SILVER CROSS EMS SEPTEMBER 2014 EMD CE

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1 SILVER CROSS EMS SEPTEMBER 2014 EMD CE

2 Sudden illness and medical emergencies are common in children and infants. Anatomical differences exist between adults and children. Respiratory care for children is extremely important.

3 Managing a pediatric emergency can be one of the most stressful situations you face as an EMD. You must remain calm and professional. Unless you are prepared, your anxiety and fear may interfere with your ability to deliver proper instructions. Caller may be at a higher state of anxiety. Ask simple questions about the emergency. Ask to speak to someone else if caller is hysterical and unable to focus on interrogation process.

4 REVIEW OF A, B, C S AND BLS FOR INFANTS AND CHILDREN

5 Differences between children and adults A child s airway is smaller in relation to the rest of the body compared to an adult s airway. A child s tongue is relatively larger than an adult s.

6 A child s upper airway is more flexible than that of an adult. The airway is narrow and more easily obstructed. For at least the first 6 months of their lives, infants can breathe only through their noses. When the demands on a child s respiratory system change, the child is able to quickly compensate by increasing breathing efforts. The child can only compensate for so long before they tire and quickly decompensate.

7 Used with permission of the American Academy of Pediatrics, Pediatric Education for Prehospital Professionals, American Academy of Pediatrics, Gathering information from the caller about the child s, level of consciousness, respiratory effort and skin will quickly give you a general impression of the emergency.

8 Indicator of how well the heart, lungs, and central nervous system are working Compare the child s appearance with what you would expect from a healthy child. Assess eye contact, muscle tone, and skin color. Red Flags: Limp, glassy stare, not interacting with environment or caregivers, high pitched cry or inconsolable.

9 Ask about child s level of distress: Labored breathing with signs of muscles retractions Abnormal sounds like wheezing or gurgling Positioning: tripod sitting up and leaning forward Nasal flaring or grunting

10 Red Flags: Pallor - pale skin or mucous membranes. Mottling blotching skin discoloration that is caused by too much or too little blood flow to skin. Cyanosis bluish tint to skin and mucous membranes from a lack of oxygen.

11 High temperatures are accompanied by: Flushed, red skin Sweating Restlessness Heart rate increases Fevers accompanied with rashes are concerning and could be a sign of a serious illness

12 Causes of cardiopulmonary arrest in children Choking Infections of the airway such as croup and epiglottitis Sudden infant death syndrome (SIDS) Accidental poisonings Injuries around the head and neck ANY RESPIRATORY EMERGENCY CAN LEAD TO CARDIAC ARREST IN PEDIATRIC PATIENTS IF NOT CORRECTED IN A TIMELY MANNER!

13 Opening the airway Use the head tilt chin lift maneuver on children to open the airway. Do not hyperextend the child s neck when you tilt the head back. Because of anatomical differences their airway should be in a more neutral or sniffing position. If no breathing or only gasping, begin CPR.

14 Basic life support for ages 1 and over Use the heel of one hand or two hands to perform chest compressions. Compress the sternum one half to one third the depth of the chest depending on the size of the child. Give breaths, making sure chest is rising. Compression to breath ratio is 30:2.

15 Basic life support for children under 1 year CPR for infants is different from adult CPR. Check for responsiveness by tapping the infant s foot or gently shaking the shoulder. Use your middle and ring fingers to compress the sternum just below the nipple line. Compress the sternum one half to one third the depth of the chest. Give gentle rescue breaths. Compression to Breath ratio is 30:2

16 Severe airway obstruction is a serious emergency. Signs and symptoms Poor air exchange Increased breathing difficulty Silent cough Inability to speak No movement

17 Use Abdominal Thrusts to expel object. Wrap arms around the patient s midsection (above belly button but below ribs) Provide quick inward and upward thrusts

18 If the child becomes unconscious, begin the steps of CPR. Remember to check the mouth for object after the compressions and before giving breaths.

19 An infant is very fragile. If you suspect an airway obstruction, assess the infant to determine whether any air exchange is occurring. If the infant is crying, the airway is not completely obstructed. If no air is moving in or out of the infant s mouth and nose, suspect an obstructed airway. The infant will start to change colors very quickly.

20 Use a combination of back slaps and the chest-thrust maneuver. Assess the infant s airway and breathing. Place the infant in a face-down position over your one arm and deliver five back slaps between the shoulder blades.

21 Use a combination of back slaps and the chest-thrust maneuver. Turn the infant face-up. Deliver five chest thrusts in the middle of the sternum with your two fingers. Repeat these steps until the object is expelled or until the infant becomes unresponsive.

22 If the infant becomes unresponsive, continue with the following steps: Begin CPR, remembering to check the airway for the object prior to giving breaths. Once the airway is clear, assess for breathing. If breathing is present, roll infant into their side and monitor until help arrives. If infant is not breathing, continue the steps of CPR giving 30 compressions and 2 breaths, alternating, until help arrives.

23 If small, round objects do not become airway obstructions, they usually pass uneventfully through the child. Sharp or straight objects are dangerous if swallowed. Arrange for prompt transport.

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25 Causes of altered mental status in children Low blood glucose level Poisoning Post-seizure state Infection Head trauma Decreased oxygen levels

26 Because infants breathe primarily through their noses, even a minor cold can cause breathing difficulties. Asthma Caused by a spasm or constriction and inflammation of smaller airways in the lungs Usually produces a wheezing sound Advise caller to get child into a position of comfort and follow their doctor s order for medication Arrange for prompt transport

27 Croup Infection of the upper airway that occurs mainly in children between 6 months and 6 years of age Results in a hoarse, whooping noise during inhalation and a seal-like, barking cough Often occurs in colder climate A lack of fright and the willingness to lie down are important signs that distinguish croup from epiglottitis. Moist, warm air helps to relax the vocal cords.

28 Epiglottitis Severe inflammation of the epiglottis The flap is so inflamed and swollen that air movement into the trachea is completely blocked. Usually occurs in children between ages 3 and 6 years The child is usually sitting upright, with chin thrust forward cannot swallow or cough. is drooling. is anxious and frightened. Make the child comfortable with as little handling as possible. Keep everyone calm.

29 Signs of respiratory distress A breathing rate of more than 60 breaths/min in infants A breathing rate of more than 30 to 40 breaths/min in children Nasal flaring on each breath Retraction of the skin between the ribs and around the neck muscles Stridor a high pitched crowing, upper airway sound, indicating swelling or a partial obstruction Cyanosis of the skin Altered mental status Combativeness or restlessness

30 Treatment of respiratory distress Try to determine the cause. Support the child s respirations by placing the child in a comfortable position, usually sitting. Keep the child as calm as possible by letting a parent hold the child if practical. Arrange for prompt transport.

31 Often results as respiratory distress proceeds Signs and symptoms A breathing rate of fewer than 20 breaths/min in an infant A breathing rate of fewer than 10 breaths/min in a child Limp muscle tone Unresponsiveness Decreased or absent heart rate A child in respiratory failure is on the verge of experiencing respiratory and cardiac arrest.

32 Circulatory failure The most common cause of circulatory failure in children is respiratory failure. Can lead to cardiac arrest Indicated by an increased heart rate, pale or bluish skin, and changes in mental status

33 Fevers are common in children. Because the temperature-regulating mechanism in young children has not fully developed, a very high temperature can occur quickly. Most children can tolerate temperatures as high as 104 F (40 C). Treatment Uncover the child so that body heat can escape. Protect the child during any seizure, and make certain that normal breathing resumes after each seizure.

34 Can result from a high fever or from disorders such as epilepsy. Seizures are relatively common in children who have sustained a serious head injury. During a seizure: The child loses consciousness. The eyes roll back. The teeth become clenched. The body shakes with jerking movements. The child s skin becomes pale or turns blue. Sometimes the child loses bladder and bowel control.

35 Treatment Move objects away to prevent injury. Maintain an adequate airway after the seizure ends. Arrange for prompt transport. Monitor and support the ABCs. After the seizure is over, cool the patient if he or she has a high fever.

36 Usually caused by gastrointestinal infections May produce severe dehydration The dehydrated child is lethargic and has very dry skin. Can lead to shock. Hospitalization may be required to replace fluids. If you suspect dehydration, arrange for transport.

37 One of the most serious causes of abdominal pain in children is appendicitis. More commonly seen in people between 10 and 25 years Usually the child is nauseated, has no appetite, and occasionally will vomit. Treat every child with a sore or tender abdomen as an emergency. Arrange for prompt transport.

38 Also called crib death Sudden and unexpected death of an apparently healthy infant Usually occurs in infants between the ages of 3 weeks and 7 months No adequate scientific explanation exists for SIDS. Be compassionate with the parents.

39 Trauma is the number one killer of children. Treat an injured child as you would treat an injured adult, but remember these differences: A child cannot communicate symptoms as well as an adult. You may need to adapt materials and equipment to the child s size. A child does not show signs of shock as early as an adult but can progress into severe shock quickly.

40 The patterns of injury sustained by children will be related to three factors: Type of trauma they experience Type of activity causing the injury Child s anatomy Motor vehicle crashes Unrestrained patients have more head and neck injuries. Restrained patients often suffer head, spinal, and abdominal injuries. Bicycle accidents Children often suffer head, spinal, abdominal, and extremity injuries. The use of bicycle helmets can greatly reduce the number and severity of head injuries.

41 Children hit by cars often sustain chest, abdominal, thigh, and extremity injuries. Falls from a height or diving accidents cause head, spinal, and extremity injuries. Burns are a major cause of injuries to children.

42 Treatment regardless of the cause of injury Do not move patient, unless in immediate danger. Check the patient s ABCs. Stop severe bleeding. Treat the patient for shock. Children show shock symptoms much more slowly than adults do, but they progress through the stages of shock quickly. Stabilize all injuries you find.

43 A child s injuries could be a result of abuse. If you suspect abuse, ensure the child s safety. Signs and symptoms Multiple fractures Bruises in various stages of healing Human bites Burns Reports of bizarre accidents Signs and symptoms of neglect Lack of adult supervision Malnourished-appearing child Unsafe living environment Untreated chronic illness In addition to experiencing abuse the child could be a victim of sexual assault.

44 Calls involving children tend to produce strong emotional reactions. You may need to talk about feelings of anger or frustration with a counselor. By attending debriefing sessions, you can: Express your feelings Learn some coping strategies Maintain a healthy approach to future calls CISD, WCSP SOCIAL WORKER , JPD SOCIAL WORKER

45 Emergency Medical Responder, 5 th edition Will County EMDPRS, June 2012 American Heart Association, 2010 guidelines American Academy of Pediatrics PEPP, 2000 Google Images