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Page 1: Common pediatric emergencies and pediatric attention

UNIVERSIDAD NACIONAL PEDRO RUÍZ GALLO

FACULTAD DE MEDICINA HUMANA

INGLÉS MÉDICO

ROSA GONZALES LLONTOP

ARBOLEDA DÍAZ OSCARBECERRA SILVA FRANKCARRASCO HERRERA DENISMENDOZA HERNÁNDEZ ALEXPISCOYA TENORIO JORGETINEO TINEO DENNY

8

Page 2: Common pediatric emergencies and pediatric attention

COMMON PEDIATRIC

EMERGENCIES

Children are not small adults!

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Recognize the acuity and implement appropriate emergency management

Discuss the etiology and natural history of common pediatric emergencies

Communicate effectively with patients, families, nursing staff, EMS personnel, ancillary service personnel, referring physicians and consultants.

GOALS AND OBJECTIVES

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Asthma

Bronchiolitis

Pneumonia

Croup

Foreign Body

5 MOST COMMON RESPIRATORY EMERGENCIES

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Pathophysiology Chronic recurrent lower airway disease with

episodic attacks of bronchial constriction

Precipitating factors include exercise, psychological stress, respiratory infections, and changes in weather & temperature

Occurs commonly during preschool years, but also presents as young as 1 year of age

Decrease size of child’s airway due to edema & mucus leads to further compromise

Asthma

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Assessment History

When was last attack & how severe was it Fever Medications, treatments administered

Physical Exam

SOB, shallow, irregular respirations, increased or decreased respiratory rate

Pale, mottled, cyanotic, cherry red lips Restless & scared Inspiratory & expiratory wheezing, rhonchi Tripod position

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Management

Assess & monitor ABC’sBig O’s (Humidified if possible)IV of LR or NS at a TKO rateAssist with prescribed medicationsPrepare for vomitingPulse oximeter Intubate if airway management

becomes difficult or fails

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Basics

Respiratory infection of the bronchioles Occurs in early childhood (younger than 1 yr) Caused by viral infection

Assessment/History

Length of illness or fever has infant been seen by a doctor Taking any medications Any previous asthma attacks or other allergy

problems How much fluid has the child been drinking

Bronchiolitis

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Signs & Symptoms

Acute respiratory distressTachypneaMay have intercostal and suprasternal

retractionsCyanosisFever & dry coughMay have wheezes - inspiratory &

expiratoryConfused & anxious mental statusPossible dehydration

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Management

Assess & maintain airwayWhen appropriate let child pick POCClear nasal passages if necessaryPrepare to assist with ventilationsIV LR or NS TKO rateIntubate if airway management becomes

difficult or fails

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Basics

Upper respiratory viral infectionOccurs mostly among ages 6 months to 3

yearsMore prevalent in fall and springEdema develops, narrowing the airway

lumenSevere cases may result in complete

obstruction

Croup

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Assessment/History

What treatment or meds have been given?

How effective?Any difficulty swallowing?Drooling present?Has the child been ill?What symptoms are present & how have

they changed?

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Physical Exam

Tachycardia, tachypneaSkin color - pale, cyanotic, mottledDecrease in activity or LOCFeverBreath sounds - wheezing,

diminished breath soundsStridor, barking cough, hoarse cry

or voice

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Management

Assess & monitor ABC’sHigh flow humidified O2; blow by if child

won’t tolerate maskLimit exam/handling to avoid agitationBe prepared for respiratory arrest, assist

ventilations and perform CPR as neededDo not place instruments in mouth or

throatRapid transport

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Basics

Common among the 1-3 age group who like to put everything in their mouths

Running or falling with objects in mouthInadequate chewing capabilitiesCommon items - gum, hot dogs, grapes

and peanuts

Aspirated Foreign Body

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Assessment

Complete obstruction will present as apnea

Partial obstruction may present as labored breathing, retractions, and cyanosis

Objects can lodge in the lower or upper airways depending on size

Object may act as one-way valve allowing air in, but not out

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Management – Complete Obstruction

Attempt to clear using BLS techniques

Attempt removal with direct laryngoscopy and Magill forceps

Cricothyrotomy may be indicated

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Management - Partial Obstruction

Make child comfortableAdminister humidified oxygenEncourage child to coughHave intubation equipment

availableTransport to hospital for removal

with bronchoscope

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Physical Assessment/Signs & symptoms

Onset very abrupt Sudden jerking of entire body, tenseness, then

relaxation LOC or confusion Sudden jerking of one body part Lip smacking, eye blinking, staring Sleeping following seizure

MILD, MODERATE, & SEVERE DEHYDRATION

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Management

If mild or moderate

Give fluids orally if there is no abdominal pain, vomiting or diarrhea and is alert

Severe

High flow O2 IV/IO with NS or LR Fluid bolus of 20 ml/kg IV/IO push Repeat fluid bolus if no improvement

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PEDIATRIC ATTENTION

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The care of the normal newborn child, he understands a special evaluation in four moments.

NEWBORN CHILD

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IMMEDIATE ATTENTION• Evaluation of the breathing,

cardiac frequency and color,Test de Apgar.

• Anthropometry and the first evaluation of age gestational.

CARE OF TRANSITION• The first hours of life of the

newborn child need of a special supervision of his temperature, vital signs and clinical general condition.

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ATTENTION OF THE NCH IN PUERPERIO• Spent the immediate period of

transition the NCH remains together with his mother in puerperal.

• This period has a great importance from the educational and preventive point of view.

PREVIOUS TO BE HIGH OF WITH HIS MOTHER OF THE HOSPITAL• It is necessary to give a last general

review• The mother needs to interest and to

catch knowledge that will facilitate to him the care of his son.

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CONTROL OF THE HEALTHY CHILD

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PAEDIATRIC CONTROLS• There will be realized pediatrics controls of

healthy children by major frequency when the child is developing

CONTROL OF THE HEALTHY CHILD• In this examination, the doctor checks the

growth and development of the baby or of the small child and tries to find problems in time.

CONSULTATIONS OR CONTROLS• They serve to receive information about

the normal development, nutrition, dream, safety, infectious diseases " and other important topics.

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CALENDAR OF ATTENTION IN PREVENTIVE HEALTH

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After the birth of the baby, the following consultation

must be between 2 and 3 days after.

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Of there in forward, the consultations must

happen to the following ages

1 MONTH. 2 YEAR

2 MONTH. 3 YEAR

4 MONTH. 4 YEAR

6 MONTH. 5 YEAR

9 MONTH. 6 YEAR

1 YEAR. 8 YEAR

15 MONTH. 10 YEAR

18 MONTH. 10-21 EVERY YEAR

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PHYSICAL EXAMINATION

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AUSCULTATION

RESPIRATORY NOISES

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INFANTILE REFLECTIONS

JAUNDICE NEWBORN

CHILD

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THAN

KS