough, head-to-toe exam; care for injuries appropriately.appropriately.

4. It is not your responsibility to confront any adult with the 4. It is not your responsibility to confront any adult with the charge of child abuse; be supportive and nonjudgmental charge of child abuse; be supportive and nonjudgmental while at the scene.while at the scene.

5. 5. Always Always report your suspicions of child abuse to the proper report your suspicions of child abuse to the proper authorities, and maintain total confidentiality with others authorities, and maintain total confidentiality with others regarding the incident.regarding the incident.

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PROGRESS CHECKPROGRESS CHECK

1. Sudden infant death syndrome occurs when an 1. Sudden infant death syndrome occurs when an apparently ____________ infant dies while sleeping. apparently ____________ infant dies while sleeping. (distressed/healthy/ill)(distressed/healthy/ill)

2. Even if a victim of SIDS is obviously dead, you should 2. Even if a victim of SIDS is obviously dead, you should ____________.____________.

(begin infant CPR/treat for shock/do a primary survey)(begin infant CPR/treat for shock/do a primary survey)3. An abuser often shows ____________ toward the child.3. An abuser often shows ____________ toward the child.(compassion/guilt/hostility)(compassion/guilt/hostility)4. Suspect child abuse if the child is ____________.4. Suspect child abuse if the child is ____________.(frightened of parents/clinging to parents/affectionate to (frightened of parents/clinging to parents/affectionate to

parents)parents)5. If you suspect child abuse, you should _________.5. If you suspect child abuse, you should _________.(confront the parents at the scene/report your suspicions to(confront the parents at the scene/report your suspicions toauthorities/ask the child to confirm your suspicions)authorities/ask the child to confirm your suspicions)

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Differing Signs and SymptomsDiffering Signs and Symptoms

In myocardial infarctionIn myocardial infarction:: Pain is less common.Pain is less common. Aching shoulders and indigestion are common.Aching shoulders and indigestion are common. The most common symptoms are shortness of The most common symptoms are shortness of

breath, fatigue, and anxiety.breath, fatigue, and anxiety.

In congestive heart failure:In congestive heart failure: Little or no dyspnea is present.Little or no dyspnea is present.

In pneumonia:In pneumonia: Fever is usually absent (it is a classic sign of Fever is usually absent (it is a classic sign of

pneumonia in other age groups). pneumonia in other age groups). Chest pain is much less common.Chest pain is much less common. Cough is much less common.Cough is much less common.

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Special Assessment Special Assessment ConsiderationsConsiderations

The elderly become debilitated much more rapidly; a The elderly become debilitated much more rapidly; a minor problem can become major within a few hours.minor problem can become major within a few hours.

The victim may be taking a number of medications.The victim may be taking a number of medications. As many as one in four elderly have psychiatric disorders, As many as one in four elderly have psychiatric disorders,

which can be the cause of some symptoms (such as which can be the cause of some symptoms (such as clouding of consciousness).clouding of consciousness).

It can be difficult to separate the effects of aging from the It can be difficult to separate the effects of aging from the consequences of disease.consequences of disease.

The victim’s chief complaint may seem trivial.The victim’s chief complaint may seem trivial. The victim may fail to report important symptoms.The victim may fail to report important symptoms. The geriatric victim is likely to suffer from more than one The geriatric victim is likely to suffer from more than one

disease at a time.disease at a time. Aging may change the victim’s response to illness and Aging may change the victim’s response to illness and

injury, causing you to underestimate the severity of the injury, causing you to underestimate the severity of the victim’s condition.victim’s condition.

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Special Examination ConsiderationsSpecial Examination Considerations

The victim may be fatigued easily.The victim may be fatigued easily. The victim may be wearing several layers of The victim may be wearing several layers of

clothing.clothing. You need to explain actions clearly before assessing You need to explain actions clearly before assessing

the elderly victim.the elderly victim. The victim may minimize or deny symptoms out of The victim may minimize or deny symptoms out of

fear of being bedridden or institutionalized or of fear of being bedridden or institutionalized or of losing a sense of self-sufficiency.losing a sense of self-sufficiency.

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Special Trauma ConsiderationsSpecial Trauma Considerations

They may have slower reflexes, failing eyesight and They may have slower reflexes, failing eyesight and hearing, arthritis, less elastic blood vessels, and fragile hearing, arthritis, less elastic blood vessels, and fragile tissues and bones.tissues and bones.

They are at higher risk for trauma from criminal They are at higher risk for trauma from criminal assault.assault.

They are prone to head injury, even from relatively They are prone to head injury, even from relatively minor trauma; signs and symptoms of brain minor trauma; signs and symptoms of brain compression develop more slowly, sometimes over compression develop more slowly, sometimes over days or weeks.days or weeks.

They often have a significant degree of degenerative They often have a significant degree of degenerative disease of the cervical vertebrae, which can gradually disease of the cervical vertebrae, which can gradually compress the roots of nerves to the arms or possibly to compress the roots of nerves to the arms or possibly to the spinal cord itself. Sudden neck movement, with or the spinal cord itself. Sudden neck movement, with or without fracture, can cause spinal cord injury. without fracture, can cause spinal cord injury.

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PROGRESS CHECKPROGRESS CHECK

1. ____________ is less common in elderly victims of 1. ____________ is less common in elderly victims of myocardial infarction. myocardial infarction. (Pain/Indigestion/Shortness of (Pain/Indigestion/Shortness of breath)breath)

2. There is usually little or no ____________ in elderly victims 2. There is usually little or no ____________ in elderly victims of congestive heart failure. of congestive heart failure. (edema/cyanosis/dyspnea)(edema/cyanosis/dyspnea)

3. ____________, a classic sign of pneumonia, is usually 3. ____________, a classic sign of pneumonia, is usually absent in the elderly. absent in the elderly. (Weakness/Pain/Fever)(Weakness/Pain/Fever)

4. Signs or symptoms may be masked in elderly victims 4. Signs or symptoms may be masked in elderly victims because they usually ____________. because they usually ____________. (take multiple (take multiple medications/ are immobile/have failing medications/ are immobile/have failing eyesight)eyesight)