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Pediatrics Review

Pediatrics Review. Compiled from “Brady Emergency Care – Ninth Edition” 2001 Chapter 31 – Infants and Children. Assessment. Pediatric Vital signs differ slightly from adults with typically higher pulse and respiration rates, and lower blood presssures.

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Pediatrics Review

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  1. Pediatrics Review Compiled from “Brady Emergency Care – Ninth Edition” 2001 Chapter 31 – Infants and Children

  2. Assessment • Pediatric Vital signs differ slightly from adults with typically higher pulse and respiration rates, and lower blood presssures. • Younger patients may not be able to convey symptoms well making assessment more critical. • Respiratory failure and shock can occur more easily in children and should be top of mind. • Assess children with the assistance of parent or caregiver when possible.

  3. Vital Signs – Respiration rates • Newborn 30-50 • Infant (1-5 mos) 25-40 • 6 mos – 5 yrs 20-30 • 6-10 yrs 15-30 • Adolescent 12-20 Note these are normal rates – conditions/stress may elevate these. Lower rates should prompt consideration of assisted ventilations.

  4. Vital Signs – Pulse Rates • Newborn 120-160 • Infant (1-5 mos) 90-140 • 6-12 mos 80-140 • Toddler (1-3 yrs) 80-130 • Preschool (3-5 yrs) 80-120 • School age (6-10yrs) 70-110 • Adolescent (11-14) 60-105

  5. Vital Signs – Blood Pressure • 3-5yrs 78-116 • 6-10yrs 80-122 • 11-14yrs 88-140 Notes – BP rarely measured on children under 3 Above numbers are systolic. Diastolic is typically 2/3 systolic.

  6. Respiratory Difficulty - Symptoms • Stridor / crowing / grunting • Muscle retractions in ribs/shoulders • Flared nostrils • Cyanosis • Decreased or increased rate

  7. Respiratory Difficulty - Treatment • Treat with O2, maintain airway, consider blocked airway for young children. • Ventilate at 20 breaths/min • Use pediatric BVM – watch rise/fall – appropriate volume • Position head neutral / sniffing position • Small trachea / large tongue

  8. Shock • Causes • dehydration • infection • trauma • blood loss • allergy • poisoning • Signs • rapid respirations • cold • weak peripheral pulse • decreased urine output • altered mental status • no tears when crying

  9. Practice Ventilate an infant and child mannequin.

  10. Shock - Treatment • Maintain Airway • High flow O2 • Keep warm • Immediate transport • Suction carefully – vegas nerve

  11. Fever • Various causes • Cool cautiously

  12. Seizures • Various causes – History? • Maintain airway • Treat for shock • Transport – Epilepsy patients or other history may defer transport.

  13. Altered Mental Status • Causes • Poisoning • Injury • Illness • Treatment • Airway • Treat for shock • Transport (Immediate) – Diabetic deferral

  14. Poisoning • Determine substance if possible • Call Medical Control (ER Doc on duty) or AMR • Treatment • Maintain airway • Treat for shock • Transport

  15. Near Drowning • Rule out causes • Injuries • Illness • Treatment • CPR • Maintain airway • Treat for hypothermia • Treat for shock • Treat any trauma

  16. Trauma - Injury Patterns / anatomy • Head – larger in proportion / lead with their head • Chest – elastic ribs allow internal injuries with no outer signs • Abdomen – belly breathers, watch abdomen for respirations

  17. Burns • Consider percentages of burned area – rule of nines. • Sterile dry dressings • Avoid hypothermia

  18. Abuse and Neglect • Psychological • Neglect • Physical • Sexual

  19. Physical Abuse Injury Patterns • shaped welts • swelling • poorly/partially healed bruises • high instance of broken bones or injuries • bites • burns

  20. Determining Signs of Abuse • Multiple visits for the same patient or siblings • Past injuries – note back and buttocks • Poorly healed wounds/fractures (i.e. no treatment received) • Cigarette burns, bilateral burns, glove/stocking pattern. • Caregiver responses: • Different stories for the same injury • Unconcerned • Difficulty controlling anger • Depression • Refusal of transport / reluctant to give history

  21. Physical Abuse – Treatments and Procedures • Treat injuries as per protocols • Document well • Gather information in a passive manner • DO NOT accuse or pass judgment • DO report your suspicions to AMR staff and IC • Verify documentation

  22. Special Needs Children • Tracheostomy tubes –obstruction, dislodged, bleeding. • Suction tube, maintain airway • Ventilators – maintain airway and manually ventilate as needed. • Central IV line – infection, bleeding, clooted, cracked. • Apply pressure and dress as needed. • Gastric tubes – Assure airway, asses mental status – hypoglycemic • Shunts – Maintain airway as necessary

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