Chapter 39 Pediatric Medical Emergencies. © 2005 by Thomson Delmar Learning,a part of The Thomson...

Chapter 39Pediatric Medical Emergencies

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Normal Childhood Development General Considerations Airway Problems Hypoperfusion

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Overview

Cardiac Arrest SIDS Altered Mental Status Stress in Caring for Children

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Normal Childhood Development

Neonate: 0 to 1 month old– Allow mother to hold child during assessment– Common illnesses: jaundice, vomiting, respiratory

distress, fever– Congenital birth defects begin to appear

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Young infant: 1 to 5 months old– Growing rapidly and becoming increasingly aware

of the surrounding environment– Common illnesses: SIDS, vomiting, diarrhea,

meningitis, child abuse, accidents


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Young infant: 1 to 5 months old– Make slow movements and use gentle handling– Keep covered as much as possible


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Older infant: 6 to 12 months old– Becoming more active and walking– Exhibit stranger anxiety– Common illnesses: febrile seizures, vomiting,

diarrhea, dehydration, bronchiolitis, MVCs, croup, child abuse, poisoning, falls


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Toddler: 1 to 3 years old– Constantly moving, becoming more independent– Needs encouragement and reassurance– May believe illness is punishment


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Toddler: 1 to 3 years old– Take a toe-to-head approach– Common illnesses: MVCs, vomiting, diarrhea,

febrile seizures, ingestions, falls, child abuse, croup, meningitis, FBAO


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Preschooler: 3 to 5 years old– Play is more sophisticated– Very attached to parents and possessions– Explain in simple and honest terms– Common illnesses: croup, asthma, ingestions,

MVCs, burns, child abuse, FBAO, drownings, epiglottitis, febrile seizures, meningitis


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School age: 6 to 12 years old– Growing quickly and very active– Increase in injuries– Get as much history information for child as

possible– Common emergencies: drowning, motor vehicle

collisions, bicycle accidents, fractures, falls, sports injuries, child abuse, burns


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Adolescent: 12 to 15 years old– Body image is very important– Peers are very important– Risk taking behavior is common– Common illnesses: mononucleosis, asthma, motor

vehicle collisions, sports injuries, suicide gestures, sexual abuse, pregnancy


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Stop and Review

What are the developmental differences among the various age groups of children?

What are the anatomical differences between children and adults?

What is a child’s typical response to illness?

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General Considerations

Initial approach– Place yourself at eye level

with child– Introduce yourself to both

child and parent– Explain why you are there

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Gathering a history– Alter technique based upon age– Question the child in a friendly manner– Ask the parent for confirmation

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Performing a physical examination– Carefully observe the child– The child’s behavior can tell a lot about

how she is feeling– Try to gain child’s confidence– Anything that may cause pain should be

done last

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Stop and Review

What are some techniques for assessment and examination in children of various developmental ages?

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Airway Problems

Foreign body airway obstruction – May be complete or partial obstruction– Open the airway and check for breathing– Reposition the airway

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Airway Problems

Foreign body airway obstruction– For an infant, provide back blows and chest

thrusts– For an older child, perform the Heimlich maneuver

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Trouble Breathing

Croup– Viral illness causes swelling of the airways– Fall and winter are prime times – Lasts several days

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Trouble Breathing

Croup – Harsh sounding cough– Worse at night than in the day– Humidified oxygen and transport

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Trouble Breathing

Epiglottitis– Bacterial infection– Inflammation of the epiglottis causes airway

obstruction– Sudden fever, brassy cough, and sore throat– Ventilate and transport to the nearest hospital

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Pediatric Asthma

Asthma– Reversible spasm of smaller airways– Wheezing– Child works harder to breathe– May have a bronchodilating medication

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Pediatric Asthma

Upper respiratory infection– Inflammation and secretions

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Hypoperfusion

The most common cause is large fluid loss from dehydration due to vomiting, diarrhea or blood loss

Tachycardia, pale skin, delayed capillary refill, nausea

Will progress to altered mental status and a fall in blood pressure

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Cardiac Arrest

Most common cause is respiratory arrest Respiratory failure leads to hypoxia, which

leads to cardiac failure and cardiac arrest 100% oxygen and chest compressions

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SIDS

Leading cause of death in children one week to one year in age

Usually occurs during sleep; more frequent in winter months

Cause of death is unknown

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Altered Mental Status

Seizures – The most common are febrile seizures brought on

by a rapid increase in body temperature– Attend to the ABCs, undress the child, wipe with

moist cloths, fan the child

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Diabetes– The result of altered glucose utilization – If conscious, provide sugar by mouth– If unconscious, transport immediately

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Behavioral– If the altered mental status is the result of a

behavioral disorder, there will generally be a history of similar episodes

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Poisoning– Signs include spilled bottle of

chemical or medications, a smell on the breath, discoloration of mouth or lips, or vomitus with pill fragments or a chemical smell

– Maintain airway and breathing, then follow local protocol

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Infections– Colds, flu, gastroenteritis, strep throat,

mononucleosis, chicken pox– Most are not life threatening– Meningitis affects the brain and is very serious

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Stress in Caring for Children

Child– The illness is frightening, but the

examination by a stranger can be even more so

– Try to put the child at ease by being calm and honest

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Family– Allow to participate in care of child– Keep informed of what is going on– If the parent cannot be calmed, separate her from

the child

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Provider– Often invokes feelings of fear or anxiety– After the call, talk about feelings with coworkers

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Stop and Review

How are airway emergencies handled? How are respiratory emergencies treated? How is hypoperfusion in children handled? What is the most common cause of

cardiac arrest? How is altered mental status managed

in a child?

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Chapter 39 Pediatric Medical Emergencies. © 2005 by Thomson Delmar Learning,a part of The Thomson...

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