Chapter 16: Pediatric Emergencies

Cognitive Objectives

6-2.1 Describe differences in anatomy and physiology of the infant, child, and adult patient.

6-2.2 Describe assessment of the infant or child.

6-2.3 Indicate various causes of respiratory emergencies in infants and children.

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Cognitive Objectives

6-2.4 Summarize emergency medical care strategies for respiratory distress and respiratory failure/arrest in infants and children.

6-2.5 List common causes of seizures in the infant and child patient.

6-2.6 Describe management of seizures in the infant and child patient.

6-2.7 Discuss emergency medical care of the infant and child trauma patient.

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Cognitive Objectives

6-2.8 Summarize the signs and symptoms of possible child abuse and neglect.

6-2.9 Describe the medical-legal responsibilities in suspected child abuse.

6-2.10 Recognize the need for First Responder debriefing following a difficult infant or child transport.

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Affective Objectives

6-2.11 Attend to the feelings of the family when dealing with an ill or injured infant or child.

6-2.12 Understand the provider’s own emotional response to caring for infants or children.

6-2.13 Demonstrate a caring attitude toward infants and children with illness or injury who require emergency medical services.

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Affective Objectives

6-2.14 Place the interests of the infant or child with an illness or injury as the foremost consideration when making any and all patient care decisions.

6-2.15 Communicate with empathy to infants and children with an illness or injury, as well as with family members and friends of the patient.

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Psychomotor Objective

6-2.16 Demonstrate assessment of the infant and child.

Knowledge and Attitude Objectives

1. Describe the differences between a child’s and an adult’s anatomy.

2. Describe the normal rates of respiration and pulse for a child.

3. Describe the purpose of the pediatric assessment triangle.

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Knowledge and Attitude Objectives

4. Explain the differences between performing the following skills on a child and on an adult:• Opening the airway • Basic life support• Suctioning• Inserting an oral airway

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Knowledge and Attitude Objectives

5. Describe how to treat a child and an infant with:• A partial (mild) airway obstruction • A complete (severe) airway obstruction • Respiratory distress • Respiratory failure • A swallowed object • Circulatory failure

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Knowledge and Attitude Objectives

6. Describe how to treat the following illnesses and medical emergencies:• Altered mental status • Asthma • Croup • Epiglottitis• Drowning• Heat illnesses

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Knowledge and Attitude Objectives

6. Continued• High fever • Seizures• Vomiting and diarrhea• Abdominal pain • Poisoning • Sudden infant death syndrome

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Knowledge and Attitude Objectives

7. Describe the patterns of pediatric injury.

8. Describe the signs and symptoms of shock in pediatric patients.

9. Explain the steps you should take to care for a child who has signs of child abuse or sexual assault.

10. Describe the need for first responder critical incident stress debriefing.

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Skill Objectives

1. Determine a child’s respiratory rate, pulse rate, and body temperature.

2. Perform the following respiratory skills on a child:• Opening the airway • Basic life support • Suctioning • Inserting an oral airway

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Skill Objectives

3. Treat the following conditions:• Partial (mild) airway obstruction in children and

infants • Complete (severe) airway obstruction in children and

infants

4. Cool a child with a high fever.

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General Considerations

• An injured child is usually frightened, anxious, and unable to clearly communicate problems.

• Parents are anxious and frightened.• Providers often have a feeling of inadequacy when

treating a child.• You must behave in a calm, controlled, professional

manner.

Pediatric Anatomy and Function

• A child’s airway is smaller in relation to the rest of his/her body.

• A child’s airway is more flexible than an adult’s.• Children are able to compensate quickly, but also “run

out of steam” quickly.• Children can lose heat much faster.

Examining a Child

• Observe the child carefully. – Does the child look sick or injured?

• Respirations – Work of breathing– Abnormal sounds – Tripod position, retractions, flaring

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Examining a Child

• Pulse rate – Normal rate for children is faster than adult rate.

• High body temperature– Often with flushed, red skin, sweating, restlessness– Touch child’s chest and head.

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Pediatric Assessment Triangle

• A quick general impression of the child using only your senses of sight and hearing

• Can be used to assess a child from a distance

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Pediatric Assessment Triangle

• Overall appearance – An indicator of how well key body

systems are working • Work of breathing

– Abnormal breath sounds– Abnormal positioning– Retractions – Flaring

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Pediatric Assessment Triangle

• Circulation to the skin – Paleness: Inadequate blood flow – Mottling: Too much or too little circulation – Cyanosis: Low levels of oxygen in the blood

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Respiratory Care

• Respiratory arrest can lead to cardiac arrest. • Causes:

– Suffocation– Infections– Poisoning– Injuries to head and neck

Basic Life Support: Children

• Differences from adult CPR:– Perform five cycles of CPR

before activating EMS system if you are alone.

– Use heel of one hand or two hands to perform chest compressions.

– Compress sternum 1/3 to 1/2 depth of chest.

Basic Life Support: Infants

• Differences from adult CPR:– Check responsiveness by tapping foot or shaking

shoulder.– Use gentle mouth-to-mouth-and-nose ventilations.– Check brachial pulse.– Use middle and ring fingers to compress sternum.– Compress sternum 1/3 to 1/2 depth of chest.

Suctioning a Child or Infant

• Use a tonsil tip to suction mouth.• Use a flexible catheter to suction nose.• Use bulb syringe to suction nose of infant.• Never suction for more than 5 seconds at a time.• Ventilate patient before repeating suctioning.

Mild Airway Obstruction

• Some air will pass around the object.

• Remove object if it is clearly visible. – Never attempt blind

finger sweeps. • Transport child to hospital.

Severe Airway Obstruction

• A serious emergency• Definition

– Poor air exchange– Increased breathing difficulty – Silent cough – Inability to speak– No air movement

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Severe Airway Obstruction

• In children:– Same steps as for adult patients– Tilt head just past neutral.– If you are alone and child becomes unresponsive,

perform five cycles of CPR before calling EMS.

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Severe Airway Obstruction

• In infants: – If child is crying, airway is not completely obstructed. – Try to determine what was happening when episode

began. – Use a combination of back slaps and chest thrusts. – If child becomes unresponsive, begin CPR.

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Respiratory Distress

• Rate of more than 60 breaths/min in infants and more than 30–40 breaths/min in children

• Flaring and retractions• Stridor• Cyanosis• Altered mental status• Combativeness or restlessness

Respiratory Failure/Arrest

• Breathing rate of fewer than: – 20 respirations/min in infants– 10 respirations/min in children

• Limp muscle tone• Unresponsiveness• Decreased or absent heart rate • Weak or absent distal pulses

Circulatory Failure

• Caused by respiratory failure• Signs and symptoms include:

– Increased heart rate– Pale or bluish skin– Changes in mental status

Key Pediatric Medical Emergencies

• Altered mental status • Respiratory emergencies• Drowning • Heat-related illnesses• High fever

• Seizures• Vomiting/diarrhea• Abdominal pain• Poisoning • SIDS

Altered Mental Status

• Various causes• If cause can be determined, treat accordingly.

Otherwise, complete your assessment.• Monitor vital signs.• Monitor ABCs.• Prepare for transport.

Asthma

• Caused by spasms and contractions of, or buildup in, the smaller airways in the lungs

• Focus on calmingthe patient.

• Place patient ina sitting position.

• Have patient breathewith pursed lips.

Croup

• Infection of upper airway• Common between 6 months and 4 years of age• Common signs include:

– Noisy, whooping inhalations– Seal-like barking cough– History of recent or current cold– Lack of fright or anxiety– Willingness to lie down

Epiglottitis

• Severe inflammation of epiglottis• Common between 3 and 6 years of age• Poses an immediate threat to life • Make the child comfortable and keep everyone

calm. • Arrange for prompt transport.

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Epiglottitis

• Common signs:– Child is sitting up.– Child cannot swallow.– Child is not coughing.– Child is drooling.– Child is anxious and

frightened.– Child’s chin is thrust

forward.

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Near Drowning

• Defined as people who survive suffocation under water• Second most common cause of death in children up

to 5 years old• First responder care includes:

– Assess ABCs and administer oxygen if available.– Dry and warm the child.– Arrange for prompt transport.

Heat-Related Illnesses

• Range from muscle cramps to heat exhaustion and heatstroke

• Heatstroke may be life threatening.– Remove clothing and wet child with water.– Monitor ABCs.– Arrange for prompt transport.

High Fevers

• Commonly caused by infections• Make certain child is not wrapped in too much clothing or

too many blankets.• Reduce temperature by undressing child.• Fan child to cool him or her down.• Protect child from injury if seizures begin.• Make certain normal breathing resumes.

Seizures

• Commonly result from high fevers• First responder care:

– Prevent injury.– Maintain adequate airway.– Arrange for prompt transport.– Monitor patient’s vital signs and support ABCs.

Vomiting and Diarrhea

• Usually caused by gastrointestinal infections• May produce dehydration• Signs include:

– Lethargy– Very dry skin

• Hospitalization may be required to replace fluids.

Abdominal Pain

• Most serious cause is appendicitis.– Cramping pain in the belly button area– Child is nauseated and has no appetite.

• Arrange for prompt transport.• Keep patient in position of comfort.

Ingested Poisoning

• Try to identify substance swallowed and amount.• Gather spilled tablets and medicine bottles.• Arrange for transport and contact poison control center.

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Ingested Poisoning

• If transport is delayed, contact poison control center and follow directions:– Dilute poison with water.– Administer activated charcoal.

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Absorbed Poisoning

• Remove any contaminated clothing.• Brush off any dry chemicals.• Wash off liquid poisons with water for 20

minutes.• Try to identify poison.• Monitor patient’s ABCs.• Arrange for prompt transport.

Sudden Infant Death Syndrome

• Also known as crib death• Usually occurs between ages of 3 weeks and 7 months• If infant is still warm, begin CPR.• Be compassionate and supportive with the parents.

Pediatric Trauma

• Children cannot communicate as well as adults.• May be shy and overwhelmed by rescuers• Materials and equipment may have to be adapted to

child’s size.• Children can progress into severe shock quickly.

Caring for Trauma in Children

• The most important things to do for an injured child are:– Open and maintain airway.– Control bleeding.– Arrange for prompt transport.

Traumatic Shock in Children

• If signs are present, child is already in severe shock. • Signs include:

– Cool, clammy skin– Rapid, weak pulse– Rapid or shallow respirations

Signs and Symptoms of Child Abuse

• Multiple fractures• Bruises at different stages

of healing• Human bites• Cigarette burns• Scalds from hot water• Bizarre accidents

without logicalexplanations

Sexual Assault of Children

• May occur in both male and female infants, children, and adolescents

• Obtain as much information as possible from child or witnesses.

• All victims of sexual assault should be transported to an appropriate facility.

First Responder Debriefing

• Many calls involve children.• Coping with serious pediatric calls:

– Talk with a counselor.– Set up a critical incident stress debriefing session.