Overview (2 of 2) In the United States, trauma is the most
common cause of death in children The elderly are the fastest
growing subset in our population
Slide 4
Our Bodies Change Over Time There are anatomic differences
between infants, children, and adults Body systems continue to
develop and mature in the young Aging body systems show signs of
dysfunction
Slide 5
ABCs Airway Anatomic differences Age and size of the patient
affects equipment choice Breathing Respiratory complications
Circulation Pediatric patients compensate well but deteriorate
quickly Geriatric patients compensate poorly and may be on
medications that affect pulse and blood pressure
Slide 6
Anatomy and Physiology: Pediatric (1 of 5) Less body fat,
increased elasticity of connective tissue, and close proximity of
organs to the body surface impair dissipation of energy applied
Incomplete calcification of bones and active growth centers limit
absorption of energy and can increase potential for injury
Slide 7
Larger head and tongue Special attention to positioning
Potential for airway obstruction Conical-shaped trachea Uncuffed
versus endotracheal tubes Shorter trachea Danger of main stem
intubation Anatomy and Physiology: Pediatric (2 of 5)
Slide 8
Anatomy and Physiology: Pediatric (3 of 5)
Slide 9
Respiratory concerns Hypoventilation and hypoxia are more
likely than hypovolemia and hypotension Injured children can
rapidly deteriorate from labored breathing to tachypnea and
progress to apnea from exhaustion Anatomy and Physiology: Pediatric
(4 of 5)
Slide 10
Shock Most pediatric injuries do not cause immediate
exsanguination Blood pressure is a poor indicator of blood loss and
peripheral perfusion Children remain in compensated shock longer
than adults, but decline very rapidly Anatomy and Physiology:
Pediatric (5 of 5)
Slide 11
Managing Pediatric Patients (1 of 5) Airway and breathing
Ensure airway patency Provide supplemental oxygen Assist
ventilations when indicated A bag-mask device may be adequate
Intubate only if bag-mask device is not effective Tachypnea and
increased effort to breathe can indicate shock Monitor for signs of
respiratory fatigue
Slide 12
Circulation Evaluate skin color, temperature, and peripheral
perfusion Pediatric patients may not show signs of hypotension
until 30% of volume is lost Decreasing pulse rate in the face of
shock is an ominous sign Fluid replacement 20 ml/kg bolus May
repeat based on clinical response Managing Pediatric Patients (2 of
5)
Slide 13
Disability Glasgow Coma Scale (GCS) Use the pediatric GCS for
preverbal children Level of consciousness (LOC) is most important
factor A child who is lethargic or asleep rather than upset may
indicate hypoperfusion or traumatic brain injury (TBI) Managing
Pediatric Patients (3 of 5)
Slide 14
Managing Pediatric Patients (4 of 5)
Slide 15
Use appropriately sized equipment Preserve body heat Frequently
reassess patients Transport: In an age-appropriate device To an
appropriate facility Managing Pediatric Patients (5 of 5)
Slide 16
Anatomy and Physiology: Geriatric (1 of 4) Overview The body
gradually loses its ability to maintain homeostasis Pre-existing
conditions can increase mortality from less severe injuries
Malnourishment is common Geriatric patients may have: Slower
cognitive responses Degenerative diseases Decline in sensory
acuity
Slide 17
Airway and breathing Ventilatory function declines Increased
stiffness in chest wall Alveolar surface decreases Decreased
ability to saturate hemoglobin with oxygen Circulation Pre-existing
diseases may compromise compensatory mechanisms Anatomy and
Physiology: Geriatric (2 of 4)
Slide 18
Disability Slower response to stimuli Declining mental and
psychomotor activity Sensory changes Hearing Vision Pain
Temperature regulation Anatomy and Physiology: Geriatric (3 of
4)
Slide 19
Musculoskeletal Loss of height due to dehydration of vertebral
discs Compressed spinal cord due to narrowing of spinal canal
Kyphosis Porous and brittle bones Loss of muscle mass Loss of range
of motion Anatomy and Physiology: Geriatric (4 of 4) Dr. P. Marazzi
/ Science Source
Slide 20
Management of Geriatric Patients Airway and breathing Loss of
soft tissue and teeth may make face mask seal difficult Circulation
Administer fluid with caution Possibility of fluid overload
Medicimage/Visuals Unlimited, Inc.
Slide 21
Burns
Slide 22
Burns: Overview All burns are serious, regardless of size Burns
are not just a skin injury Large burns involve multiple organ
systems Smoke inhalation can be life-threatening It is often more
dangerous than the burn itself Children account for 20% of all burn
victims Consider the possibility of intentional injury (abuse)
Slide 23
Burn Assessment (1 of 4) Depth of injury Superficial
(first-degree) Partial-thickness (second-degree) Superficial Deep
Full-thickness (third- and fourth-degree) Burn depth may evolve
over time
Slide 24
Burn Assessment (2 of 4) Courtesy of Dr. Jeffrey Guy
Slide 25
Burn Assessment (3 of 4) Courtesy of Dr. Jeffrey Guy.
Slide 26
Burn Assessment (4 of 4) Extent of burn (burn size estimation)
Percent of body surface area (BSA) involved Rule of nines
Slide 27
Burn Management: Primary Assessment (1 of 3) Conduct the
primary assessment Airway occlusion may occur as swelling
progresses Consider early airway intervention Breathing may become
compromised from chest wall eschar or toxic pulmonary injury
Monitor ventilatory rate, SpO 2, and ETCO 2
Slide 28
Burn Management: Primary Assessment (2 of 3) Circulatory status
may be compromised as fluid leaks into damaged tissue causing
swelling and hypotension Ensure IV access and fluid
replacement
Slide 29
Burn Management: Primary Assessment (3 of 3) Disability Altered
mentation suggests hypotension or hypoxia Expose Allows for
complete assessment but may lead to loss of body temperature Cover
patient upon completion of assessment
Slide 30
Burn Management (1 of 3) Specific burn therapy Stop any ongoing
burning Cover with dry, sterile nonadherent dressing (sheet) Do not
use any ointments or other topical antibiotic
Slide 31
Burn Management (2 of 3) Specific burn therapy: Initiate fluid
administration Parkland formula: total fluid in first 24 hours (24
ml)(body weight in kg)(% BSA burned) Half of total fluid should be
given in the first 8 hours after burn Second half of total fluid
should be given in the next 16 hours after burn Adults receive
lactated Ringers Pediatric patients receive 5% dextrose in lactated
Ringers
Slide 32
Burn Management (3 of 3) Analgesia Adequate pain relief is
critical Narcotic analgesics are indicated for significant burns
Ice is not a proper analgesic Leads to hypothermia May increase the
overall size and depth of burn Transport to burn center as
indicated
Slide 33
Extended or Delayed Transport Need to provide care for extended
time period Continue to provide same type and level of care Be
cautious of and monitor for: Hyperventilation Fluid overload Body
heat loss Continually reassess the patient
Slide 34
Multiple Patient Situations
Slide 35
Multiple Patient Situations (1 of 2) A multiple patient
scenario occurs each time there is more than one patient Are there
sufficient resources available on scene to manage all patients?
Triage is used primarily when the number of patients exceeds the
immediate treatment and/or transport capacity
Slide 36
Multiple Patient Situations (2 of 2) Transport only one
critical patient per ambulance (ideally) When possible, distribute
patients to all available hospitals Avoid overloading the closest
hospital when possible
Slide 37
Trauma Resuscitation Issues
Slide 38
Trauma Resuscitation Issues (1 of 3) It may be allowable to
withhold or terminate resuscitation efforts in: Injuries not
compatible with life Pulseless and nonbreathing blunt trauma
victims Trauma patients with witnessed cardiopulmonary arrest and
15 minutes of unsuccessful resuscitation and CPR Courtesy Norman
McSwain, MD, FACS, NREMT-P
Slide 39
Trauma Resuscitation Issues (2 of 3) Special consideration in
trauma resuscitation must be given to victims who have greater
likelihood of survival, including: Hypothermia Immersion incidents
Lightning strike Other situations as defined by local protocol
Slide 40
Trauma Resuscitation Issues (3 of 3) In many EMS systems,
online medical control is necessary to confirm the decision to
terminate resuscitation efforts Policies and protocols for
termination of resuscitation efforts: Should be developed and
implemented under the guidance of the EMS systems medical director
Should include notification of the appropriate law enforcement
agencies and medical examiner EMS providers should have access to
resources for debriefing and counseling as needed
Slide 41
Summary EMS providers will often encounter special patient
populations and situations Awareness of the unique aspects of each
will optimize patient management and outcome EML/ShutterStock, Inc.
Photodisc Roger Nomer/AP Images
