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Pediatric medical emergencies
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:
    1. Tachypnea
    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
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
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
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
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:

Age:

Preemie

Neonate

6 mo.

1-2 yr.

4-6 yr.

8-12 yr.

Adult

Tube size:

2.5

3-3.5

3.5-4

4-5

5-5.5

6-7

7.5-8.5

Blade size:

0

0-1

1

1-2

2

2-3

4-5

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
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.

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

Causes:   

·          Foreign bodies

·          Swelling (infection, allergic response)

·          Trauma

Signs and Symptoms:

·          Stridor, noisy

·          Retractions on inspiration

Field Management of Partial Airway Obstruction:

·        BLS procedure

·          Position of Comfort

·          Oxygen

·          Do not agitate

·        ALS procedure

·          Same as BLS

Complete Airway Obstruction

Causes:

·          Foreign bodies

·          Swelling

·          Trauma

Signs/Symptoms:

·          No noise or cough

·          Increased respiratory difficulty

·          Altered mental status

Field Management of Complete Airway Obstruction:

·        BLS procedures

·          Clear airway

·          Foreign body procedures

·        ALS procedures

·          Magill forcep

·          Foreign body removal

Croup

Pathophysiology:

·          Viral infection common in patients 3 months to 3 years.

·          Inflammation of the larynx and surrounding tissues cause the primary symptoms.

Signs and Symptoms:

·          Barking cough

·          Stridor

·          Accessory muscle use

·          Nasal flaring

Field Management of Croup:

·        BLS procedure

·          Humidified (if available) oxygen

·          Position

·          Transport

·        ALS procedure:

·          Same

Epiglottitis

Pathophysiology:

·          Bacterial infection common in patients 3-7 years.  Swelling of the epiglottis can progress rapidly to complete airway obstruction.

Signs and Symptoms:

·          Severe dyspnea/stridor

·          Tripod position

·          Drooling

·          Dysphagia

·          Difficulty swallowing