Pediatric Patients BCFPD Program
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.
The approach to the pediatric patient should be gentle and slow.
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
Emotional support of the infant or child continues during transport. Kenneth Kerr
Infants and young children should be allowed to remain in their mothers arms. Jeff Forster
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.
Preschoolers Ages 3 to 5 years Know how to talk Fear mutilation Seek comfort and support from within home Distorted sense of time
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.
School-Age Children Ages 6 12 years. Active and carefree age group. Give this age group responsibility of providing history. Respect modesty.
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.
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.
Anatomical and physiological considerations in the infant and child
Anatomical and physiological considerations in the infant and child
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
Signs and symptoms of shock (hypoperfusion) in a child
Signs of respiratory distress. Notice the conditions that can be determined by quick observation.
Signs of Increased Respiratory Effort
Normal Vital Signs: Infants and Children
Pediatric Weights and Pound-Kilogram Conversion
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.
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.
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.
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
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.
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.
In placing a mask on a child, it should fit on the bridge of the nose and cleft of the chin.
Circulation Two problems lead to cardiopulmonary arrest in children: Shock Respiratory failure
Vascular Access Neck veins Scalp veins Arms Hands Feet Intraosseous infusion
Intraosseous Infusion Indications Children less than 6 years of age Existence of shock or cardiac arrest Unresponsive patient Unsuccessful peripheral IV
Intraosseous Infusion Contraindications Fracture in the bone chosen for IO Fracture of the pelvis or extremity fracture of bone, proximal to the chosen site
Intraosseous administration
Correct needle placement for intraosseous administration
Fluid Administration Accurate fluid dosing in children is crucial!
Respiratory Emergencies Infections Upper airway distress Croup Epiglottitis Lower airway distress Asthma Bronchiolitis
Symptoms of Croup and Epiglottitis
Epiglottitis Croup
Positioning of the child with epiglottitis. Often there will be excessive drooling. Kenneth Kerr
The child with epiglottitis should be administered humidified oxygen and transported in a comfortable position. Kenneth Kerr
The young asthma patient may be making use of a prescribed inhaler to relieve symptoms. Kenneth Kerr
Possible indicators of ingested poisoning in children
Applying a Pediatric Immobilization System
Position the patient on the immobilization system.
Adjust the color-coded straps to fit the child.
Attach the four-point safety system.
Fasten the adjustable head-support system.
The patient fully immobilized to the system
Move the immobilized patient onto the stretcher and fasten the loops at both ends to connect to the stretcher straps.
Nasogastric Intubation Indications: Inability to achieve adequate tidal volume during ventilation due to gastric distention Presence of gastric distention in an unresponsive patient
Measure the NG tube from the tip of the nose, over the ear, to the tip of the xiphoid process.
Lubricate the end of the tube. Then pass it gently downward along the nasal floor to the stomach.
Auscultate over the epigastrium to confirm correct placement. Listen for bubbling while injecting 10 20 cc of air into the tube.
Use suction to aspirate stomach contents.
Secure the tube in place.