Chapter 39

1. Chapter 39 Pediatric Medical Emergencies

2. Overview • Normal Childhood Development • General Considerations • Airway Problems • Hypoperfusion

3. Overview • Cardiac Arrest • SIDS • Altered Mental Status • Stress in Caring for Children

5. Normal Childhood Development • Neonate: 0 to 1 month old • Allow mother to hold child during assessment • Common illnesses: jaundice, vomiting, respiratory distress, fever • Congenital birth defects begin to appear

6. Normal Childhood Development • Young infant: 1 to 5 months old • Growing rapidly and becoming increasingly aware of the surrounding environment • Common illnesses: SIDS, vomiting, diarrhea, meningitis, child abuse, accidents

7. Normal Childhood Development • Young infant: 1 to 5 months old • Make slow movements and use gentle handling • Keep covered as much as possible

8. Normal Childhood Development • Older infant: 6 to 12 months old • Becoming more active and walking • Exhibit stranger anxiety • Common illnesses: febrile seizures, vomiting, diarrhea, dehydration, bronchiolitis, MVCs, croup, child abuse, poisoning, falls

9. Normal Childhood Development • Toddler: 1 to 3 years old • Constantly moving, becoming more independent • Needs encouragement and reassurance • May believe illness is punishment

10. Normal Childhood Development • Toddler: 1 to 3 years old • Take a toe-to-head approach • Common illnesses: MVCs, vomiting, diarrhea, febrile seizures, ingestions, falls, child abuse, croup, meningitis, FBAO

11. Normal Childhood Development • Preschooler: 3 to 5 years old • Play is more sophisticated • Very attached to parents and possessions • Explain in simple and honest terms • Common illnesses: croup, asthma, ingestions, MVCs, burns, child abuse, FBAO, drownings, epiglottitis, febrile seizures, meningitis

12. Normal Childhood Development • School age: 6 to 12 years old • Growing quickly and very active • Increase in injuries • Get as much history information for child as possible • Common emergencies: drowning, motor vehicle collisions, bicycle accidents, fractures, falls, sports injuries, child abuse, burns

13. Normal Childhood Development • Adolescent: 12 to 15 years old • Body image is very important • Peers are very important • Risk taking behavior is common • Common illnesses: mononucleosis, asthma, motor vehicle collisions, sports injuries, suicide gestures, sexual abuse, pregnancy

14. Stop and Review • What are the developmental differences among the various age groups of children? • What are the anatomical differences between children and adults? • What is a child’s typical response to illness?

15. General Considerations • Initial approach • Place yourself at eye level with child • Introduce yourself to both child and parent • Explain why you are there

16. General Considerations • Gathering a history • Alter technique based upon age • Question the child in a friendly manner • Ask the parent for confirmation

17. General Considerations • Performing a physical examination • Carefully observe the child • The child’s behavior can tell a lot about how she is feeling • Try to gain child’s confidence • Anything that may cause pain should be done last

18. Stop and Review • What are some techniques for assessment and examination in children of various developmental ages?

19. Airway Problems • Foreign body airway obstruction • May be complete or partial obstruction • Open the airway and check for breathing • Reposition the airway

20. Airway Problems • Foreign body airway obstruction • For an infant, provide back blows and chest thrusts • For an older child, perform the Heimlich maneuver

21. Trouble Breathing • Croup • Viral illness causes swelling of the airways • Fall and winter are prime times • Lasts several days

22. Trouble Breathing • Croup • Harsh sounding cough • Worse at night than in the day • Humidified oxygen and transport

23. Trouble Breathing • Epiglottitis • Bacterial infection • Inflammation of the epiglottis causes airway obstruction • Sudden fever, brassy cough, and sore throat • Ventilate and transport to the nearest hospital

24. Pediatric Asthma • Asthma • Reversible spasm of smaller airways • Wheezing • Child works harder to breathe • May have a bronchodilating medication

25. Pediatric Asthma • Upper respiratory infection • Inflammation and secretions

26. Hypoperfusion • The most common cause is large fluid loss from dehydration due to vomiting, diarrhea or blood loss • Tachycardia, pale skin, delayed capillary refill, nausea • Will progress to altered mental status and a fall in blood pressure

27. Cardiac Arrest • Most common cause is respiratory arrest • Respiratory failure leads to hypoxia, which leads to cardiac failure and cardiac arrest • 100% oxygen and chest compressions

28. SIDS • Leading cause of death in children one week to one year in age • Usually occurs during sleep; more frequent in winter months • Cause of death is unknown

29. Altered Mental Status • Seizures • The most common are febrile seizures brought on by a rapid increase in body temperature • Attend to the ABCs, undress the child, wipe with moist cloths, fan the child

30. Altered Mental Status • Diabetes • The result of altered glucose utilization • If conscious, provide sugar by mouth • If unconscious, transport immediately

31. Altered Mental Status • Behavioral • If the altered mental status is the result of a behavioral disorder, there will generally be a history of similar episodes

32. Altered Mental Status • Poisoning • Signs include spilled bottle of chemical or medications, a smell on the breath, discoloration of mouth or lips, or vomitus with pill fragments or a chemical smell • Maintain airway and breathing, then follow local protocol

33. Altered Mental Status • Infections • Colds, flu, gastroenteritis, strep throat, mononucleosis, chicken pox • Most are not life threatening • Meningitis affects the brain and is very serious

34. Stress in Caring for Children • Child • The illness is frightening, but the examination by a stranger can be even more so • Try to put the child at ease by being calm and honest

35. Stress in Caring for Children • Family • Allow to participate in care of child • Keep informed of what is going on • If the parent cannot be calmed, separate her from the child

36. Stress in Caring for Children • Provider • Often invokes feelings of fear or anxiety • After the call, talk about feelings with coworkers

37. Stop and Review • How are airway emergencies handled? • How are respiratory emergencies treated? • How is hypoperfusion in children handled? • What is the most common cause of cardiac arrest? • How is altered mental status managed in a child?