Transcript Chapter 30

Chapter 30
Pediatric Emergencies
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
30.1 List and describe the anatomical and
physiological differences between
children and adults.
30.2 List and describe the six stages of child
growth and development.
30.3 List the normal range of vital signs for
each pediatric age group.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
30.4 Understand and be able to incorporate
communication tips and techniques for
assessing and interacting with a
pediatric patient.
30.5 Describe the signs and symptoms of
respiratory distress and failure in a child.
30.6 List and describe the signs and
symptoms of various pediatric disorders.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
30.7 List the most common cause of cardiac
arrest in pediatric patients.
30.8 List common causes of seizures in
pediatric patients.
30.9 List five indicators of potential child
abuse and neglect.
30.10 Define sudden infant death syndrome.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Objectives
30.11 Describe and demonstrate how to
assess a pediatric patient, using the
pediatric assessment triangle.
30.12 Describe and demonstrate how to
manage common pediatric illnesses
and injuries.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Anatomy
and Physiology
 Human growth and development
 Common pediatric illnesses and
injuries
 Child abuse and neglect
 Shock
 Assessment
 Management
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
An eight-year old kayaker has slipped and fallen on a
rock with her arm outstretched. She is cradling it
against her life jacket, shivering violently, and her lips
have turned blue. When you approach she screams
and begins to cry. Her grandmother is also at the
scene.
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Inherent
differences in intellect, size,
proportion, and metabolism
 Large variations in behavior, vital
signs, ability to cope occur at various
stages of development
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
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Airway
 Relatively
small mouths and airways
◦ Tongue is proportionally larger &
bulbous until about age 8
◦ Tonsils & adenoids swelling can cause
respiratory distress
 Glottis
opening is narrow
◦ Foreign body obstruction concerns
continued
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©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Airway
continued
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Airway
 Trachea
is shorter, smaller, softer,
more flexible
◦ May collapse if neck is hyperextended
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Head
 Proportionally
larger & heavier
◦ Issues with neutral c-spine/airway mgt
 Brain
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is proportionally smaller
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©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Skin, Bones, Joints
 Surface
area is greater, skin is thinner
 Less muscle mass & body fat
 Musculoskeletal system is immature
and grows rapidly
 Bones, joints, ligaments are softer &
more flexible
◦ Higher rate of internal organ injury
◦ Greenstick fractures
◦ Growth plate issues
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Metabolism
 High
metabolism rate leads to bursts
of energy followed by fatigue
 Need for regular meals
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Breathing
 Newborns
breath through their nose
 Infants/small children use diaphragm
 Rates & minute volume are higher
 High incidence of respiratory failure
◦ May be first indication of emergency
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Bleeding and Shock
 Cardiovascular/nervous
systems are
vulnerable to toxins
 Proportionally less blood, bleed like
adults
 Initial compensation to shock is
better, but fails quickly
◦ Hypovolemia is dangerous
 Thermal
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regulation can be of concern
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Human Growth and
Development
 Six
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stages
Newborn
Infant
Toddler
Pre-school
School-age
Adolescent
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©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Newborn and Infant
 Newborn
spans 28 days
◦ Breathing must begin properly
◦ Warmth is essential
◦ Crying is response to stimuli
 Infant
spans first year of life
◦ Dependent on caregivers
◦ Vary responses
◦ Gross motor skills develop
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©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Newborn and Infant
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Toddler & Pre-School
 Toddler
from 1 to 3 years of age
◦ Curiosity may lead to serious injury
◦ Speech, fine motor skills develop
◦ Limited socialization
 Pre-school
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from 3-6 years of age
Communication skills improve
Motor skills/balance develop
Social skills, abstract thinking develop
Gender awareness emerges
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Toddler & Pre-School
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School-Age
 Care
for most basic needs with help
 Can differentiate emotional/physical
pain
 Controlling emotion is difficult
 Require simple language
 Can make decisions, be part of a
team
 Concepts of right, wrong, acceptance,
consequences develop
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School-Age
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Adolescent
12 – 18
 Become independent, peer oriented
 May feel invincible – accidents and
injuries common
 Privacy, sexuality are issues
 Understand complex thought, develop
opinions, influenced by peers
 Ages
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Adolescent
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Common Illnesses and
Injuries
 Some
unique to this population
 Vary in severity
 Occur more frequently in one group
than others
 Often respiratory related
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©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Airway Problems
 Upper
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◦
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Croup
Tonsillitis
Foreign body airway obstruction
Epiglottitis
 Lower
◦ Pneumonia
◦ Bronchiolitis
◦ Asthma
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©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Airway Problems
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Respiratory Failure/Cardiac
Arrest
 Young
children are susceptible
 Heart and respiratory rate increase
 Respiratory system becomes
exhausted – fails
 Hypoxia follows, then cardiac arrest
 Bradycardia with resp distress is an
ominous sign
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Abdominal Pain
 Common
cause is constipation/stool
holding
 Gastroenteritis, appendicitis are also
sources
 Nausea, vomiting, diarrhea also
common (NVD)
◦ Severe cases lead to dehydration,
hypovolemia and shock
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Seizures
 Febrile
are most common
◦ 6 mos. To 5 years
◦ Combination of infection, high temp
◦ Most are generalized, short, harmless
 Status
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epilepticus
Lasts longer than 10 mins.
Prolonged post-ictal state
3 or more in a row, no return to normal
True emergency
 Absence
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©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Meningitis and Poisoning
 Meningitis
is caused by an infection
◦ Develops over 1-4 days, contagious
◦ Lethargy, fever, headache, stiff neck
◦ True medical emergency
 Accidental
poisoning
◦ Often can’t tell the difference
◦ Put things in their mouth
◦ Small amounts have large effect
 Adolescent
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©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Poisoning
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
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Sudden Infant Death
Syndrome
 Cause
is unknown
◦ may run in families, be preceded by
sleep apnea or anoxia
 Decline
in cases over last 15 years
◦ Sleep in nonprone position
◦ Avoid soft bedding and objects
◦ Not sleeping with adults
 No
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known prevention
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Trauma
 Inherent
risk taking behavior
 Leading cause of death
◦ Vehicle crashes, firearms, drowning
 Blunt
trauma is leading source of
injury
 Head injury common, severe
 Lower spine injury incidence
continued
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Trauma
 Chest/abdomen
injuries transfer
energy to organs
◦ Contusions and internal bleeding may
result
 Commitio
cordis is life threat
◦ Blow to the chest, interrupts normal
electrical pattern of heart
◦ Treated with defibrillation
 Extremities
BRADY
◦ Greenstick fractures may occur
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Burns and Electrocution
 Scald
related are most common in
toddler & pre-school
 Open flame burns common in schoolage children and adolescents
 Chemical burns are less common
 Electrical injuries occur when infants,
toddlers stick objects into outlets or
chew cords
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Child Abuse and Neglect
 Legal,
not medical terms
◦ Are crimes
◦ Reporting requirements vary by state
 Transcends
culture, class, race,
religion
 Abusers are parents or close adults
◦ Shaken baby syndrome
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Child Abuse and Neglect
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Shock
 Hypovolemic
is most common
◦ Dehydration due to vomiting, diarrhea,
external blood loss or internal bleeding
◦ Vascular reserve is smaller, smaller loss
is more serious
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Shock
 Sepsis,
anaphylaxis, poisoning are
also causes
 Cardiogenic is rare
 Obstructive may occur due to blunt
trauma
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Shock
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
Smiling, you crouch down beside her. You introduce
yourself to her and to her grandmother and reassure
both of them that you are there to help. You ask and
receive the grandmother’s permission to examine
the child. Sensing her fear and pain, you ask the
child her name.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
You ask the girl, “Where does it hurt?” She stops
crying and points with her left index finger at her right
upper arm and shoulder. You carefully lift the child
out of the water and onto more stable ground, being
careful to protect her injured arm and shoulder. With
the help of other OEC Technicians, you remove the
child’s life-jacket, compliment her for wearing a
helmet, and continue to wrap her torso in the space
blanket.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Pulse/resp
rates may change rapidly
 Crying complicates
 Stable appearance doesn’t mean no
problem
 All actions take into account
developmental stage
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Pediatric
Assessment Triangle
◦ Appearance
◦ Work of breathing
◦ Circulation to skin
continued
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
continued
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Parental
permission, or implied
consent
◦ Parent cooperation may = child’s
 Use
◦
◦
◦
◦
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clues based on child’s behavior
Activity level
Eye contact
Irritable or agitated?
Response to caregiver’s voice
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Respiratory
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◦
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◦
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◦
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◦
effort
Appearance is striking
May be in tripod position
“Sniffing” position in infants
Drooling (epiglottitis)
Use of accessory muscles
See-saw (paradoxical) breathing
Listen for sounds of breathing
Check rate
Is air moving well?
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
 Circulation
◦ Check skin color characteristics
 History
◦
◦
◦
◦
BRADY
May come from caregiver
Talk to child if possible, be calm
Adjust vocab as appropriate
Be aware of privacy issues
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Honesty, Trust,
Communication
honest – trust lost may not be
regained, can affect care
 Interaction with caregiver could
“make or break” scene
 Be
◦ Find out what is normal
◦ Ask about NVD
◦ Cover history
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Honesty, Trust,
Communication
 Explain
actions
 Screaming/crying can create difficulty
 Use eye contact, empathy – don’t
show irritation/anger
 Don’t promise what you can’t deliver
 Phrase questions carefully
 Give child choices if possible
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Physical Exam
 May
want to distract young children
and involve them in the process
◦ Allow them to remain in parent’s arms
 Take
pulse, respirations (most
important vital sign for young child)
 Use pediatric cuff for BP
 Do regular secondary
◦ Do head after trunk/extremities
◦ Palpate injured area last
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Child Abuse
 Suspect
child abuse if:
◦ The parent is verbally abusive to child
◦ The child withdraws completely or shows
true fear
◦ Injuries are found to multiple body
parts/various ‘ages’
◦ History is inconsistent with injury pattern
 Be
aware of your state’s reporting
requirements
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Control
external bleeding
aggressively
 If sick child isn’t getting better with
care, they are likely getting worse
 Be aware of neutral head position
 Use high flow oxygen/ped’s mask
 Airway related disorders should be
continued
transported quickly
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Monitor
seizure patient, when it stops
open/clear airway
◦ Use recovery position if no spinal injury
is suspected
 Febrile
seizures are managed by
cooling
 Shock can be present with no S or S
◦ If suspected, transport
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
After confirming that there are no immediate threats
to life, your secondary assessment reveals an
obvious deformity over the lateral third of the right
clavicle with bruising and swelling noted over the
girl’s right upper arm. You tell her that you’d like to
splint her arm, which will help take away some of the
pain.
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National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
You explain, however, to both the girl and her
grandmother, that it might hurt when you move the
arm into the splint and sling. The girl looks at her
grandmother, who gives her an encouraging smile
and tells you, “We’ll both be big girls.” After
splinting, you accompany the child and her
grandmother downriver in a large oar boat. Her vital
signs remain stable. An ambulance takes her to the
hospital. She has a broken clavicle.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Children are not miniature adults; they do
not see, perceive, or respond to the world
as adults do.
 Children undergo six growth and
development stages: the newborn stage,
infancy, the toddler stage, the preschool
period, the school-age period, and
adolescence.

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Whenever possible, incorporate caregivers
or parents into the assessment process.
 Be sensitive to an adolescent’s need for
independence, respect, and privacy.
 A child can maintain a normal blood
pressure and appearance during
compensated shock.
 Children can change rapidly

continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
Assume that the condition of a child who
looks sick and is not improving with care is
worsening.
 Report suspected child abuse to the proper
authorities.
 Approach children slowly and gently. Smile
and be friendly.
 A child who is crying or screaming has a
patent airway.
continued

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
A slow heart rate in a child with respiratory
distress is an ominous sign of severe
illness and impending cardiac arrest.
 Cardiac arrest in children is usually
preceded by respiratory failure.
 Parents often demonstrate their fear by
showing anger or irritation.

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ