31: Pediatric Emergencies

Cognitive Objectives (1 of 3)

6-1.1 Identify the developmental considerations

for the following pediatric age groups: infants,
toddlers, preschool, school age, adolescent.
6-1.2 Describe the differences in anatomy and
physiology between the infant, the child, and
the adult patient.
6-1.3 Differentiate the response of the ill or
injured infant or child (age specific) from that
of an adult.
 Cognitive Objectives (2 of 3)

6-1.8 Identify the signs and symptoms of shock

(hypoperfusion) in an infant and child patient.
6-1.11 List common causes of seizures in the
infant and child patient.
6-1.13 Differentiate between the injury patterns
in adults, infants, and children.
 Cognitive Objectives (3 of 3)
6-1.15 Summarize the indicators of possible child
abuse and neglect.
6-1.16 Describe the medical/legal responsibilities in
suspected child abuse.
6-1.17 Recognize the need for EMT-B debriefing
following a difficult infant or child transport.
 Affective Objectives
6-1.18 Explain the rationale for having knowledge and
skills appropriate for dealing with the infant and
child patient.
6-1.19 Attend to the feelings of the family when
dealing with an ill or injured infant or child.
6-1.20 Understand the provider’s own response
(emotional) to caring for infants or children.
• There are no psychomotor objectives for this
chapter.
 Airway Differences
• Larger tongue relative to
the mouth
• Larger epiglottis
• Less well-developed rings
of cartilage in the trachea
• Narrower, lower airway
 Breathing Differences
• Infants breathe faster than children or adults.
• Infants use the diaphragm when they
breathe.
• Sustained, labored breathing may lead to
respiratory failure.
 Circulation Differences
• The heart rate increases for illness and injury.
• Vasoconstriction keeps vital organs nourished.
• Constriction of the blood vessels can affect
blood flow to the extremities.
 Skeletal Differences
• Bones are weaker and more flexible.
– They are prone to fracture with stress.
• Infants have two small openings in the skull
called fontanels.
– Fontanels close by 18 months.
Growth and Development
• Thoughts and behaviors of children
usually grouped into stages
– Infancy
– Toddler years
– Preschool age
– School age
– Adolescence
 Infant
• First year of life
• They respond mainly to
physical stimuli.
• Crying is a way of
expression.
• They may prefer to be with
caregiver.
• If possible, have caregiver
hold the infant as you start
your examination.
 Toddler
• 1 to 3 years of age
• They begin to walk and
explore the environment.
• They may resist separation
from caregivers.
• Make any observations you
can before touching a
toddler.
• They are curious and
adventuresome.
 Preschool
• 3 to 6 years of age
• They can use simple language effectively.
• They can understand directions.
• They can identify painful areas when
questioned.
• They can understand when you explain
what you are going to do using simple
descriptions.
• They can be distracted by using toys.
 School Age
• 6 to 12 years of age
• They begin to think like adults.
• They can be included with the parent when
taking medical history.
• They may be familiar with physical exam.
• They may be able to make choices.
 Adolescent
• 12 to 18 years of age
• They are very concerned about body image.
• They may have strong feelings about being
observed.
• Respect an adolescent’s privacy.
• They understand pain.
• Explain any procedure that you are doing.
 Family Matters
• When a child is ill or injured, you have several
patients, not just one.
• Caregivers often need support when medical
emergencies develop.
• Children often mimic the behavior of their
caregivers.
• Be calm, professional, and sensitive.
Pediatric Emergencies (1 of 3)
• Dehydration
– Vomiting and diarrhea
– Greater risk than adults
• Fever
– Rarely life threatening
– Caution if occurring with rash
 Pediatric Emergencies (2 of 3)
• Meningitis is an inflammation of the tissue that
covers the spinal cord and brain.
• Caused by an infection
• If left untreated can lead to brain damage or death.
 Pediatric Emergencies (3 of 3)
• Febrile seizures
– Common between 6 months and 6 years
– Last less than 15 minutes
• Poisoning
– Signs and symptoms vary widely.
– Determine what substances were involved.
 Physical Differences
• Children and adults suffer different injuries from
the same type of incident.
• Children’s bones are less developed than an
adult’s.
• A child’s head is larger than an adult’s, which
greatly stresses the neck in deceleration
injuries.
Psychological Differences
• Children are not as psychologically
mature.
• They are often injured due to their
undeveloped judgment and lack of
experience.
 Injury Patterns:
Automobile Collisions
• The exact area of
impact will depend on
the child’s height.
• A car bumper dips
down when stopping
suddenly, causing a
lower point of impact.
• Children often sustain
high-energy injuries.
 Injury Patterns:
Sports Activities
• Head and neck injuries can occur from high-
speed collisions during contact sports.
• Immobilize the cervical spine.
• Follow local protocols for helmet removal.
 Head Injuries
• Common injury among children
• The head is larger in proportion to an
adult.
• Nausea and vomiting are signs of pediatric
head injury.
 Chest Injuries
• Most chest injuries in
children result from blunt
trauma.
• Children have soft, flexible
ribs.
• The absence of obvious
external trauma does not
exclude the likelihood of
serious internal injuries.
 Abdominal Injuries
• Abdominal injuries are very common in children.
• Children compensate for blood loss better than
adults but go into shock more quickly.
• Watch for:
– Weak, rapid pulse
– Cold, clammy skin
– Poor capillary refill
 Injuries to the Extremities
• Children’s bones bend more easily than
adults’ bones.
• Incomplete fractures can occur.
• Do not use adult immobilization devices
on children unless the child is large
enough.
 Pneumatic Antishock
Garments (PASG)
• Rarely used for treating children
• When to use a PASG:
– Obvious lower extremity trauma
– Pelvic instability
– Clear signs and symptoms of decompensated shock
• Should only be used if it fits properly
• Should never inflate the abdominal compartment
 Burns
• Most common burns involve exposure to hot
substances.
• Suspect internal injuries from chemical
ingestion when burns are present around lips
and mouth.
• Infection is a common problem with burns.
• Consider the possibility of child abuse.
 Submersion Injury
• Drowning or near drowning
• Second most common cause of
unintentional death of children in the
United States
• Assessment and reassessment of ABCs
are critical.
• Consider the need for C-spine protection.
 Child Abuse
• Child abuse refers to any improper or
excessive action that injures or harms a
child or infant.
• This includes physical abuse, sexual abuse,
neglect, and emotional abuse.
• More than 2 million cases are reported
annually.
• Be aware of signs of child abuse and report
suspicions to authorities.
Signs of Child Abuse
 Questions Regarding
Signs of Abuse (1 of 4)
• Is the injury typical for the child’s
developmental stage?
• Is reported method of injury consistent with
injuries?
• Is the caregiver behaving appropriately?
• Is there evidence of drinking or drug abuse?
 Questions Regarding
Signs of Abuse (2 of 4)
• Was there a delay in seeking care for the
child?
• Is there a good relationship between child
and caregiver?
• Does the child have multiple injuries at
various stages of healing?
• Does the child have any unusual marks or
bruises?
 Questions Regarding
Signs of Abuse (3 of 4)
• Does the child have several types of
injuries?
• Does the child have burns on the hands
or feet involving a glove distribution?
• Is there an unexplained decreased level
of consciousness?
 Questions Regarding
Signs of Abuse (4 of 4)
• Is the child clean and an
appropriate weight?
• Is there any rectal or vaginal
bleeding?
• What does the home look like?
Clean or dirty? Warm or cold? Is
there food?
Emergency Medical Care
• EMT-Bs must report all suspected
cases of child abuse.
• Most states have special forms for
reporting.
• You do not have to prove that abuse
occurred.
 Sexual Abuse
• Children of any age or either sex can be
victims.
• Limit examination.
• Do not allow child to wash, urinate, or
defecate.
• Maintain professional composure.
• Transport.
 Sudden Infant Death
Syndrome (SIDS)
• Several known risk factors:
– Mother younger than 20 years old
– Mother smoked during pregnancy
– Low birth weight
 Tasks at Scene
• Assess and manage the patient.
• Communicate with and support the
family.
• Assess the scene.
 Assessment and Management
• Assess ABCs and provide interventions as
necessary.
• If child shows signs of postmortem changes,
call medical control.
• If there is no evidence of postmortem changes,
begin CPR immediately.
 Communication and Support
• The death of a child is very stressful for the
family.
• Provide support in whatever ways you can.
• Use the infant’s name.
• If possible, allow the family time with the
infant.
 Scene Assessment
• Carefully inspect the environment, following local
protocols.
• Concentrate on:
– Signs of illness
– General condition of the house
– Family interaction
– Site where infant was discovered
Apparent Life-Threatening Event
• Infant found not breathing, cyanotic, and
unresponsive but resumes breathing with
stimulation
• Complete careful assessment.
• Transport immediately.
• Pay strict attention to airway management.
 Death of a Child (1 of 2)
• Be prepared to support the family.
• Family may insist on resuscitation efforts.
• Introduce yourself to the child’s caregivers.
• Do not speculate on the cause of death.
 Death of a Child (2 of 2)
• Allow the family to see the child and say good-bye.
• Be prepared to answer questions posed by
caregivers.
• Seek professional help for yourself if you notice
signs of posttraumatic stress.
 Children With Special Needs
• Children born prematurely who have associated
lung problems
• Small children or infants with congenital heart
disease
• Children with neurologic diseases
• Children with chronic diseases or with functions
that have been altered since birth
Tracheostomy Tube
 Artificial Ventilators
• Provide respirations for children unable to
breathe on their own.
• If ventilator malfunctions, remove child from
the ventilator and begin ventilations with a
BVM device.
• Ventilate during transport.
Central IV Lines
 Gastrostomy Tubes
• Food can back up the esophagus into the lungs.
• Have suction readily available.
• Give supplemental oxygen if the patient has
difficulty breathing.
 Shunts
• Tubes that drain excess fluid from around
brain
• If shunt becomes clogged, changes in
mental status may occur.
• If a shunt malfunctions, the patient may
go into respiratory arrest.