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Oklahoma Prehospital Pediatric Supplement

2003. Oklahoma EMSC Resource Center. 2. Introduction. OSDH-EMS approvedPAC's course to include in EMT-B 1998's NSC in 1993USDOT-NHTSA: EMT-B 1994's NSC in 1995EMSC Pediatric Supplement (Revision of PAC's) to include in EMT-B 1994's NSC in 1996Mandatory inclusion into EMT-B courses. 2003. Oklahoma EMSC Resource Center.

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Oklahoma Prehospital Pediatric Supplement

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    1. 2003 Oklahoma EMSC Resource Center 1 Oklahoma Prehospital Pediatric Supplement Developed by the Oklahoma EMSC Resource Center for the: “Infants and Children Module of the 1994 EMT-Basic Curriculum” PART 1: INTRODUCTORY

    2. 2003 Oklahoma EMSC Resource Center 2 Introduction OSDH-EMS approved PAC’s course to include in EMT-B 1998’s NSC in 1993 USDOT-NHTSA: EMT-B 1994’s NSC in 1995 EMSC Pediatric Supplement (Revision of PAC’s) to include in EMT-B 1994’s NSC in 1996 Mandatory inclusion into EMT-B courses

    3. 2003 Oklahoma EMSC Resource Center 3 PART 1: Introductory This section covers the following informational areas. - Emergency Medical Services for Children - Injury Prevention Methodology - Anatomy and Physiology - Approaching Children - Vital Signs Assessment - Assessment Tools

    4. 2003 Oklahoma EMSC Resource Center 4 Objectives Define Emergency Medical Services for Children (EMSC). Objective: 6-1.0 Discuss how an integrated EMSC system can affect patient outcome. Objective: 6-1.0 A Identify methods/mechanisms of injury prevention for Infants and Children. Objective: 6-1.0 B

    5. 2003 Oklahoma EMSC Resource Center 5 Objectives (Continued) Identify two (2) anatomic and physiologic differences between children and adults regarding skin and body surface. Objective: 6-1.2 A Identify four (4) areas to consider when taking the child’s history. Objective: 6-1.3 A

    6. 2003 Oklahoma EMSC Resource Center 6 Objectives (Continued) Describe important factors in taking and interpreting vital signs. Objective: 6-1.3 B Pulse Respirations Blood Pressure Temperature Identify a minimum of four (4) significant differences between the adult and pediatric airway which affect ventilation. Objective: 6-1.3 C

    7. 2003 Oklahoma EMSC Resource Center 7 Emergency Medical Services for Children (EMSC) OBJECTIVE: 6-1.0 Definition A program designed to reduce child and youth mortality and morbidity due to severe illness or trauma. History 1984 Legislation National Management MCHB NHTSA Oklahoma Management OUHSC

    8. 2003 Oklahoma EMSC Resource Center 8 EMSC (Continued) National Resource Centers National EMSC-NRC National EMSC Resource Alliance (NERA) Oklahoma Resource Center Oklahoma EMSC Resource Center Oklahoma Education and Training Pediatric Specialty Courses PALS PEPP PPC ENPC

    9. 2003 Oklahoma EMSC Resource Center 9 EMSC (Continued) Prehospital Curricula Pediatric ’94 NSC Supplement Injury Prevention Bystander Care Emergency 1st Care for Childcare Providers Childcare Health and Safety Courses Other Areas Pediatric Resource Library Education Assessment and Management Tools Information Center Instructional Outcome Statistics and Improvement

    10. 2003 Oklahoma EMSC Resource Center 10 EMSC (Continued) OBJECTIVE 6-1.0 A Integrated EMSC Systems Prevention Prehospital E D’s I C U’s Rehab Community Psychological Trauma Systems State Agencies

    11. 2003 Oklahoma EMSC Resource Center 11 EMSC (Continued) Patient Outcome Affect Prevention Reduction Emergencies Disability Death Negative Impact Family Community

    12. 2003 Oklahoma EMSC Resource Center 12 Injury Prevention OBJECTIVE 6-1.0 B Methodology and Mechanisms C P R and 1st Aid Training Certification Requirement Bicycle Safety Community Injury Prevention Programs Data Analysis Common Injury Specific Education

    13. 2003 Oklahoma EMSC Resource Center 13 Anatomy and Physiology (A&P) OBJECTIVE 6-1.2 A Skin and Body Surface Area (BSA) Infants and Young Children Head = 20% BSA BSA Larger in Proportion to Body Mass Changes by Body Part through Childhood Assumes Adult as Adolescent Thin Skin and Less Subcutaneous Fat Prone to Hypothermia and Deeper Burns than Adult Resuscitation and Drug Therapy Reduced in Hyperthermia Newborn Temperature Regulation Not Well Developed

    14. 2003 Oklahoma EMSC Resource Center 14 A & P (Continued)

    15. 2003 Oklahoma EMSC Resource Center 15 Pediatric Approach OBJECTIVE 6-1.3 A Obtaining a History Primary Caregiver Information Reassures and Calms Elements Similar to Adult Additional Elements Birth Weight Problems with Pregnancy Current Estimated Weight

    16. 2003 Oklahoma EMSC Resource Center 16 Pediatric Approach (Continued) Cooperation Enhancement Permit “Transition Phase” Level of Child Calm and Friendly Mannerism Cooperation of Child Uncooperative Child A-B-C’s Appropriate? Condition Known? Don’t Waste Time!

    17. 2003 Oklahoma EMSC Resource Center 17 Pediatric Approach (Continued) General Examination Guidelines Remain and Display Calmness Assessment Life-Threatening = Head to Toe Non-Life-Threatening = Toe to Head Non-Traumatic = In Caregivers Lap/Arms Use Assessment Tools Take Opportune Advantages Color and Moistness of Mucous Membranes Presence of Tears Inspiratory Breath Sounds

    18. 2003 Oklahoma EMSC Resource Center 18 Pediatric Assessment Triangle (PAT)

    19. 2003 Oklahoma EMSC Resource Center 19 Pediatric Trauma Score (PTS)

    20. 2003 Oklahoma EMSC Resource Center 20 Other Assessment Tools

    21. 2003 Oklahoma EMSC Resource Center 21

    22. 2003 Oklahoma EMSC Resource Center 22 Vital Signs OBJECTIVE 6-1.3 B PULSE CENTRAL Carotid Femoral PERIPHERAL Radial Brachial Popliteal Pedal

    23. 2003 Oklahoma EMSC Resource Center 23 Vital Signs (Continued) Monitor Pulse 30 seconds minimum Rate and Quality Central and Peripheral Tachycardia (Fast) and Triggers Compensatory Mechanism Shock Anxiety Fever Pain Medical Illness Traumatic Injury Environmental Insult

    24. 2003 Oklahoma EMSC Resource Center 24 Vital Signs (Continued) Bradycardia (Slow) and Triggers End Stages Shock Hypothermia Hypoxia/Hypoxemia Cardiac Pathology Congenital Anomalies Certain Medications Rates Decrease through Childhood to Adolescence

    25. 2003 Oklahoma EMSC Resource Center 25 Vital Signs (Continued) RESPIRATION OBSERVATION Begins with P-A-T Prior to and During Exam For Following Tachypnea (Fast) or Bradypnea (Slow) Hyperpnea (Deep) or Hypopnea (Shallow) Apnea (Absent) Use of Accessory Muscles Intercostal, Subcostal, Subclavicular, or Diaphragmatic Noises Wheezing (Inspiratory and/or Expiratory), Grunting (Expiratory), Rhonchi (Upper Airway Rattling), Rales (Lower Airway Crackles) Nasal Flaring

    26. 2003 Oklahoma EMSC Resource Center 26 Vital Signs (Continued) Tachypnea (Fast) and Triggers Compensatory Mechanism Shock Anxiety Fever Pain Medical Illness Traumatic Injury Environmental Insult Monitor 30 seconds minimum Rate, Depth, and Quality

    27. 2003 Oklahoma EMSC Resource Center 27 Vital Signs (Continued) BLOOD PRESSURE Compensatory Mechanism Sustains Normotension (Normal BP) Longer in Pediatrics Hypotension (Low BP) Confirms Decompensated Shock Peripheral Pulse Presence Infants (Birth to 12 months) = Minimum Systolic Pressure of 60 mmHg Children (1 year to 8 years) = Minimum Systolic Pressure of 70 + (2 x Age in Years) Normal Diastolic = 2/3 Systolic Appropriate Size BP Cuff Mandatory

    28. 2003 Oklahoma EMSC Resource Center 28 Vital Signs (Continued) TEMPERATURE Protective Mechanism Environmental (Heat and Cold) Regulator Microbial Protection Assessment Rectally (Most Accurate): Normal = 36ş C (96.8 ş F) Axillary or Tympanic: Normal = 36.5ş C (97.6 ş F) Orally: Normal = 37ş C (98.6 ş F) Fever: Most common cause of seizure in infants

    29. 2003 Oklahoma EMSC Resource Center 29 Vital Signs (Continued) PULSE OXIMETRY Placement Proximal to Central Circulation Earlobe = Recommended Site Administer O2 if SAO2 < 95% CO binds with Hemoglobin 200 times faster than O2 Pulse Ox of NO VALUE in such case

    30. 2003 Oklahoma EMSC Resource Center 30 Airway: Pediatric vs Adult OBJECTIVE 6-1.3 C Airway Differences Pediatric Head Prominent Occiput Tongue Larger More Anterior Epiglottis “U” Shaped Floppier Protrudes more in Laryngopharynx

    31. 2003 Oklahoma EMSC Resource Center 31 Airway (Continued) Pediatric (Continued) Trachea Shorter Infant: 4-5 cm Child: 8 cm More Flexible Rings Less Well Developed Smallest Airway Diameter = Cricoid Ring Larynx More Anterior More Cephalad Cords Shorter and Concave Lungs: (Tidal Volume Dependent on Diaphragmatic Movement) Adult Opposite that Mentioned

    32. 2003 Oklahoma EMSC Resource Center 32 Summary: Section 1 EMSC: Defined and Integrated Pediatric Injury Prevention Methodology Pediatric A&P vs Adult Approach to Obtaining Medical History Assessing and Interpreting Vital Signs Pediatric vs Adult Airway

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