| Pediatric Assessment | ||||||||||||||||||||||||
| Pediatric History | ||||||||||||||||||||||||
| Pediatric Pulmonary Emergencies | ||||||||||||||||||||||||
SIGNS OF RESPIRATORY DISTRESS/FAILURE
Evidence of increased work of breathing in a child may include the following:
2. Accessory muscle use 3. Retractions (intercostal, subcostal, or suprasternal) 4. Nasal flaring 5. Position of comfort - tripod/sniffing 6. Grunting (ominous sign!) 7. Cyanosis 8. Diaphoresis 9. Decreased level of consciousness/ agitation 10. Apnea 11. Tachycardia or bradycardia ° Use of accessory muscles ° Head bobbing ° Open-mouth breathing | ||||||||||||||||||||||||
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INDICATIONS FOR AIRWAY MANAGEMENT/ INTUBATION 1. Acute Respiratory failure: PO2 <60 mm Hg PCO2 > 50 mm Hg Apnea Hypoventilation 2. Shock/severe metabolic acidosis 3. Neurological res uscitation - GCS <8 4. Airway protection OTHER INDICATIONS Burns Inability to control secretions Loss of gag reflex Status epilepticus/ Status asthmaticus Ingestions | ||||||||||||||||||||||||
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DISPOSITION Admit: Persistent respiratory distress Hypoxia Poor response to treatment Concurrent pneumonia Multiple visits for same episode Poor parental compliance Inability to tolerate fluids Hypercapnia or normal CO2 on blood gas indicates distress Low threshold for patients with history of intubation | ||||||||||||||||||||||||
| Basic Airway Management & Endotracheal Intubation | ||||||||||||||||||||||||
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Contents of Procedures 1) Absess Incision and Drainage 2) Arterial Blood Sampling (ABG) 3) Arthrocentesis 4) Basic Airway Management & Endotracheal Intubation 5) Electrical Cardioversion 6) Central Venous Line Placement 7) Chest Tube and Fuhrman Catheter Insertion 8) Procedural Sedation 9) Defibrillation 10) External Jugular Venous Catheter 11) Foley (Urethral) Catheterization 12) Vascular Access: Placement of an Intraosseous Needle 13) Lumbar Puncture 14) Nasogastric Intubation 15) Paracentesis 16) Peripheral Intravenous Access 17) Repair of Lacerations: Sutures, Staples, and Dermabond Glue 18) Splinting 19) Thoracentesis 20) Transcutaneous Pacing | ||||||||||||||||||||||||
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Respiratory Distress Respiratory Failure Respiratory Arrest Respiratory Distress Tachycardia (May be bradycardia in neonate) Head bobbing, stridor, prolonged expiration Abdominal breathing Grunting--creates CPAP Respiratory Emergencies Croup Epiglottitis Asthma Status Asthmaticus Bronchiolitis Foreign body aspiration Bronchopulmonary dysplasia Asthma: History How long has patient been wheezing? How much fluid has patient had? Asthma vs Bronchiolitis Asthma Age - > 2 years Fever - usually normal Family Hx - positive Hx of allergies - positive Response to Epi - positive Bronchiolitis Age - < 2 years Fever - positive Family Hx - negative Hx of allergies - negative Response to Epi - negative Volvulus or intussusception Spina bifida Bloody stools Cystic fibrosis Gastritis Near drowning Peptic ulcer disease Severe constipation Rectal prolapse Bony deformity Slipped Capital Femoral Epiphysis (SCFE) Supracondylar fractures Laxative ingestion Household electrical injuries Post-ictal (convulsion) Electrical injury Neurocardiogenic syncope Mental status alterations Frostbite Dysrhythmias Traumatic brain injury | ||||||||||||||||||||||||
Endotracheal
tube and laryngoscope sizes:
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By the end of this presentation the learner will be able to: 1. List anatomical difference between children and adults 2. Discuss common respiratory emergencies in children 3. Describe appropriate interventions for a child in respiratory distress 4. Discuss some uncommon presentations of children in respiratory distress | ||||||||||||||||||||||||
| Neonatal respiratory distress syndrome | ||||||||||||||||||||||||
| # Pediatric BLS # Recognizing impending respiratory failure and shock # Initiate treatment based on the child's physiologic status as identified by the rapid cardiopulmonary assessment # Stabilize and evaluate the pediatric trauma patient # Identify and manage unstable rhythms # Initiate the first 10 minutes of pediatric resuscitation # Triage the patient to definitive care | ||||||||||||||||||||||||
| Pediatric Advanced Life Support (PALS) | ||||||||||||||||||||||||
| * Describe the differences between pediatric and adult airways and their effect on airway management; describe the difference between pediatric and adult response to hypovolemia. * Describe the usual patterns of injury in infants and children, recognizing the difference between adult and pediatric orthopedic injuries and injuries that warrant investigation of possible abuse. | ||||||||||||||||||||||||
| * Benign Neonatal Convulsions | ||||||||||||||||||||||||
| * Child Abduction | ||||||||||||||||||||||||
| * Child Abuse in Emergency Medicine | ||||||||||||||||||||||||
| * Child Sexual Abuse in Emergency Medicine | ||||||||||||||||||||||||
| * Childhood Migraine Variants | ||||||||||||||||||||||||
| * Child Trafficking | ||||||||||||||||||||||||
| * Congenital Coxa Vara | ||||||||||||||||||||||||
| * Congenital Vertical Talus | ||||||||||||||||||||||||
| * Croup or Laryngotracheobronchitis in Emergency Medicine | ||||||||||||||||||||||||
| * Crying Child | ||||||||||||||||||||||||
| * Diaper Rash | ||||||||||||||||||||||||
| * Emergent Management of Pediatric Epiglottitis | ||||||||||||||||||||||||
| * Erythema Toxicum Neonatorum | ||||||||||||||||||||||||
| * Febrile Seizures in Emergency Medicine | ||||||||||||||||||||||||
| * Fever in the Neonate and Young Child | ||||||||||||||||||||||||
| * Fifth Disease or Erythema Infectiosum | ||||||||||||||||||||||||
| * Hair Tourniquet Removal | ||||||||||||||||||||||||
| * Hand-Foot-and-Mouth Disease in Emergency Medicine | ||||||||||||||||||||||||
| * Harlequin Ichthyosis | ||||||||||||||||||||||||
| * Infantile Cortical Hyperostosis | ||||||||||||||||||||||||
| * Intussusception in Emergency Medicine | ||||||||||||||||||||||||
| * Juvenile Nasopharyngeal Angiofibroma | ||||||||||||||||||||||||
| * Madelung Deformity | ||||||||||||||||||||||||
| * Migraine in Children | ||||||||||||||||||||||||
| * Multiple Epiphyseal Dysplasia | ||||||||||||||||||||||||
| * Neonatal Seizures | ||||||||||||||||||||||||
| * Nursemaid Elbow | ||||||||||||||||||||||||
| * Pediatric Acute Respiratory Distress Syndrome | ||||||||||||||||||||||||
| * Pediatric Anaphylaxis | ||||||||||||||||||||||||
| * Pediatric Apnea | ||||||||||||||||||||||||
| * Pediatric Bronchiolitis | ||||||||||||||||||||||||
| * Pediatric Dehydration | ||||||||||||||||||||||||
| * Pediatric Fever | ||||||||||||||||||||||||
| * Pediatric Foreign Body Ingestion | ||||||||||||||||||||||||
| * Pediatric Gastroenteritis | ||||||||||||||||||||||||
| * Pediatric Gastrointestinal Bleeding | ||||||||||||||||||||||||
| * Pediatric Genu Valgum | ||||||||||||||||||||||||
| * Pediatric Headache in Emergency Medicine | ||||||||||||||||||||||||
| * Pediatric Henoch-Schonlein Purpura | ||||||||||||||||||||||||
| * Pediatric Kawasaki Disease | ||||||||||||||||||||||||
| * Pediatric Limp | ||||||||||||||||||||||||
| * Pediatric Measles | ||||||||||||||||||||||||
| * Pediatric Meningitis and Encephalitis | ||||||||||||||||||||||||
| * Pediatric Mumps | ||||||||||||||||||||||||
| * Pediatric Pharyngitis | ||||||||||||||||||||||||
| * Pediatric Pyloric Stenosis | ||||||||||||||||||||||||
| * Pediatric Reactive Airway Disease | ||||||||||||||||||||||||
| * Pediatric Rubella | ||||||||||||||||||||||||
| * Pediatric Scarlet Fever | ||||||||||||||||||||||||
| * Pediatric Sedation | ||||||||||||||||||||||||
| * Pediatric Status Epilepticus | ||||||||||||||||||||||||
| * Pediatric Tachycardia | ||||||||||||||||||||||||
| * Pertussis in Emergency Medicine | ||||||||||||||||||||||||
| * Prevention and Management of Meconium Aspiration | ||||||||||||||||||||||||
| * Reye Syndrome | ||||||||||||||||||||||||
| * Roseola Infantum in Emergency Medicine | ||||||||||||||||||||||||
| * Rotavirus | ||||||||||||||||||||||||
| * Spondyloepiphyseal Dysplasia | ||||||||||||||||||||||||
| * Sudden Infant Death Syndrome in Emergency Medicine |
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1. Know that appropriate airway management is the key to success in
pediatric resuscitation. 2. Know the clinical signs of respiratory failure. 3. Know the unique features of the pediatric airway and their implications for airway management. 4. List three common causes of upper airway emergencies in children and the clinical features of upper airway obstruction. 5. Know clinical presentation of lower airway obstruction. 6. List four signs of respiratory distress. 7. Describe appropriate field management of the child in respiratory distress based on level of consciousness. 8. Know that adequate oxygenation and ventilation must be ensured before transport is initiated. |
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PEDIATRIC
MEDICAL EMERGENCIES INTRODUCTION Optimal patient care requires that the EMT-1 be familiar with the most common medical emergencies affecting pediatric patients. During this lesson we will discuss the following: · Respiratory Emergencies · Obstruction · Croup · Epiglottitis · Asthma · Neurological Emergencies · Seizures · Meningitis · Fever · Dehydration · Sudden Infant Death Syndrome (SIDS) · Poisoning LESSON OBJECTIVES At the completion of this lesson the participants will be able to: 1. State the signs and symptoms and field management of airway obstruction in pediatric patients. 2. Discuss the pathophysiology, signs and symptoms, and field management of croup. 3. Discuss the pathophysiology, signs and symptoms, and field management of epiglottitis. 4. Discuss the pathophysiology, signs and symptoms, and field management of pediatric asthma. 5. List 10 common causes of pediatric seizures. 6. Describe the field management of pediatric seizures. 7. Discuss the pathophysiology, signs and symptoms, and field management of meningitis. 8. Verbalize common causes of dehydration in pediatric patients and appropriate field treatment. 9. Discuss common causes of dehydration in pediatric patients and appropriate field management. 10. State the EMT-Is role in handling a suspected SIDS victim. 11. Describe the common household products that may be responsible for accidental poisoning in the pediatric patient. SKILLS Pediatric Airway Management Pharmacology KEY VOCABULARY The following terms will be used during this lesson: · Idiopathic epilepsy - seizures that occur with no identified cause. · Photophobia - sensitivity to light · Nuchal rigidity - stiffness of the neck associated with meningeal irritation. · Tonic Phase - phase of a seizure characterized by tension or contraction of muscles · Clonic - alternating contraction and relaxation of muscles · Status epiliepticus - two or more seizures without any intervening periods of consciousness. · Febrile - elevated body temperature KEY CONCEPTS The following section provides information and space for taking notes on the key concepts discussed by the instructor. RESPIRATORY EMERGENCIES Partial Airway Obstruction
Complete Airway Obstruction
Croup
Epiglottitis
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