Transcript PEDIATRIC EMERGENCIES

SILVER CROSS EMS
SEPTEMBER 2014
EMD CE
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Sudden illness and medical emergencies are
common in children and infants.
Anatomical differences exist between adults
and children.
Respiratory care for children is extremely
important.
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Managing a pediatric emergency can be one
of the most stressful situations you face as
an EMD.
◦ You must remain calm and professional.
◦ Unless you are prepared, your anxiety and fear
may interfere with your ability to deliver proper
instructions.
◦ Caller may be at a higher state of anxiety.
◦ Ask simple questions about the emergency.
◦ Ask to speak to someone else if caller is hysterical
and unable to focus on interrogation process.
REVIEW OF
A, B, C’S AND BLS FOR
INFANTS AND CHILDREN
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Differences
between children
and adults
◦ A child’s airway is
smaller in relation
to the rest of the
body compared to
an adult’s airway.
◦ A child’s tongue is
relatively larger than
an adult’s.
◦ A child’s upper airway is more flexible than that of
an adult.
◦ The airway is narrow and more easily obstructed.
◦ For at least the first 6 months of their lives, infants
can breathe only through their noses.
◦ When the demands on a child’s respiratory system
change, the child is able to quickly compensate by
increasing breathing efforts.
◦ The child can only compensate for so long before
they tire and quickly decompensate.
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Used with permission of the American Academy of Pediatrics,
Pediatric Education for Prehospital Professionals,
© American Academy of Pediatrics, 2000.
Gathering
information from
the caller about
the child’s, level of
consciousness,
respiratory effort
and skin will
quickly give you a
general impression
of the emergency.
◦ Indicator of how well the heart, lungs, and central
nervous system are working
◦ Compare the child’s appearance with what you
would expect from a healthy child.
◦ Assess eye contact, muscle tone, and skin color.
Red Flags:
Limp, glassy stare, not interacting with
environment or caregivers, high pitched cry or
inconsolable.
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Ask about child’s level of distress:
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Labored breathing with signs of muscles retractions
Abnormal sounds like wheezing or gurgling
Positioning: tripod sitting up and leaning forward
Nasal flaring or grunting
◦ Red Flags:
◦ Pallor - pale skin or mucous membranes.
◦ Mottling – blotching skin discoloration that is caused
by too much or too little blood flow to skin.
◦ Cyanosis – bluish tint to skin and mucous membranes
from a lack of oxygen.
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High temperatures are accompanied by:
◦ Flushed, red skin
◦ Sweating
◦ Restlessness
◦ Heart rate increases
◦ Fevers accompanied with rashes are concerning
and could be a sign of a serious illness
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Causes of cardiopulmonary arrest in children
◦ Choking
◦ Infections of the airway such as croup and
epiglottitis
◦ Sudden infant death syndrome (SIDS)
◦ Accidental poisonings
◦ Injuries around the head and neck
◦ ANY RESPIRATORY EMERGENCY CAN LEAD TO
CARDIAC ARREST IN PEDIATRIC PATIENTS IF NOT
CORRECTED IN A TIMELY MANNER!
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Opening the airway
◦ Use the head tilt–chin
lift maneuver on
children to open the
airway.
◦ Do not hyperextend
the child’s neck when
you tilt the head back.
◦ Because of anatomical
differences their
airway should be in a
more neutral or
“sniffing” position.
◦ If no breathing or only
gasping, begin CPR.
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Basic life support for
ages 1 and over
◦ Use the heel of one hand
or two hands to perform
chest compressions.
◦ Compress the sternum
one half to one third the
depth of the chest
depending on the size of
the child.
◦ Give breaths, making
sure chest is rising.
◦ Compression to breath
ratio is 30:2.
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Basic life support for children under 1 year
◦ CPR for infants is different from adult CPR.
 Check for responsiveness by tapping the
infant’s foot or gently shaking the shoulder.
 Use your middle and ring fingers to compress
the sternum just below the nipple line.
 Compress the sternum one half to one third
the depth of the chest.
 Give gentle rescue breaths.
 Compression to Breath ratio is 30:2
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Severe airway obstruction is a serious
emergency.
Signs and symptoms
◦ Poor air exchange
◦ Increased breathing difficulty
◦ Silent cough
◦ Inability to speak
◦ No movement
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Use Abdominal
Thrusts to expel
object.
◦ Wrap arms around
the patient’s midsection (above belly
button but below
ribs)
◦ Provide quick
inward and upward
thrusts
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If the child becomes unconscious, begin the
steps of CPR.
◦ Remember to check the mouth for object after the
compressions and before giving breaths.
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An infant is very fragile.
If you suspect an airway obstruction, assess
the infant to determine whether any air
exchange is occurring.
◦ If the infant is crying, the airway is not completely
obstructed.
◦ If no air is moving in or out of the infant’s mouth
and nose, suspect an obstructed airway. The infant
will start to change colors very quickly.
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Use a combination of
back slaps and the
chest-thrust
maneuver.
◦ Assess the infant’s
airway and breathing.
◦ Place the infant in a
face-down position
over your one arm and
deliver five back slaps
between the shoulder
blades.
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Use a combination of
back slaps and the
chest-thrust maneuver.
◦ Turn the infant face-up.
◦ Deliver five chest thrusts
in the middle of the
sternum with your two
fingers.
◦ Repeat these steps until
the object is expelled or
until the infant becomes
unresponsive.
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If the infant becomes unresponsive, continue
with the following steps:
◦ Begin CPR, remembering to check the airway for
the object prior to giving breaths.
◦ Once the airway is clear, assess for breathing. If
breathing is present, roll infant into their side and
monitor until help arrives.
◦ If infant is not breathing, continue the steps of CPR
giving 30 compressions and 2 breaths, alternating,
until help arrives.
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If small, round objects do not become airway
obstructions, they usually pass uneventfully
through the child.
Sharp or straight objects are dangerous if
swallowed.
◦ Arrange for prompt transport.
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Causes of altered mental status in children
◦ Low blood glucose level
◦ Poisoning
◦ Post-seizure state
◦ Infection
◦ Head trauma
◦ Decreased oxygen levels
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Because infants breathe primarily through
their noses, even a minor cold can cause
breathing difficulties.
Asthma
◦ Caused by a spasm or constriction and
inflammation of smaller airways in the lungs
◦ Usually produces a wheezing sound
◦ Advise caller to get child into a position of comfort
and follow their doctor’s order for medication
◦ Arrange for prompt transport
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Croup
◦ Infection of the upper airway that occurs
mainly in children between 6 months and
6 years of age
◦ Results in a hoarse, whooping noise during
inhalation and a seal-like, barking cough
◦ Often occurs in colder climate
◦ A lack of fright and the willingness to lie down are
important signs that distinguish croup from
epiglottitis.
◦ Moist, warm air helps to relax the vocal cords.
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Epiglottitis
◦ Severe inflammation of the epiglottis
◦ The flap is so inflamed and swollen that air movement
into the trachea is completely blocked.
◦ Usually occurs in children between ages 3 and 6 years
◦ The child is usually sitting upright, with chin
thrust forward
 cannot swallow or cough.
 is drooling.
 is anxious and frightened.
◦ Make the child comfortable with as little handling as
possible. Keep everyone calm.
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Signs of respiratory distress
◦ A breathing rate of more than 60 breaths/min in infants
◦ A breathing rate of more than 30 to 40 breaths/min in
children
◦ Nasal flaring on each breath
◦ Retraction of the skin between the ribs and around the
neck muscles
◦ Stridor – a high pitched crowing, upper airway sound,
indicating swelling or a partial obstruction
◦ Cyanosis of the skin
◦ Altered mental status
◦ Combativeness or restlessness
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Treatment of respiratory distress
◦ Try to determine the cause.
◦ Support the child’s respirations by placing the
child in a comfortable position, usually sitting.
◦ Keep the child as calm as possible by letting a
parent hold the child if practical.
◦ Arrange for prompt transport.
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Often results as respiratory distress proceeds
Signs and symptoms
◦ A breathing rate of fewer than 20 breaths/min in an
infant
◦ A breathing rate of fewer than 10 breaths/min in a
child
◦ Limp muscle tone
◦ Unresponsiveness
◦ Decreased or absent heart rate
A child in respiratory failure is on the verge of
experiencing respiratory and cardiac arrest.
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Circulatory failure
◦ The most common cause of circulatory failure in
children is respiratory failure.
◦ Can lead to cardiac arrest
◦ Indicated by an increased heart rate, pale or bluish
skin, and changes in mental status
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Fevers are common in children.
Because the temperature-regulating mechanism
in young children has not fully developed, a very
high temperature can occur quickly.
Most children can tolerate temperatures as high
as 104°F (40°C).
Treatment
◦ Uncover the child so that body heat can escape.
◦ Protect the child during any seizure, and make certain
that normal breathing resumes after each seizure.
Can result from a high fever or from disorders such as
epilepsy.
Seizures are relatively common in children who have
sustained a serious head injury.
During a seizure:
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The child loses consciousness.
The eyes roll back.
The teeth become clenched.
The body shakes with jerking movements.
The child’s skin becomes pale or turns blue.
Sometimes the child loses bladder and bowel control.
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Treatment
◦ Move objects away to prevent injury.
◦ Maintain an adequate airway after the seizure
ends.
◦ Arrange for prompt transport.
◦ Monitor and support the ABCs.
◦ After the seizure is over, cool the patient if he or
she has a high fever.
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Usually caused by gastrointestinal infections
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May produce severe dehydration
◦ The dehydrated child is lethargic and has very dry
skin.
◦ Can lead to shock.
◦ Hospitalization may be required to replace fluids.
◦ If you suspect dehydration, arrange for transport.
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One of the most serious causes of abdominal
pain in children is appendicitis.
◦ More commonly seen in people between 10 and 25
years
◦ Usually the child is nauseated, has no appetite,
and occasionally will vomit.
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Treat every child with a sore or tender
abdomen as an emergency.
Arrange for prompt transport.
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Also called crib death
Sudden and unexpected death of an
apparently healthy infant
Usually occurs in infants between the ages of
3 weeks and 7 months
No adequate scientific explanation exists for
SIDS.
Be compassionate with the parents.
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Trauma is the number one killer of children.
Treat an injured child as you would treat an
injured adult, but remember these
differences:
◦ A child cannot communicate symptoms as well as
an adult.
◦ You may need to adapt materials and equipment
to the child’s size.
◦ A child does not show signs of shock as early as
an adult but can progress into severe shock
quickly.
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The patterns of injury sustained by children will be
related to three factors:
◦ Type of trauma they experience
◦ Type of activity causing the injury
◦ Child’s anatomy
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Motor vehicle crashes
◦ Unrestrained patients have more head and neck injuries.
◦ Restrained patients often suffer head, spinal, and abdominal
injuries.
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Bicycle accidents
◦ Children often suffer head, spinal, abdominal, and extremity
injuries.
◦ The use of bicycle helmets can greatly reduce the number and
severity of head injuries.
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Children hit by cars
often sustain chest,
abdominal, thigh,
and extremity
injuries.
Falls from a height or
diving accidents
cause head, spinal,
and extremity
injuries.
Burns are a major
cause of injuries to
children.
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Treatment regardless of the cause of injury
◦ Do not move patient, unless in immediate danger.
◦ Check the patient’s ABCs.
◦ Stop severe bleeding.
◦ Treat the patient for shock.
 Children show shock symptoms much more slowly
than adults do, but they progress through the stages
of shock quickly.
◦ Stabilize all injuries you find.
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A child’s injuries could be a result of abuse. If you suspect abuse,
ensure the child’s safety.
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Signs and symptoms
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Multiple fractures
Bruises in various stages of healing
Human bites
Burns
Reports of bizarre accidents
Signs and symptoms of neglect
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Lack of adult supervision
Malnourished-appearing child
Unsafe living environment
Untreated chronic illness
In addition to experiencing abuse the child could be a victim of sexual assault.
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Calls involving children tend to produce strong
emotional reactions.
You may need to talk about feelings of anger or
frustration with a counselor.
By attending debriefing sessions, you can:
◦ Express your feelings
◦ Learn some coping strategies
◦ Maintain a healthy approach to future calls
◦ 1-800-225-CISD, WCSP SOCIAL WORKER 815-724-1878,
JPD SOCIAL WORKER 815-724-3205
Emergency Medical Responder,
5th edition
 Will County 9-1-1 EMDPRS, June 2012
 American Heart Association,

2010 guidelines
American Academy of Pediatrics PEPP,
2000
 Google Images
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