September 2013 CE. Site code # E Caring for the Pediatric Patient

Transcription

1 September 2013 CE Site code # E-1213 Caring for the Pediatric Patient Objectives by Reviewed/revised by Sharon Hopkins, RN, BSN, EMT-P To view on the Advocate Condell website visit: 1

2 Date of CE presentation: September 2013 Topic: Caring for the Pediatric Patient Behavioral Objectives: Upon successful completion of this module, the EMS provider will be able to: Define the pediatric patient Identify growth and developmental characteristics of infants and children. Describe the difference in anatomical structures between adults and children. Describe appropriate interactions with families and significant others of ill and injured children. Discuss characteristics unique to pediatric vital signs. Define pediatric respiratory distress, failure, and arrest. Discuss tips for interventions for pediatric airway emergencies. Review basic CPR techniques for neonatal, infant, and child populations. Actively participate in case scenario discussion. Actively participate in calculating and preparing a variety of medications for the pediatric patient. Successfully complete the post quiz with a score of 80% or better Bibliography Bledsoe, B., Porter, R., Cherry, R. Paramedic Care Principles & Practices, 4th edition. Brady Limmer, D., O Keefe, M. Emergency Care 12th Edition. Brady Region X SOP s; IDPH Approved January 6, Defining the pediatric patient Newborn first hours after birth Neonates birth to one month Infants 1 month to 1 year Toddlers 1 3 years Preschoolers 3 5 years School-age 6 12 years Adolescents years 2

3 Region X SOP s The pediatric patient is considered to be under the age of 16 Calculating blood pressure This means the patient is considered a pediatric patient through age 15 Pediatric SOP s are to be followed Medications are based on weight Medication dosages are maxed at the dose the adult would receive The larger child would should never get a dose larger than one that would be given to an adult IF patient is of average height and weight, can use a formula for acceptable blood pressure: 2x age + 70 = average acceptable B/P < (2 x age) + 65 = too low; suspect and investigate for hypotension Pediatric Assessment Triangle AHA 2010 CPR Guidelines 3

4 Inadequate 40-60/min (1/seconds) breathing with to achieve HR pulse >100/min Rescue breaths 12-20/min (1 every 3-5 sec) Rescue breaths 10-12/min (1 every 5-6 seconds Ventilations 40-60/min (1/sec) to with advanced achieve HR >100/min airway in place Rescue breaths 8-10/min (1 every 6-8 sec) asynchronous with chest compressions delivered over 1 sec Administering Injections Finding sites on the pediatric patient: Deltoid 2-3 fingers below the AC joint; more posterior than anterior Thigh great source in pediatrics Identify the site by one hand below the groin and one hand above the knee Hip can palpate greater trochanter in relationship to the iliac crest AVOID the buttocks in the non-ambulatory population muscle not defined so no muscle mass present!!! Make sure to have patient well secured (i.e.: manually restrained) so they don t move during the administration of the injection! 4

5 SQ vs IM injections SQ injection After prepping site, pinch skin up to isolate the subcutaneous layer. Needle at 45 0 angle (can be 90 0 angle because short needles are used). Volume is usually limited to 1 ml to avoid irritation. IM injection After prepping site, pull skin taut to assure entry into a muscle. Needle straight in at 90 0 angle. Volume is limited by site and size of patient. Generally, the thigh and buttock can tolerate larger volumes than the deltoid area. The buttock is avoided in children too young to walk as this muscle mass is not developed yet. Adding an air plug (0.1 ml of air) into the syringe AFTER exact dosing volume has been drawn up helps push the medication further into the tissue. This prevents leakage or medication loss. 5

6 Medication Dosing Practice Find the dosage and volume on the Region X SOP med charts; compare to the Broselow tape 40# (18 kg) child with Narcan 50# (23 kg) child with Epinephrine 1: # (40 kg) child with Fentanyl 35# (16 kg) child with Zofran 44# (20 kg) child with Lidocaine 70# (32 kg) child with Benadryl 88# (40 kg)child with Versed Working in small groups, prepare syringes for the following medications and dosages following the Region X SOP s: Adenosine for 38 pounds Dextrose 12.5% for 4 pounds Narcan for 26 pounds Glucagon for 58 pounds Epinephrine 1:1000 for 46 pounds Fentanyl for 88 pounds Zofran for 35 pounds Diphenhydramine for 63 pounds File: CE, EMS; CE Packets; 2013; September Caring for Pediatric Patient; Rev 9/16/13 6