2. Developmental Concerns Infants Newborns and infants (Birth
to 1 yr) Minimal stranger anxiety Do not like to be separated from
parents Do not tolerate NRBs Poor thermoregulators = Need to be
kept warm Breathing rate best obtained at a distance Note -Chest
rise Color Level of activity Examine heart and lungs 1st Head last
Builds confidence Allows optimal assessment before child becomes
agitated
3. Developmental Concerns Toddlers Toddlers- (1 yr-3 yrs) Do
not like to be touched Do not like being separated from parents Do
not like having clothing removed Do not tolerate NRBs Children
interpret illness as punishment Remove Examine - Replace Assure the
pt they have not been bad Afraid of needles Fear of pain Trunk to
head assessment Builds confidence Done before child becomes
agitated
4. Developmental Concerns Preschool Preschool- (3 yrs-6yrs) Do
not like to be touched Do not like being separated from parents Do
not like to have clothing removed -Remove Assess Replace Do not
tolerate NRBs Assure child they were not bad Afraid of blood Fear
of pain Fear of permanent injury Modest
5. Developmental Concerns Adolescents School age- (6 yrs- 12
yrs) Afraid of blood Fear of pain Fear of permanent injury Modest
Fear if disfigurement Adolescent- (12 yrs-18 yrs) Fear of permanent
injury Modest Fear of disfigurement Treat as adults May desire to
be assessed privately Away from parents/administrators/friends
6. Anatomical/Physiological Concerns: Airway Small airways
throughout the resp system Tongue is large in relations to small
mandible DO NOT hyperextend Infants are obligate nose breathers Can
be significant airway complication in unresponsive child
Positioning airway is different Easily blocked by secretions and
swelling Suctioning the nasopharynx can improve respirations
Children can compensate well for short periods of time Increased
breathing rate and effort of breathing Compensation rapidly
followed by decompensation Rapid respiratory muscle fatigue General
fatigue of the infant
7. Airway Techniques Airway opening Head tilt chin lift = no
trauma Modified jaw thrust = trauma Do not hyperextend Infants
below 1 y/o sniffing position Small children 1-8 yrs Extend but do
not hyperextend
8. Another type of sniffing position
9. Suctioning Suctioning Blood, vomit, small particulate matter
from airway Nasopharynx Rigid suction catheter Insert only as far
back as you can see Pressure less than 300 mmHg Should not exceed
100 mmHg in newborns Suction for 15 seconds or less Soft suction
catheter Suction for 15 seconds or less If appropriate,
hyperventilate the pt before and after suctioning If airway is full
of secretions that cannot be easily cleared Log roll pt onto
side
10. Airway Adjuncts Adjuncts Oral airways Not for initial
artificial ventilation Should not have a gag reflex Size as normal
Use tongue depressor Insert tongue blade to base of tongue Push
down against tongue while lifting upwards Insert OPA directly in
without rotation Nasal airways Not for initial artificial
ventilation Size as normal Insert as normal Contraindicated in
trauma
11. Oxygen Deliver Oxygen Delivery Nonrebreathers Blow By Hold
O2 tubing 2 from face Insert tubing into a paper cup or stuffed
animal Artificial Ventilation Mask/bag size determined by age/size
of pt Consider trauma -Neonatal Pediatric - Child Modified jaw
thrust Manual in line stabilization Mouth to mask ventilation Use
of BVM Squeeze bag slowly and evenly allowing chest rise Rate at 20
breaths per minute Provide O2 at 100% using an O2 reservoir
12. Infants and Children Assessment Pediatric Assessment
Triangle General impression can be obtained from overall appearance
(Well v. sick) Mental Status Effort of breathing Color Quality of
cry/speech Interaction to parents/environment Normal behavior based
on age Playing Moving around Attentive v non attentive Eye contact
Recognized parents Responds to parents calling Emotional state
Response to the EMT Tone/body position
13. Approach to Evaluation Begin from across the room MOI Scene
size up General impression Respiratory assessment Note chest
expansion/symmetry Effort of breathing Nasal flaring Stridor,
crowing, noisy Retractions Grunting Respiratory rate Perfusion
assessment Skin color
14. Approach to Evaluation Hands on Hands on Approach Assess
breath sounds Assess circulation Present Absent Stridor or wheezing
Assess brachial or femoral pulse Assess peripheral pulse Assess
capillary refill Assess BP in children 3 y/o and older Assess skin
color, temperature, moisture Detailed physical exam Trunk to head
approach Situation and age dependant Should help reduce
infant/child anxiety
15. Common Problems Partial Airway Obstruction Partial Airway
Obstruction S/S Infants who are alert and sitting Stridor, crowing,
noisy Retractions on inspiration Pink Good peripheral perfusion
Still alert, not unconscious Emergency care Allow position of
comfort Assist younger child to sit up Do not lay down May sit on
parents lap Offer O2 Transport Do not agitate child Limited
exam
16. Common Problems Complete Airway Obstruction Complete Airway
Obstruction S/S No crying/speaking and cyanosis Childs cough
becomes ineffective Increased resp difficulty with stridor Loss of
consciousness AMS Emergent clearing of airway -Total blockage of
airway -ORPartial obstruction with -AMS Cyanosis Infant procedures
Child procedures Attempt artificial ventilation with BVM and good
seal
17. Airway Obstructions Complete obstructions Infants less than
1 y/o Back blows/chest thrusts Visual foreign body removal Children
1 y/o+ Abdominal thrusts Visual foreign body removal
18. Upper v Lower Respiratory Presentations Upper Airway
Obstruction Lower Airway Disease Stridor on inspiration Wheezing
and breathing effort on exhalation Rapid breathing without stridor
Complete Airway Obstruction No crying No speaking Cyanosis No
coughing
19. S/S of Resp Compromise S/S of Early Respiratory Distress
Nasal flaring Retractions Intercostal, Supraclavicular, Subcostal
Adnominal, Neck Stridor Audible wheezing Grunting S/S of
Progressive Respiratory Distress Rate above 60 breaths per minute
Cyanosis Decreased muscle tone Severe use of accessory muscles Poor
peripheral perfusion AMS Grunting S/S of Respiratory Arrest Rate
less than 10 breaths per minute Limp/flaccid muscle tone
Unconscious Slow, absent heart rate Weak, absent distal pulses
20. Treatment of Resp Compromise Emergency Care of Respiratory
Compromise O2 O2 and Assist ventilation is severe distress Resp
distress and AMS Cyanosis with O2 Resp distress with poor muscle
tone Resp failure Provide O2 and ventilate with Resp arrest
21. Common Problems Seizures General comments: Assessment
Assess for injuries incurred by seizure activity Caused by Rarely
life threatening in children with a Hx However, consider any
seizure to be life threatening May be brief or prolonged Although
they can be brief there could be a more serious underlying problem
Fevers Infections Trauma Hypoglycemia Poisoning Hypoxia Idiopathic
Hx of seizures Has the child has prior seizures? If yes, is this
the normal seizure pattern? Has the child taken any anti seizure
medications?
22. Treatment of Seizures Assure airway position and patency If
no C-spine trauma place pt on side Have suction ready Provide O2
Treat S/S of respiratory compromise if found Inadequate breathing
and AMS may follow a seizure Transport
23. Common Problems Altered Mental Status Caused by
Hypoglycemia Poisoning Seizure Infection Head trauma Hypoxia
Hypoperfusion Emergency Care Assure patency of airways Be prepared
to artificially ventilate/suction Transport
24. Common Problems Poisoning Poisoning Common reason for EMS
activation Identify suspected container through Hx Bring container
to hospital if possible Emergency Care Responsive Pt Contact med
control Consider activated charcoal O2 Transport Monitor pt for
AMS/unresponsiveness Unresponsive Pt Assure patency of airway Be
prepared to artificially ventilate O2 Call med control Transport
Rule out trauma as cause of AMS
25. Common Problems Fever Fever General comments: Many causes,
rarely life threatening Severe case is meningitis Fever with a rash
is a significant finding May precipitate a febrile seizure
Emergency Care Transport Be prepared for a seizure
26. Common Problems Shock Shock General comments: Common
Causes: Diarrhea and dehydration Trauma Vomiting Blood loss
Infection Abd injuries Less common causes: Rarely a primary cardiac
event Allergic reactions Poisoning Cardiac S/S Rapid resp rate
Pale, cool, clammy skin Weak/absent peripheral pulses Delayed
capillary refill Decreased urine output ALOC/AMS Absence of tears
even when crying
27. Treatment of Shock Assure airway/O2 Be prepared to
artificially ventilate Manage bleeding if present Place pt in shock
position Keep warm IMMEDIATE transport Detailed exam en route if
time permits
28. Common Problems Water Related Accidents Near Drowning
Ventilation is TOP priority Consider possible trauma hypothermia
possible ingestion (alcohol, etc) Protect airway Suction if
necessary Secondary Drowning Syndrome Minutes to hours after the
event Deteriorate after breathing normally Therefore, transport ALL
near drowning pts
29. Common Problems SIDS Sudden Infant Death Syndrome (SIDS)
S/S Sudden death of infant within 1st year Causes are many and not
well understood Most commonly found during early morning Emergency
Care Try to resuscitate unless rigor mortis Parents will be in
distress Avoid comments that may place blame
30. Infants and Children Trauma Injuries are the #1 COD in
infants/children Blunt injury is mot common Pattern of injury if
different from adults Motor Vehicle Passengers Struck with riding
bicycle Injuries to head/neck Burns Sport injuries Head, Spine, Abd
injury Falls from heights Unrestrained = Head/Neck injuries
Restrained= Abdomen and spinal injuries Head/neck Child abuse
31. Infants and Children Trauma: Specific Body Regions Head
Chest Soft very pliable ribs May have injuries without external
signs Abdomen Maintain airway via modified jaw thrust More likely
to sustain head injuries S/S of shock with head injury suggest
other injuries Respiratory arrest is common secondary to head
injury Common S/S = Nausea/Vomiting Major airway complication =
Tongue More common in children than adults Often a source of hidden
injuries ALWAYS consider this in multi-system trauma pt who is
deteriorating without external S/S Be aware of complications of
gastric distention Extremities Manage in the same manner as
adults
32. Other Considerations PASG, Burns Pneumatic Anti Shock
Garments Use ONLY if child fits Do not inflate abd compartment
Indication S/S hypoperfusion S/S of pelvic instability Criticality
of burns Cover with sterile dressing Possible transport to a burn
center per protocol
33. Care of the traumatically injured pediatric Assure airway
position and patency Use modified jaw thrust O2 Assist ventilation
in resp distress Ventilate with BVM in resp arrest Immobilization
IMMEDIATE transport
34. Abuse and Neglect Abuse Neglect Multiple bruises in
different stages of healing Injury inconsistent with MOI Repeated
calls to the same location Fresh burns Parents seem inappropriately
unconcerned Conflicting stories Fear on the part of the child to
discus how they were hurt S/S of Neglect Giving insufficient
attention/respect to an individual who has a right to that
attention S/S of Abuse Improper or excessive action so as to injure
or cause harm Lack of adult supervision Malnourished appearing
child Unsafe living environment Untreated chronic illness CNS
injuries are the most lethal in the field (Shaken Baby Syndrome) Do
NOT accuse in the field Required reporting by state law What you
SEE and what you HEAR NOT what you THINK
35. Virginia Child Abuse Hotline In State (800) 552-7096 Out of
State (804) 786-8536
36. Special Needs Children Examples: Premature babies with lung
disease Babies and children with heart disease Infants/children
with neurological disease Children with chronic diseases Often
these pt are at home technologically dependant
37. Infants and Children Special Needs Children Tracheostomy
Tube Complications: Obstruction, Bleeding, Air leak, Dislodged,
Infection Care: Maintain open airway Suction Maintain position of
comfort Transport Home Ventilators Care: Assure patency of airway
Artificially ventilate with O2 Transport The parents will be
familiar with the equipment Shunts Device running from brain to abd
to drain excess CSF Will find reservoir on side of skull Be
prepared for AMS Prone to resp arrest Manage airway Assure adequate
ventilation Transport
38. Infants and Children Special Needs Children Central Lines
Complications Care Cracked line Infection Clotting off Bleeding If
bleeding, apply pressure Transport Gastronomy Tube and Gastric
Feeding Tube inserted directly into stomach for feeding Be alert
for breathing problems: Assure adequate airway Have suction ready
If diabetic Hx, anticipate AMS O2 Transport Sitting Lying on Right
side, head elevated
39. Family Response Multiple patients Calm, supportive
interaction with family Improves ability to deal with child Calm
parents = Calm child Agitate parents = Agitate child Parents may
respond with anger/hysteria Allow parents to remain part of the
care unless condition does not allow Parents should instructed to
calm child Child cannot be cared for in isolation from family
Transport in position of comfort Hold O2, etc Parents are EXPERTS
on what is normal and abnormal for their child
40. Provider Response Anxiety from lack of experience Fear of
failure Stress of identifying pt with own child Much of adult
learning applies to children REMEMBER the differences PRACTICE