Pediatric Emergencies

Machela Worthington

Neonate (0 - 1 month)

Well developed senses of smell & hearing

Congenital illness- illness that child is born with, symptoms show up as child grows & develops

Young Infant (1 - 5 months)

Growing rapidly, curiosity & amazement are developing as they observe their environment

Common illnesses: sudden infant death syndrome vomiting & diarrhea meningitis child abuse accidents **Increased risk of having hypothermia**

Older Infant (6 - 12 months)

Becoming more active, standing, & walking Common problems: febrile seizures vomiting & diarrhea dehydration bronchiolitis motor vehicle collision croup child abuse poisonous ingestion falls

Toddler (1 - 3 yrs.)

Constantly moving, becoming independent Do not like being away from parents Common emergencies: ingestions falls motor vehicle collisions vomiting & diarrhea febrile seizures child abuse croup meningitis ingestion of foreign bodies

Preschool (3 - 5 yrs.)

Motor development, plays sophisticated games Common problems: croup asthma ingestions motor vehicle collisions epiglittitis meningitis burns child abuse foreign body ingestions drowning febrile seizures

School Age (6 - 12 yrs.)

Brain is now 90% of adult weight physically growing quick, very active Common occurrences: drowning motor vehicle collisions bike accidents fractures falls sports injuries child abuse burns

Adolescent (12 - 15 yrs.)

Undergoing various degrees of growth Great deal of importance on body image & peers Risk-taking behavior Common emergencies: mononucleosis (mono) asthma motor vehicle collisions sports injuries suicide gestures sexual abuse pregnancy drug & alcohol related emergencies

Airway Problems

-More common in kids than adults

Foreign Body Obstruction-an object put in the mouth of a child and which object gets caught in airway.

Incomplete Obstruction-when object is not completely blocking airway, to get the object out, encourage child to cough.

Pediatric Vital Signs

Age Respiratory Rate Heart Rate Systolic BPNB 30 - 60 100 - 160 50 - 701 - 6 weeks 30 - 60 100 - 160 70 - 956 months 25 - 40 90 - 120 80 - 1001 year 20 - 30 90 - 120 80 - 1003 years 20 - 30 80 - 120 80 - 1106 years 18 - 25 70 - 110 80 - 10010 years 15 - 20 60 - 90 90 - 120

Normal Pediatric Vital Signs by Age

Trouble Breathing

Croup-a viral illness, causes swelling of upper airways, larynx, trachea, & bronchi.

most common in fall & winterbegins with upper respiratory infectionlasts several dayscontracted by children 6 months - 4 yrs. oldsymptoms:coughrunny nosesore throattrouble breathing

Trouble Breathing (cont.)

Epiglittitls-bacterial infection of epiglottis

less common than croup, more likely to cause life-threating airway obstructioncovers tracheal opening, blocks airwaysymptoms:high feverbrassy cough

Respiratory Infections

Pediatric Asthma-common disease, involves reversible spasm of smaller airways in chest

common in children, outgrows diseasecommon triggers:coldexerciseanimal danderdustsmoke & airborne irritantsrespiratory infections

Signs of Respiratory Difficulty/Failure

*High Respiratory Rate *Shallow Respirations*Intercostal Retractions *Accessory Muscle Use*Nasal Flaring *Sternal Retractions*Noisy Respirations

*Cyanosis *Low Respiratory Rate*Altered Mental Status *Bradycardia*Abdominal Breathing

Signs of Respiratory Diffi culty in a Child

Signs of Respiratory Failure in a Child

Hypoperfusion & Hypoydemia

common cause: large fluid loss resulting in

hypovolemia common cause of pediatric loss: dehydration vomitting blood loss from trauma diarrhea

Cardiac Arrest

most common cause: Respiratory arrest-child goes into

respiratory failure, leads to profound hypoxia, leads to cardiac failure, & cardiac arrest.

Provide good ventilation with 100% oxygen & cardiac compressions

SIDS (Sudden Infant Death Syndrome)

Occurs at a rate of 2 in 1,000 births leading cause of death in children 1 week - 1 yr.. Males are more commonly affected than females winter months have more cases than other

months Common causes: infants of mothers of low socioeconomic groups infants of low birth weights

Altered Mental Status

Seizures(febrile seizure)-most common

caused by a rapid increase of body temp.associated with infection, fever causes short-circuit to brain causing seizuredoes not last more than a few minuteshas a brief period of lethargy and confusion, then a return of a normal mental statuschild is at higher risk of experiencing a high fever, not at risk for chronic seizures.

Altered Mental Status

Diabetes-condition of altered glucose utilization

nothing should be placed in mouth

Altered Mental Status

Behavioral-these disorders result in abnormal behavior

Poisoning-high risk if children are able to get a hold of household cleaners, cosmetic products, and medications

Signs of poisoning:discoloration of mouth or lipssmell on breathvomit with chemical smellCALL POSION CONTROL CENTER IMMEDIATELY!

Infections

many are NOT life-threatening spread from child to child: colds flu chicken pox gastroenteritis(stomach bug) strep throat mononucleosis(viral)

Meningitis

Infectious disease caused by a virus or bacteria, transmitted by coughing or sneezing

infection of the lining surrounding brain & spinal cord very serious! Symptoms: stiff neck fever headache rash altered mental status seizures(maybe)

Pediatric Trauma

#1 killer of children over 1 yr.. Old

largely preventable majority occur in motor vehicle

collisions

Pediatric Trauma by Age

Age Gatagory Types of Trauma ExamplesToddlers Blunt Trauma Motor Vehicle

Drowning Pool & BucketBurn Trauma ScaldingPoisoning Household cleaners

School Age Blunt Trauma M.V.CFalls Bicycle

Burn Trauma Intentional firesAdsolescents Blunt Trauma M.V.C

Penetrating trauma Suicide/homicidePoisoning Overdose

Pediatric Trauma by Age Catagory

Blunt Trauma

Motor Vehicle Collisions

anyone has potential for being seriously injuredsport cars hit teenagers, direct trauma from bumper causes lower leg injuriesteen is thrown, chest & head injurytruck strikes school-age child, direct injury causes head injuriesresults in internal bleeding, hypoperfusion and shock

Hypoperfusion

Child becomes very pale & diaphoretic child’s capillary refill will become

prolonged, beyond normal-2 sec. Child may complain of nausea heart continues to pump adequate amount

of blood to vital organs child’s peripheral pluses becomes weaker

as body shifts

Chest Injury

Rib cage bends inward, then springs back to original state

takes a great deal of force to break a child’s rib

internal injury is also associated with pediatric rib fracture

Abdominal Injury

Child’s liver & spleen are only protected by rib cage

liver & spleen are very susceptible to injury

Head Injury

Signs & Symptoms:

loss of consciousness headaches blurred vision nausea vomit

Spinal Injury

**Greater risk for children--heads are larger**

**Motor Vechicles footballmotor vehicle collisions rock climbingmotor vehcile v.s. pedestrain downhill skiing/snowboardingmotorcycles **Crimesnow moblies gunshot wounds**Sports knife woundsswimming/diving blunt trauma--assault

Causes of Pediatric Spinal Trauma

Bone Injury

Great deal of force to fracture a bone of a child

Burns

Result of child abuse playing with matches pulling hot pan off stove

Child Abuse

Child abuse-emotional, physical, or sexual injury inflicted by a parent or another person

Neglect-parent failure to act 500,000 - 4 million children are

abused each year in the U.S.

Procedures or Items used to treat emergencies Tracheostomies-opening in front of neck that

has been surgically created to allow placement of rigid tube(tracheostomy tube)-maintains adequate oxygenation & ventilation.

Mechanical Ventilators-very small & portable. Children that have trouble breathing independently.

Central Venous Catheters-children often have these that require frequent intravenous medications or blood sampling. Intravenous catheter is placed in upper are or chest.

Procedures or Items used to treat emergencies (cont.) Feeding Tubes-soft, flexible tubes

placed into stomach that provides liquid nutrition to children

Cerebrospinal Fluid Shunts (CSF)-special catheter that drains excess CSF off brain & into abdomen. Also called Ventriculoperitoneal Shunts (VP)-under skin, extends from ventricles of brain to peritoneal cavity.