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Chapter 32 Pediatric Emergencies

Pediatric Emergencies Caring for sick and injured children presents

_______________________ challenges. EMT-Bs may find themselves anxious when dealing with

critically ill or injured children. Treatment is the same as that for adults in

_______________________ emergency situations.

Communication With the Patient and the Family You may have more than _______________________

patient. – Caregiver may need help and support.

A calm parent contributes to a calm child. – An agitated parent means child will act same way.

Remain _______________________ , efficient, professional, and sensitive.

Growth and Development Thoughts and behaviors of children usually grouped into

stages – _______________________ – Toddler years – _______________________ age – School age – _______________________

Infant First _______________________ of life They respond mainly to physical stimuli. _______________________ is a way of expression. They may prefer to be with _______________________

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Assessment of Infants Observe infant from a _______________________ . Caregiver should hold baby during assessment. Provide _______________________ comfort.

– Warm hands and end of stethoscope. Do painful procedures at _______________________ of

assessment.

Toddler ____________ to ___________ years of age They begin to walk and explore the environment. They may resist _______________________ from

caregivers. Start to learn body systems Vocabulary grows rapidly

Assessment of Toddlers May have stranger anxiety May resist separation from caregiver May have a hard time describing

_______________________ Can be _______________________ Persistent _______________________ can be a

symptom of serious illness or injury.

Preschool Age Children ___________ to ___________ years of age They can use simple language effectively. They can understand _______________________ . They can identify painful areas when questioned. They can _______________________ when you explain

what you are going to do using simple descriptions.

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Assessment of Preschool Children Much _______________________ must still be

obtained from caregivers. Appeal to child’s imagination to facilitate examination. Never _______________________ to the patient. Patient may be easily distracted.

School Age Children __________ to __________ years of age Beginning to act more like adults Can think in concrete terms Can respond sensibly to questions Can help take care of themselves _______________________ is important. Children begin to understand death

Assessment of School Age Children (1 of 2) Assessment begins to be more like adults’. Talk to the child, not just the caregiver. Start with head and move to the

_______________________ . Give the child _______________________ if possible. Ask only questions that let you control the answer:

– Would you like me to take the BP on the right or left arm?

Assessment of School Age Children (2 of 2) Allow the child to listen to his or her heartbeat through

the stethoscope. Can understand difference between physical and

emotional pain Give them simple _______________________ about

what is causing pain and what will be done about it.

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Ask the parent’s or caregiver’s advice about which _______________________ will work best.

Adolescents __________to __________years of age They are very concerned about body image. They may have strong feelings about being observed. Puberty begins Feel “_______________________ ” They understand _______________________ .

Assessment of Adolescents (1 of 3) Respect an adolescent’s _______________________ . Explain any procedure that you are doing. Can often understand complex concepts and treatment

_______________________ Allow them to be involved in their own care. Provide _______________________ , while lending

guidance.

Assessment of Adolescents (2 of 3) EMT of same _______________________ should do

assessment, if possible. Allow them to speak openly and ask questions. Risk-taking behaviors are common.

– Can ultimately facilitate development and judgment, and shape identity

– Can also result in _______________________ , dangerous sexual practices, and teen pregnancy

Assessment of Adolescents (3 of 3) Female patients may be _______________________ :  Important to report this information to receiving facility. Adolescent may not want parents to know this

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information. Try to interview _______________________ the

caregiver/parent present.

Differences Between Pediatrics and Adults

Airway Differences  Larger, rounder _______________________  Larger tongue relative to the mouth  Larger _______________________  Less well-developed rings of cartilage in the trachea Narrower, lower _______________________

Breathing Differences (1 of 2)  Infants breathe _______________________ than

children or adults.  Infants use the diaphragm when they breathe. Sustained, labored breathing may lead to respiratory

_______________________ . Respiratory problems are the leading cause of

cardiopulmonary arrest in the pediatric population.

Breathing Differences (2 of 2) During respiratory _______________________ , the

pediatric patient is working harder to breathe and will eventually go into respiratory failure.

Respiratory failure occurs when the pediatric patient has exhausted all _______________________ mechanisms.

Waste products collect, leading to respiratory arrest, a total _______________________ .

Circulation Differences (1 of 2) The normal heart rate is faster than adults.

– Infants heart can beat __________ beats/min or more.

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The heart rate increases for _______________________ and injury.

Primary method used to compensate for decreased perfusion

_______________________ keeps vital organs nourished.

Constriction of the blood vessels can affect blood flow to the extremities.

Circulation Differences (2 of 2) Pediatrics are more dependent on actual cardiac output.

– Blood being pumped out of heart in __________ minute

May be in shock despite normal blood pressure A small amount of blood loss can lead to

_______________________ .

Gastrointestinal System (1 of 3) _______________________ muscles are less

developed.  Less protection from trauma.  Liver, spleen, kidneys are proportionally larger and

situated more anteriorly and close to one another. – Prone to bleeding and injury – There is a higher risk for multiple

_______________________ injury.

Gastrointestinal System (2 of 3) Signs and symptoms of acute abdomen may be vague. Abdominal walls are underdeveloped. May not be able to _______________________ origin

of pain Take complaints of abdominal pain seriously.

– Large amount of _______________________ may

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occur within abdominal cavity, without signs of shock.

Gastrointestinal System (3 of 3)  Liver and _______________________ injuries are

common in this age group. Needs to be monitored for shock; may include AMS,

_______________________ , tachycardia, and bradycardia

Musculoskeletal System (1 of 4) Open growth _______________________ allow bones

to grow. As a result of growth plates, children’s bones are softer

and more flexible, making them prone to stress fracture.

Bone _______________________ discrepancies can occur if injury to growth plate occurs. – Immobilize all strains and sprains.

Musculoskeletal System (2 of 4) Bones of an infant’s head are

_______________________ and soft. Fontanelles (soft spots) are located at front and back of

head. – Will close at particular _______________________ of

development

Musculoskeletal System (3 of 4) _______________________ can be a useful

assessment tools – Bulging indicates intracranial pressure

Thoracic cage is highly elastic and pliable. – Composed of cartilaginous connective tissue – Ribs and vital organs are less protected.

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Muscles and bones grow into _______________________ .

Musculoskeletal System (4 of 4) The younger the child, the more

_______________________ the bone structures. – Sprains are uncommon and femur fractures rare.

Older children are prone to _______________________ bone fractures due to more risks and activity.

Integumentary System (1 of 2) _______________________ skin and less subcutaneous

fat Higher ratio of body surface area to body mass leads to

larger fluid and heat losses. Composition of skin is thinner and tends to

_______________________ more easily