Pediatric Patients. BCFPD Paramedic Education Program. EMS Education Paramedic Level

Transcription

1 Pediatric Patients BCFPD Program

2 Basic Considerations Much of the initial patient assessment can be done during visual examination of the scene. Involve the caregiver or parent as much as possible. Allow caregivers to stay with child during treatment and transport.

3 The approach to the pediatric patient should be gentle and slow.

4 Responding to Patient Needs The child s most common reaction to an emergency is fear of: Separation Removal from a family place Being hurt Being mutilated or disfigured The unknown

5 Emotional support of the infant or child continues during transport. Kenneth Kerr

6 Infants and young children should be allowed to remain in their mothers arms. Jeff Forster

7 Toddlers Ages 1 to 3 years. May stray from parents more frequently. Parents are the only ones who can comfort them. Language development begins. Approach child slowly.

8 Preschoolers Ages 3 to 5 years Know how to talk Fear mutilation Seek comfort and support from within home Distorted sense of time

9 To overcome a child s fear of the non-rebreather mask, try it on yourself or have the patient try it on before attempting to place it on the child.

10 School-Age Children Ages 6 12 years. Active and carefree age group. Give this age group responsibility of providing history. Respect modesty.

11 Adolescents Ages 13 to 18. Are very body conscious. May consider themselves grown up. Desire to be liked and included by peers. Are generally good historians. Relationships with parents may be strained.

12 Anatomical and physiological considerations in the infant and child Ribs are more horizontal with little curvature, leading to AP chest expansion as opposed to AP and superior elevation less ability to increase tidal volume. Epiglottis is more oblong or u-shaped more difficult to control in airway maneuvers. Less cardiovascular reserve. Compensate through increases in rate rather than contractile force. Starling s reflex does not develop until between 6 and 8 years of age. Heart rates can be much higher in children than adults and should be considered to be critical findings in the acutely ill or injured child.

13 Anatomical and physiological considerations in the infant and child

14 Anatomical and physiological considerations in the infant and child

15 Anticipating Cardiopulmonary Arrest Respiratory rate greater than 60 Heart rate greater than 180 or less than 80 (under 5 years) Heart rate greater than 180 or less than 60 (over 5 years) Respiratory distress Trauma Burns Cyanosis Altered level of consciousness Seizures Fever with petechiae

16 Signs and symptoms of shock (hypoperfusion) in a child

17 Signs of respiratory distress. Notice the conditions that can be determined by quick observation.

18 Signs of Increased Respiratory Effort

19 Normal Vital Signs: Infants and Children

20 Pediatric Weights and Pound-Kilogram Conversion

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22 Airway Positioning In the supine position, an infant s or child s larger head tips forward, causing airway obstruction. Placing padding under the patient s back and shoulders will bring the airway to a neutral or slightly extended position.

23 OPA a) In an adult, the airway is inserted with the tip pointing to the roof of the mouth, then rotated into position. b) In an infant or small child, the airway is inserted with the tip pointing toward the tongue and pharynx, in the same position it will be in after insertion.

24 The Pediatric Airway A straight blade is preferred for greater displacement of the tongue. The pediatric airway narrows at the cricoid cartilage. Uncuffed tubes should be used in children under 8 years of age. Intubation is likely to cause a vagal response in children.

25 Infant/Child Endotracheal Tubes Use a resuscitation tape that estimates ET tube size based on height. Estimate the correct diameter, based on the child s little finger. (Patient s age in years + 16) 4

26 Suction Decrease suction pressure to less than 100 mmhg in infants. Avoid excessive suctioning time less than 15 seconds per attempt. Avoid stimulation of the vagus nerve. Check the pulse frequently.

27 Ventilation Avoid excessive bag pressure and volume. Obtain chest rise and fall. Allow time for exhalation. Disable BVM pop-off valves. Avoid hyperextension of the neck.

28 In placing a mask on a child, it should fit on the bridge of the nose and cleft of the chin.

29 Circulation Two problems lead to cardiopulmonary arrest in children: Shock Respiratory failure

30 Vascular Access Neck veins Scalp veins Arms Hands Feet Intraosseous infusion

31 Intraosseous Infusion Indications Children less than 6 years of age Existence of shock or cardiac arrest Unresponsive patient Unsuccessful peripheral IV

32 Intraosseous Infusion Contraindications Fracture in the bone chosen for IO Fracture of the pelvis or extremity fracture of bone, proximal to the chosen site

33 Intraosseous administration

34 Correct needle placement for intraosseous administration

35 Fluid Administration Accurate fluid dosing in children is crucial!

36 Respiratory Emergencies Infections Upper airway distress Croup Epiglottitis Lower airway distress Asthma Bronchiolitis

37 Symptoms of Croup and Epiglottitis

38 Epiglottitis Croup

39 Positioning of the child with epiglottitis. Often there will be excessive drooling. Kenneth Kerr

40 The child with epiglottitis should be administered humidified oxygen and transported in a comfortable position. Kenneth Kerr

41 The young asthma patient may be making use of a prescribed inhaler to relieve symptoms. Kenneth Kerr

42 Possible indicators of ingested poisoning in children

43 Applying a Pediatric Immobilization System

44 Position the patient on the immobilization system.

45 Adjust the color-coded straps to fit the child.

46 Attach the four-point safety system.

47 Fasten the adjustable head-support system.

48 The patient fully immobilized to the system

49 Move the immobilized patient onto the stretcher and fasten the loops at both ends to connect to the stretcher straps.

50 Nasogastric Intubation Indications: Inability to achieve adequate tidal volume during ventilation due to gastric distention Presence of gastric distention in an unresponsive patient

51 Measure the NG tube from the tip of the nose, over the ear, to the tip of the xiphoid process.

52 Lubricate the end of the tube. Then pass it gently downward along the nasal floor to the stomach.

53 Auscultate over the epigastrium to confirm correct placement. Listen for bubbling while injecting cc of air into the tube.

54 Use suction to aspirate stomach contents.

55 Secure the tube in place.