ChapterChapter

Infants andInfants and

ChildrenChildren

Twenty-FiveTwenty-Five

ChapterChapter

Pediatric respiratory emergencies

Other pediatric medical emergencies

Pediatric trauma

Twenty-FiveTwenty-FiveCORE CONCEPTSCORE CONCEPTS

Newborns and Infants: Birth to 1 YearNewborns and Infants: Birth to 1 Year

Very little anxiety fromVery little anxiety fromexposure to strangers.exposure to strangers.

Dislike separation from Dislike separation from parents.parents.

(Continued)(Continued)

Newborns and InfantsNewborns and Infants

Dislike feeling of oxygen maskDislike feeling of oxygen maskon face.on face.

Need warmth:Need warmth:• Warm hands and stethoscopeWarm hands and stethoscope

(Continued)(Continued)

Newborns and InfantsNewborns and Infants

Obtain respiratory rate fromObtain respiratory rate froma distance.a distance.

If listening to lungs, do it earlyIf listening to lungs, do it early(before child becomes upset)(before child becomes upset)..

Examine head last to Examine head last to build confidence.build confidence.

Newborns and InfantsNewborns and Infants

Toddler: 1 to 3 YearsToddler: 1 to 3 Years

DislikeDislike Being touchedBeing touched Separation from parentsSeparation from parents Removal of clothingRemoval of clothing

(remove, examine, replace)(remove, examine, replace)

Feeling of oxygen mask Feeling of oxygen mask on face on face

(Continued)(Continued)

ToddlersToddlers

Think illness/injury is punishment.Think illness/injury is punishment. Afraid of needles, pain.Afraid of needles, pain. Examine trunk first, head last. Examine trunk first, head last.

ToddlersToddlers

Preschool: 3 to 6 YearsPreschool: 3 to 6 Years

DislikeDislike Being touchedBeing touched Separation from parentsSeparation from parents Removal of clothingRemoval of clothing

(remove, examine, replace)(remove, examine, replace)

Feeling of oxygen mask Feeling of oxygen mask on face on face

(Continued)(Continued)

PreschoolersPreschoolers

Think illness/injury is punishment.Think illness/injury is punishment. Afraid of blood, pain,Afraid of blood, pain,

permanent injury.permanent injury. Modest.Modest. Have magical thoughts.Have magical thoughts.

PreschoolersPreschoolers

School Age: 6 to 12 YearsSchool Age: 6 to 12 Years

Afraid of blood and pain.Afraid of blood and pain. Afraid of permanent injuryAfraid of permanent injury

and disfigurement.and disfigurement.

Modest.Modest.

School-Age ChildSchool-Age Child

Adolescent: 12 to 18 YearsAdolescent: 12 to 18 Years

Afraid of permanent injuryAfraid of permanent injuryand disfigurement.and disfigurement.

Modest.Modest. Treat as an adult.Treat as an adult. Examine in private if possibleExamine in private if possible

(away from adults)(away from adults)..

AdolescentAdolescent

Airway Differences between Airway Differences between Adults and ChildrenAdults and Children

Small airways are more easily Small airways are more easily blocked. blocked. Child's tongue is larger.Child's tongue is larger. Infants are nose breathers.Infants are nose breathers.

• Suctioning nasopharynx improvesSuctioning nasopharynx improves breathing significantly.breathing significantly.

(Continued)(Continued)

Airway Differences betweenAirway Differences betweenAdults and ChildrenAdults and Children

Put child’s head in neutral position,Put child’s head in neutral position,not hyperextended.not hyperextended.

Children can compensate Children can compensate (breathe (breathe

faster/harder)faster/harder) for a while, then for a while, then get worse rapidly.get worse rapidly.

Airway Differences betweenAirway Differences betweenAdults and ChildrenAdults and Children

Opening the airway Use head-tilt,Opening the airway Use head-tilt,chin-lift procedure chin-lift procedure withoutwithout hyperextension. hyperextension.

Ensure small enough catheter.Ensure small enough catheter. Do not insert too deeply.Do not insert too deeply. Suction as briefly as possible.Suction as briefly as possible.

SuctioningSuctioning

Treating Mild Airway Treating Mild Airway ObstructionObstruction

Place in position of comfort (parent’s lap okay).

Administer high-concentration oxygen.

Transport without agitating.

Severe Airway Severe Airway ObstructionObstruction

No crying or speechInitial difficulty breathing that

worsensCough becomes weak and ineffectiveAltered mental status,

unconsciousness

INFANTS

Back blows andchest thrusts

CHILDREN

Abdominalthrusts

Remove visible foreign body.

Clearing Foreign BodyClearing Foreign BodyObstructionsObstructions

Attempt artificial ventilation with BVM.

Use correct size.Use correct size. Use tongue depressor to hold down tongue.Use tongue depressor to hold down tongue.

Insert right side upInsert right side up ((not upside downnot upside down))..

Oral AirwaysOral Airways

Use proper size.Use proper size. Insertion technique is sameInsertion technique is same

as for adult.as for adult.

Nasal AirwaysNasal Airways

Nonrebreather MaskNonrebreather Mask

Hold tubing 2 inches from face,Hold tubing 2 inches from face,

OROR Insert tubing into paper Insert tubing into paper

cup. Do not use cup. Do not use styrofoam cup.styrofoam cup.

Blow-By TechniqueBlow-By Technique

Use proper size mask and bag.Use proper size mask and bag. If trauma is involved, use jawIf trauma is involved, use jaw

thrust (not head tilt).thrust (not head tilt).

If unable to maintain mask sealIf unable to maintain mask sealwith one hand, use two.with one hand, use two.

(Continued)(Continued)

Artificial VentilationArtificial Ventilation

Mouth-to-Mask VentilationMouth-to-Mask Ventilation

Bag-Mask Device:Bag-Mask Device:• Squeeze bag slowly/evenly until chest rises.Squeeze bag slowly/evenly until chest rises.• From birth to puberty (about 12 years old), From birth to puberty (about 12 years old),

ventilate 12–20 times a minute, each lasting ventilate 12–20 times a minute, each lasting 1 second.1 second.

• If the patient has reached puberty, ventilate If the patient has reached puberty, ventilate 10–12 times a minute, each lasting 1 second.10–12 times a minute, each lasting 1 second.

• Use oxygen reservoir to provide 100% Use oxygen reservoir to provide 100% oxygen.oxygen.

•

Artificial VentilationArtificial Ventilation

• Mental statusMental status• BreathingBreathing• ColorColor

Observe:Observe:

Observe:Observe:• Quality of cry or speechQuality of cry or speech• Emotional stateEmotional state• Response to your presenceResponse to your presence• Tone and body positionTone and body position

(Continued)(Continued)

Assessment: General ImpressionAssessment: General Impression

Observe:Observe:• Interaction with environmentInteraction with environment

and parentsand parents• Normal behavior for age?Normal behavior for age?• Playing or moving around?Playing or moving around?• Attentive?Attentive?• Eye contact?Eye contact?• Recognize and respond to parents?Recognize and respond to parents?

Assessment: General ImpressionAssessment: General Impression

As soon as you see patient, check:As soon as you see patient, check:• Mechanism of injuryMechanism of injury• SurroundingsSurroundings• Healthy or sick appearanceHealthy or sick appearance

(Continued)(Continued)

Approach to EvaluationApproach to Evaluation

Assess respirations:Assess respirations:• Chest expansion and symmetryChest expansion and symmetry• Effort of breathingEffort of breathing• Nasal flaringNasal flaring• RetractionsRetractions

(Continued)(Continued)

Approach to EvaluationApproach to Evaluation

Assess respirations:Assess respirations:• Crowing or noisy respirationsCrowing or noisy respirations• StridorStridor• GruntingGrunting• Respiratory rateRespiratory rate

Assess perfusion:Assess perfusion:• Skin color (CTC)Skin color (CTC)

(Continued)(Continued)

Approach to EvaluationApproach to Evaluation

When you reach child,When you reach child,

• Breath soundsBreath sounds present or absent?present or absent?• Stridor?Stridor?• Wheezing?Wheezing?

continue breathing assessmentcontinue breathing assessmentusing stethoscope:using stethoscope:

(Continued)(Continued)

Approach to EvaluationApproach to Evaluation

Assess circulation:Assess circulation:• Brachial or femoral pulseBrachial or femoral pulse• Peripheral pulsesPeripheral pulses• Capillary refillCapillary refill• Blood pressure Blood pressure (if over age 3)(if over age 3)

• Skin color, temperature, conditionSkin color, temperature, condition

Approach to EvaluationApproach to Evaluation

Generally start at trunk andGenerally start at trunk andevaluate head last.evaluate head last.

Alter order of steps to fit situation.Alter order of steps to fit situation. Avoid making child more anxious. Avoid making child more anxious.

Detailed Physical ExamDetailed Physical Exam

PPEDIATRICEDIATRICRESPIRATORYRESPIRATORYEMERGENCIESEMERGENCIES

Patient Patient ASSESSMENTASSESSMENT

Partial Airway ObstructionPartial Airway Obstruction

Signs and SymptomsSigns and Symptoms

Stridorous, crowing, or noisyStridorous, crowing, or noisyrespirationsrespirations

Retractions on inspirationRetractions on inspiration Pink mucous membranes and Pink mucous membranes and nail beds nail beds AlertAlert

Patient Patient CARECARE

Partial Airway ObstructionPartial Airway Obstruction

Emergency Care StepsEmergency Care Steps

Allow position of comfortAllow position of comfort(parent’s lap okay)(parent’s lap okay)..

Do not lay child flat.Do not lay child flat. Offer high-concentration oxygen.Offer high-concentration oxygen. Transport without agitating.Transport without agitating.

(Do not assess blood pressure.)(Do not assess blood pressure.)

Patient Patient ASSESSMENTASSESSMENT

Complete Airway ObstructionComplete Airway Obstruction

Signs and SymptomsSigns and Symptoms

No crying or speechNo crying or speech Initial breathing difficulty that worsensInitial breathing difficulty that worsens Cough becomes weak and ineffectiveCough becomes weak and ineffective Altered mental status, unconsciousnessAltered mental status, unconsciousness

Patient Patient CARECARE

Complete Airway ObstructionComplete Airway Obstruction

Emergency Care StepsEmergency Care Steps

Clear airway with infant/childClear airway with infant/childforeign body procedures.foreign body procedures.

Attempt artificial ventilation withAttempt artificial ventilation withBVM. Assure good seal between BVM. Assure good seal between mask and face.mask and face.

Upper airway obstructionUpper airway obstruction• Stridor on inspirationStridor on inspiration

Lower airway diseaseLower airway disease• Wheezing and respiratory effort on Wheezing and respiratory effort on exhalation OR rapid breathing exhalation OR rapid breathing without stridorwithout stridor

Respiratory EmergenciesRespiratory Emergencies

Tell new EMT-Bs that pediatric care experts emphasize that the priority of children in respiratory distress is “AAA,” not just “ABC.” In other words, if you manage the patient’s airway and oxygenate, circulation improvement will follow!

PPRECEPTOR RECEPTOR PPEARLEARL

Patient Patient ASSESSMENTASSESSMENT

Early Respiratory DistressEarly Respiratory Distress

Signs and SymptomsSigns and Symptoms

Nasal flaringNasal flaring RetractionsRetractions

• Between ribs Between ribs (intercostal)(intercostal)

• Above clavicles Above clavicles (supraclavicular)(supraclavicular)

• Below ribs Below ribs (subcostal)(subcostal)

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Early Respiratory DistressEarly Respiratory Distress

Signs and SymptomsSigns and Symptoms

StridorStridor Retractions of neck, Retractions of neck, abdominal muscles abdominal muscles Audible wheezingAudible wheezing GruntingGrunting

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Early Respiratory DistressEarly Respiratory Distress

Signs and SymptomsSigns and Symptoms

Respiratory rate > 60/minuteRespiratory rate > 60/minute CyanosisCyanosis Decreased muscle toneDecreased muscle tone Excessive use of accessory musclesExcessive use of accessory muscles

Patient Patient ASSESSMENTASSESSMENT

Respiratory DistressRespiratory Distress

Signs and SymptomsSigns and Symptoms

Poor peripheral perfusionPoor peripheral perfusion Altered mental statusAltered mental status GruntingGrunting

Patient Patient ASSESSMENTASSESSMENT

Respiratory ArrestRespiratory Arrest

Signs and SymptomsSigns and Symptoms

Respiratory rate < 10/minuteRespiratory rate < 10/minute Little or no muscle toneLittle or no muscle tone UnconsciousnessUnconsciousness Slow/absent heart rateSlow/absent heart rate Weak/absent pulseWeak/absent pulse

Signs of Respiratory DistressSigns of Respiratory Distress

Patient Patient CARECARE

Respiratory EmergenciesRespiratory Emergencies

Emergency Care StepsEmergency Care Steps

Administer high-concentration oxygen.Administer high-concentration oxygen. Ventilate if respiratory distress is severe:Ventilate if respiratory distress is severe:

• Altered mental statusAltered mental status• Cyanosis not improving with oxygenCyanosis not improving with oxygen• Poor muscle tonePoor muscle tone• Respiratory failureRespiratory failure• Respiratory arrestRespiratory arrest

PPEDIATRICEDIATRICTRAUMATRAUMA

TraumaTrauma

In the United States, injuries kill In the United States, injuries kill more children and infants thanmore children and infants than

any other cause of death.any other cause of death.

• Unrestrained passenger head andUnrestrained passenger head and neck injuries neck injuries

Motor vehicle crashesMotor vehicle crashes

• Restrained passenger abdominalRestrained passenger abdominal and lower spine injuries and lower spine injuries

(Continued)(Continued)

Blunt TraumaBlunt Trauma(Most Common Type of Injury)(Most Common Type of Injury)

Motor vehicle crashesMotor vehicle crashes• Struck while riding bicycleStruck while riding bicycle

(head, spine, abdominal injuries)(head, spine, abdominal injuries)

• Pedestrian struck by vehiclePedestrian struck by vehicle(abdominal, femur, head injuries)(abdominal, femur, head injuries)

(Continued)(Continued)

Blunt TraumaBlunt Trauma

Falls from heightFalls from height• Head and neck injuriesHead and neck injuries

Diving into shallow waterDiving into shallow water• Head and neck injuriesHead and neck injuries

BurnsBurns Sports injuriesSports injuries Child abuseChild abuse

Blunt TraumaBlunt Trauma

HeadHead• Airway maintenance is critical.Airway maintenance is critical.• Head injury is common.Head injury is common.• Can result in respiratory arrest.Can result in respiratory arrest.• Nausea and vomiting are common.Nausea and vomiting are common.

(Continued)(Continued)

Blunt TraumaBlunt TraumaSpecific Types of InjurieSpecific Types of Injuriess

ChestChest• Children’s ribs are less rigid thanChildren’s ribs are less rigid than

adults’ ribs.adults’ ribs.

• Result in injury to internal organsResult in injury to internal organswithout external wounds.without external wounds.

(Continued)(Continued)

Blunt TraumaBlunt TraumaSpecific Types of InjuriesSpecific Types of Injuries

AbdomenAbdomen• More commonly injured in childrenMore commonly injured in children

than adults.than adults.• May be subtle and difficult to detect.May be subtle and difficult to detect.• Under stress, children swallow airUnder stress, children swallow air

(may cause gastric distention, impede (may cause gastric distention, impede

breathing)breathing)..(Continued)(Continued)

Blunt TraumaBlunt TraumaSpecific Types of InjuriesSpecific Types of Injuries

ExtremitiesExtremities• Managed the same as adultsManaged the same as adults

Blunt TraumaBlunt TraumaSpecific Types of InjuriesSpecific Types of Injuries

Pneumatic Antishock GarmentPneumatic Antishock Garment• Use only if:Use only if:

• Child fits in garment.Child fits in garment.• Trauma occurs with hypoperfusionTrauma occurs with hypoperfusion and pelvic instability.and pelvic instability.

• Do not inflate abdominal compartment.Do not inflate abdominal compartment.

TraumaTraumaOther ConsiderationsOther Considerations

(Continued)(Continued)

BurnsBurns• Cover with sterile dressingCover with sterile dressing

(sterile sheet works well)(sterile sheet works well)..• Follow local protocol with regard toFollow local protocol with regard to

transport to burn center.transport to burn center.

TraumaTraumaOther ConsiderationsOther Considerations

Patient Patient CARECARE

TraumaTrauma

Emergency Care StepsEmergency Care Steps

Establish and maintain airway withEstablish and maintain airway withjaw thrust.jaw thrust.

Suction and ventilate as needed.Suction and ventilate as needed. Provide high-concentration oxygen.Provide high-concentration oxygen. Immobilize spine.Immobilize spine. Transport.Transport.

Diarrhea, vomiting, dehydration Trauma and blood loss Infection Abdominal injuries

CausesCauses

Allergic reactions Poisoning Cardiac problems

UncommonUncommonCausesCauses

Shock (Hypoperfusion)Shock (Hypoperfusion)

Tell new EMT-Bs that one way to remember how little blood children have is to envision that an infant’s total blood volume would fill only a soda can and a school age child’s a six-pack.

PPRECEPTOR RECEPTOR PPEARLEARL

Patient Patient ASSESSMENTASSESSMENT

Shock (Hypoperfusion)Shock (Hypoperfusion)

Signs and SymptomsSigns and Symptoms

Rapid breathingRapid breathing Pale, cool, clammy skinPale, cool, clammy skin Weak/absent peripheral pulsesWeak/absent peripheral pulses Delayed capillary refillDelayed capillary refill

(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

Shock (Hypoperfusion)Shock (Hypoperfusion)

Signs and SymptomsSigns and Symptoms

Decreased urine outputDecreased urine outputInspect diaper/ask parents when last changed.Inspect diaper/ask parents when last changed.

Changes in mental statusChanges in mental status Lack of tears when cryingLack of tears when crying

Signs of Shock (Hypoperfusion)Signs of Shock (Hypoperfusion)

Patient Patient CARECARE

Shock (Hypoperfusion)Shock (Hypoperfusion)

Emergency Care StepsEmergency Care Steps Assure airway and giveAssure airway and give

high-concentration oxygen.high-concentration oxygen. Ventilate as needed.Ventilate as needed. Control bleeding.Control bleeding. Elevate legs.Elevate legs. Keep warm.Keep warm. Transport promptly.Transport promptly.

Patient Patient CARECARE

Near Drowning (submersion)Near Drowning (submersion)

Emergency Care StepsEmergency Care Steps

Ventilation is top priority.Ventilation is top priority. Consider possibilities of trauma,Consider possibilities of trauma,

hypothermia, and drug ingestionhypothermia, and drug ingestion(especially alcohol in teenagers)(especially alcohol in teenagers) ..

Transport. Transport. (Some patients deteriorate (Some patients deteriorate minutes/hours later.)minutes/hours later.)

AbuseAbuse

Improper or excessive action so as to Improper or excessive action so as to injure or cause harminjure or cause harm

NeglectNeglect

Giving insufficient attention or respect Giving insufficient attention or respect to someone who has a claim to that to someone who has a claim to that attentionattention

KKEY TERMSEY TERMS

Physical abuse and neglect arePhysical abuse and neglect areforms of child abuse EMT-B forms of child abuse EMT-B

is most likely to suspect.is most likely to suspect.

EMT-B must be aware of EMT-B must be aware of condition in order tocondition in order to

recognize it.recognize it.

Tell new EMT-Bs that the ED physician is required to report cases of child abuse. Therefore, they should complete the PCR with factual information that they observed about the child’s home environment, the condition of the home, the reaction of the parents or other caretakers, the child’s hygiene, and general interaction of all family members involved, and call it to the attention of the physician.

PPRECEPTOR RECEPTOR PPEARLEARL

Patient Patient ASSESSMENTASSESSMENT

AbuseAbuse

Signs and SymptomsSigns and Symptoms

Multiple bruises in different stagesMultiple bruises in different stagesof healingof healing

Injury inconsistent withInjury inconsistent withmechanism describedmechanism described

Repeated calls to same addressRepeated calls to same address(Continued)(Continued)

Patient Patient ASSESSMENTASSESSMENT

AbuseAbuse

Signs and SymptomsSigns and Symptoms

Fresh burnsFresh burns Apparent lack of enough concernApparent lack of enough concern in parents in parents Conflicting storiesConflicting stories Child’s hesitancy to describe howChild’s hesitancy to describe how injury occurred injury occurred

Patient Patient ASSESSMENTASSESSMENT

NeglectNeglect

Signs and SymptomsSigns and Symptoms

Lack of adult supervisionLack of adult supervision Apparent malnourishmentApparent malnourishment Unsafe living environmentUnsafe living environment Untreated chronic illnessUntreated chronic illness

Head injuries are most lethalHead injuries are most lethal(shaken baby syndrome)(shaken baby syndrome)..

Do not accuse anyone in the field.Do not accuse anyone in the field.

(Continued)(Continued)

Handling Abuse and NeglectHandling Abuse and Neglect

Required reportingRequired reporting• Follow state laws and local regulations.Follow state laws and local regulations.• Document objective information: Document objective information: what what

you SEE and HEAR, not what you merely THINK you SEE and HEAR, not what you merely THINK..

Handling Abuse and NeglectHandling Abuse and Neglect

PPEDIATRICEDIATRICMEDICAL MEDICAL

EMERGENCIESEMERGENCIES

SeizuresSeizures

Rarely life-threatening inRarely life-threatening inchildren, but EMT-B should children, but EMT-B should take seriously.take seriously.

May be brief or prolonged.May be brief or prolonged. May cause injuries.May cause injuries.

Fever Infection Poisoning Hypoglycemia Trauma Hypoxia Idiopathic

CausesCauses

(unknown cause)(unknown cause)

SeizuresSeizures

Patient Patient ASSESSMENTASSESSMENT

Child after SeizureChild after Seizure

Signs and SymptomsSigns and Symptoms

Has child had seizures before?Has child had seizures before? If yes, was this typical seizure?If yes, was this typical seizure? Was antiseizure medication taken?Was antiseizure medication taken?

Patient Patient CARECARE

SeizuresSeizures

Emergency Care StepsEmergency Care Steps

Establish airway.Establish airway. Position on left side if no spine trauma.Position on left side if no spine trauma. Have suction ready.Have suction ready. Give oxygen. Ventilate if respiratoryGive oxygen. Ventilate if respiratory

distress/arrest.distress/arrest. Transport.Transport.

Hypoglycemia Poisoning Postseizure Infection Head trauma Hypoxia Shock

CausesCauses

Altered Mental StatusAltered Mental Status

Patient Patient CARECARE

Altered Mental StatusAltered Mental Status

Emergency Care StepsEmergency Care Steps

Establish airway.Establish airway. Ventilate and suction as needed.Ventilate and suction as needed. Transport.Transport.

Patient Patient CARECARE

Poisoning: Responsive PatientPoisoning: Responsive Patient

Emergency Care StepsEmergency Care Steps

Contact medical direction.Contact medical direction. Give activated charcoal as directed.Give activated charcoal as directed. Administer oxygen.Administer oxygen. Transport and monitor patient.Transport and monitor patient.

Patient Patient CARECARE

Poisoning: Unresponsive PatientPoisoning: Unresponsive Patient

Emergency Care StepsEmergency Care Steps

Rule out trauma.Rule out trauma. Establish airway.Establish airway. Administer oxygen; ventilate Administer oxygen; ventilate as needed. as needed. Contact medical direction.Contact medical direction. Transport.Transport.

FeverFever

Many things can cause fever.Many things can cause fever. Meningitis is one of worst. MayMeningitis is one of worst. May

appear as fever with rash.appear as fever with rash.

Transport.Transport. Be prepared for seizures.Be prepared for seizures.

Sudden Infant DeathSudden Infant DeathSyndrome (SIDS)Syndrome (SIDS)

Sudden death occurs withoutSudden death occurs without identifiable cause in infant identifiable cause in infant < 1 year old. < 1 year old. Cause is not well understood.Cause is not well understood. Most common time of discoveryMost common time of discovery is early morning. is early morning.

Patient Patient CARECARE

SIDSSIDS

Emergency Care StepsEmergency Care Steps

Try to resuscitate unless rigorTry to resuscitate unless rigor

mortis is present.mortis is present. Avoid comments that blame parents.Avoid comments that blame parents. Expect parents to feel remorse and guilt.Expect parents to feel remorse and guilt.

IINFANTS ANDNFANTS ANDCHILDREN WITHCHILDREN WITHSPECIAL NEEDSSPECIAL NEEDS

Premature babies with lung diseasePremature babies with lung disease Heart diseaseHeart disease Neurologic diseaseNeurologic disease Chronic disease or altered functionChronic disease or altered function

since birthsince birth

Children with Special NeedsChildren with Special Needs

Tracheostomy tubeTracheostomy tube Central intravenous linesCentral intravenous lines Gastrostomy tubesGastrostomy tubes ShuntsShunts

Technologically DependentTechnologically DependentChildren Children (“High-Tech Kids”)(“High-Tech Kids”)

ObstructionObstruction BleedingBleeding Air leakAir leak Dislodged tubeDislodged tube InfectionInfection

Tracheostomy TubeTracheostomy TubeComplicationsComplications

Patient Patient CARECARE

Tracheostomy Tube

Emergency Care StepsEmergency Care Steps

Maintain open airway.Maintain open airway. Suction.Suction. Maintain position of comfort.Maintain position of comfort. Transport.Transport.

Parents are usually veryParents are usually veryfamiliar with equipment.familiar with equipment.

Home Artificial VentilationHome Artificial Ventilation

Patient Patient CARECARE

Home Artificial VentilationHome Artificial Ventilation

Emergency Care StepsEmergency Care Steps

Assure airway.Assure airway. Artificially ventilate withArtificially ventilate with

high-concentration oxygen.high-concentration oxygen. Transport.Transport.

IVs that are very long IVs that are very long • Tip in vein near heartTip in vein near heart

ComplicationsComplications• Cracked lineCracked line• InfectionInfection• Clotting offClotting off• BleedingBleeding

Central Intravenous LinesCentral Intravenous Lines

Patient Patient CARECARE

Central Intravenous Lines

Emergency Care StepsEmergency Care Steps

If bleeding, apply pressure.If bleeding, apply pressure. Transport.Transport.

ShuntShuntTube running from brain to abdomenTube running from brain to abdomento drain excess cerebrospinal fluidto drain excess cerebrospinal fluid

Gastrostomy TubeGastrostomy TubeTube placed directly into the stomach for a Tube placed directly into the stomach for a child who cannot be fed by mouthchild who cannot be fed by mouth

KKEY TERMSEY TERMS

Patient Patient CARECARE

ShuntShunt

Emergency Care StepsEmergency Care Steps

Assure airway and ventilate as needed.Assure airway and ventilate as needed. Transport.Transport.

Patient Patient CARECARE

Gastrostomy Tube

Emergency Care StepsEmergency Care Steps

Assure patent airway.Assure patent airway. Suction as needed. Suction as needed. Provide high-concentration oxygen.Provide high-concentration oxygen. Transport patient sitting or lying onTransport patient sitting or lying on

right side with head elevated.right side with head elevated.

1. Describe two characteristics of a 1. Describe two characteristics of a

typical child in each of the fivetypical child in each of the fiveage groups.age groups.

2. Describe the management of pediatric2. Describe the management of pediatric respiratory distress.respiratory distress.3. How do children compensate for 3. How do children compensate for blood blood loss compared to an adult?loss compared to an adult?4. What are some indications of4. What are some indications of child abuse? child abuse?

RREVIEW QUESTIONSEVIEW QUESTIONS