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Pediatric Patients

Pediatric Patients. & Emergencies. Family Matters. When a child is ill or injured, you may have several patients, not just one. Children mimic caregiver behavior Be calm, professional, and sensitive. Anatomic Differences. Less circulating blood Lose body heat more easily

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Pediatric Patients

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  1. Pediatric Patients & Emergencies

  2. Family Matters • When a child is ill or injured, you may have several patients, not just one. • Children mimic caregiver behavior • Be calm, professional, and sensitive.

  3. Anatomic Differences • Less circulating blood • Lose body heat more easily • Bones are more flexible • Less fat surrounding organs • Could be much internal damage with little external visible trauma

  4. Skeletal Differences • Bones are prone to fracture with stress. • Infants have two openings in the skull called fontanels. • close by 18 months.

  5. Airway Differences • Larger tongue relative to the mouth • Less well-developed rings of cartilage in the trachea • Head tilt-chin lift may occlude the airway.

  6. Breathing Differences • Infants breathe faster than children or adults. • Infants use the diaphragm when they breathe. • Sustained, labored breathing may lead to respiratory failure.

  7. Circulation Differences • The heart rate increases for illness and injury • Very effective vasoconstriction keeps vital organs nourished • Pale, extremities, decreased cap refill are early signs of perfusion problems

  8. Approach to Assessment • level of activity, work of breathing, and skin color • cap refill • ALS backup or immediate transport? • Pediatric patients crash harder than adults • Transport to peds facilities when possible

  9. Capillary Refill

  10. Treatment Considerations • Oxygen - treat same as adult – Use “blow-by” administration if needed • Patient position - same as adult • *Remember* airway and breathing are focus

  11. Growth and Development • Usually grouped into stages • Infant • Toddler • Preschool • School-age • Adolescent

  12. Infant • first year of life • respond physical stimuli • crying is main means of expression • have caregiver hold pt

  13. Toddler • 1 to 3 years of age • mobile • may resist separation • don’t like being restrained • can be distracted

  14. Preschool • 3 to 6 years of age • can understand directions • can identify painful areas • fearful of pain • allow them to handle equipment • explain what you are going to do

  15. School-Age Child • 6 to 12 years of age • begin to think like adults • can be included when taking medical history • should be familiar with physical exam • allow them to make choices when possible

  16. The Adolescent • 12 to 18 years of age • concerned about body image • may have strong feelings about being observed • respect their privacy • they understand pain • explain any procedure

  17. Notes • never lie to a child

  18. Vital Signs

  19. Respirations Abnormal respirations are a common sign of illness or injury Less than 3, count rise and fall of abdomen Note effort of breathing/noises Note if they are crying

  20. Respiration Notes • Less than 12 breaths/min • More than 60 breaths/min, • ALOC and/or an inadequate tidal volume = ventilation with a BVM device

  21. Pulse Infants -brachial or femoral Child- use carotid Count at least 1 minute Note strength

  22. Blood Pressure • Use right size cuff • Difficult scene? Don’t waste time • Under 3? No BP

  23. Skin Signs • important sign • feel for temperature and moisture • always check capillary refill

  24. Pediatric Problems

  25. Fever • Common Causes • Infections • Neoplasm (cancer) • Drug ingestion • Collagen vascular disease • High environmental temperatures

  26. Emergency Care for Fever • Ensure BSI • Begin passive cooling • Remove clothing/coverings • Damp towels • No ice • No alcohol • No cold water baths

  27. Febrile Seizures • common in children 6 months to 6 years • most caused by high fever • hx of infection • generalized grand mal seizure • less than 15 minutes

  28. Treatment • ABC’s • protect patient • recovery position • high flow oxygen • suction prn • passive cooling measures • transport

  29. Dehydration • Dry lips and gums • Fewer wet diapers • Sunken eyes • Poor skin turgor • Sleepy or irritable • Sunken fontanels

  30. Care for Dehydration • Assess the ABCs • Obtain baseline vital signs • ALS backup may be needed for IV administration

  31. Airway Obstruction • Croup • An infection of the airway below the level of the vocal cords, caused by a virus • Epiglottitis • Infection of the soft tissue in the area above the vocal cords • Foreign body Aspiration

  32. Croup • barking cough • stridor • wheezing • rales • accessory muscle use • nasal flaring • grunting

  33. Epiglottitis • severe dyspnea • stridor • inability to swallow - DROOLING • fever • tripod position

  34. Foreign body aspiration • Partial Blockage • coughing • accessory muscle use • nasal flaring • wheezing • Complete Blockage • no sound • no cry • stridor • cyanosis • loss of consciousness

  35. treatment • ABC’s • high flow oxygen • position of comfort do not attempt to visualize the throat! do not put anything into patient’s mouth.

  36. Asthma • dyspnea • wheezing • accessory muscle use • nasal flaring • respiratory rate - observe

  37. Treatment • ABC’s • high flow oxygen • position of comfort • transport

  38. What is the most frequent cause of cardiac arrest in pediatrics?

  39. Respiratoryarrest!

  40. want to save a pediatric patient? aggressive ventilation & high flow oxygen

  41. USC video! Pediatric respiratory distress

  42. Meningitis • Inflammation of meninges • Bacterial or viral • Permanent brain damage/death

  43. Signs and Symptoms of Meningitis • Fever • ALOC • Headache • Seizure • Stiff neck • Vomiting • Photophobia • Irritability • Bulging fontanel

  44. Neisseria meningitidis • rapid onset • pinpoint cherry-red spots or larger purple/black rash • sepsis, shock, and death • all suspected cases considered contagious

  45. Treatment • BSI • ABC’s • protect patient • high flow oxygen • passive cooling for fever • monitor for shock • Transport • Call ALS for backup if unstable

  46. Submersion Injury • Drowning or near drowning • Second most common cause of unintentional death • ABC’s • May be in respiratory or cardiac arrest • C-spine precautions? • Be ready to suction • Keep warm

  47. Poisoning • Poisoning is common in children • Ask specific questions of caregivers • Focus on the ABCs • Give oxygen • Provide transport • Child’s condition could change at any time

  48. Pediatric Resuscitation Tape Measure (Aka: Broslow tape) • Used to determine height, weight, and proper equipment.

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