Pediatric Emergencies: Anatomy, Growth, Illnesses, and Injuries

1. Chapter 30 Pediatric Emergencies

2. 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

3. 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

4. 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

5. 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.

6. Topics • Anatomy and Physiology • Human growth and development • Common pediatric illnesses and injuries • Child abuse and neglect • Shock • Assessment • Management

7. 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.

8. 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

9. Anatomy and Physiology

10. 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

11. Airway continued

12. Airway • Trachea is shorter, smaller, softer, more flexible • May collapse if neck is hyperextended

13. Head • Proportionally larger & heavier • Issues with neutral c-spine/airway mgt • Brain is proportionally smaller

14. 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

15. Metabolism • High metabolism rate leads to bursts of energy followed by fatigue • Need for regular meals

16. 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

17. 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 regulation can be of concern

18. Human Growth and Development • Six stages • Newborn • Infant • Toddler • Pre-school • School-age • Adolescent

19. 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

20. Newborn and Infant

21. 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 from 3-6 years of age • Communication skills improve • Motor skills/balance develop • Social skills, abstract thinking develop • Gender awareness emerges

22. Toddler & Pre-School

23. 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

24. School-Age

25. Adolescent • Ages 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

26. Adolescent

27. Common Illnesses and Injuries • Some unique to this population • Vary in severity • Occur more frequently in one group than others • Often respiratory related

28. Airway Problems • Upper • Croup • Tonsillitis • Foreign body airway obstruction • Epiglottitis • Lower • Pneumonia • Bronchiolitis • Asthma

29. Airway Problems

30. 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

31. 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

32. Seizures • Febrile are most common • 6 mos. To 5 years • Combination of infection, high temp • Most are generalized, short, harmless • Status epilepticus • Lasts longer than 10 mins. • Prolonged post-ictal state • 3 or more in a row, no return to normal • True emergency • Absence

33. 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 issues

34. Poisoning

35. 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 known prevention

36. 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

37. 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 • Greenstick fractures may occur

38. Burns and Electrocution • Scald related are most common in toddler & pre-school • Open flame burns common in school- age children and adolescents • Chemical burns are less common • Electrical injuries occur when infants, toddlers stick objects into outlets or chew cords

39. 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

40. Child Abuse and Neglect

41. 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

42. Shock • Sepsis, anaphylaxis, poisoning are also causes • Cardiogenic is rare • Obstructive may occur due to blunt trauma

43. Shock

44. 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.

45. 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.

46. Assessment • Pulse/resp rates may change rapidly • Crying complicates • Stable appearance doesn’t mean no problem • All actions take into account developmental stage continued

47. Assessment • Pediatric Assessment Triangle • Appearance • Work of breathing • Circulation to skin continued

48. Assessment continued

49. Assessment • Parental permission, or implied consent • Parent cooperation may = child’s • Use clues based on child’s behavior • Activity level • Eye contact • Irritable or agitated? • Response to caregiver’s voice continued

50. Assessment • Respiratory 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