PEDIATRICS…
...more than just little people
Airway Differences Larger tongue relative to
the mouth Less well-developed
rings of cartilage in the trachea
Head tilt-chin lift may occlude the airway.
Breathing Differences Infants breathe faster than children
or adults. Infants use the diaphragm when
they breathe. Sustained, labored breathing may
lead to respiratory failure.
Circulation Differences The heart rate increases for
illness and injury. Vasoconstriction keeps vital
organs nourished. Constriction of the blood
vessels can affect blood flow to the extremities.
Skeletal Differences
Bones are weaker and more flexible. They are prone to fracture with
stress. Infants have two small openings
in the skull called fontanels. Fontanels close by 18 months.
Growth and Development Thoughts and behaviors of
children usually grouped into stages Infancy Toddler years Preschool age School age Adolescence
Infant First year of life They respond mainly to
physical stimuli. Crying is their main
avenue of expression. They may prefer to be with
caregiver. If possible, have caregiver
hold the infant as you start your examination.
Toddler 1 to 3 years of age They begin to walk and
explore the environment. They may resist separation
from caregivers. Make any observations you
can before touching a toddler. They are curious and
adventuresome.
Preschool 3 to 6 years of age They can use simple language effectively. They can understand directions. They can identify painful areas when
questioned. They can understand what you are going to
do using simple descriptions. They can be distracted by using toys.
School-Age Child 6 to 12 years of age They begin to think like adults. They can be included with the parent when
taking medical history. They may be familiar with physical exam. They may be able to make choices.
The Adolescent 12 to 18 years of age They are very concerned about body
image. They may have strong feelings about
being observed. Respect an adolescent’s privacy. They understand pain. Explain any procedure that you are doing.
Approach to Assessment Obtain a complete set of baseline vitals.
Assess the need for ALS backup or immediate transport.
A child’s condition may deteriorate rapidly during transport.
Have pediatric resuscitation equipment ready.
Vital Signs by Age
Appe
aran
ce Breathing
Pediatric Triangle
The Pediatric Triangle
Circulation/Skin Color
AppearanceLook at the patient from across the
room……this is an important indicator of
oxygenation, brain perfusion,
and overall CNS function
AppearanceAlertness
Eye contactDistractibilityConsolabilitySpeech/Cry
Spontaneous motor activity
Sick or Not Sick!
BreathingAbnormal body position
Audible or abnormal airway sounds
RetractionsEffort/work of breathing
BreathingA child with abnormal breath
sounds needs high flow oxygen and immediate ALS
intervention!
Sick or Not Sick?
Circulation & Skin SignsColor
TemperatureCapillary refill time
Pulse quality
Skin Signs
Feel for temperature and moisture.
Estimate capillary refill.
Pulse In infants, feel over
the brachial or femoral area.
In older children use the carotid artery.
Count for at least 1 minute.
Note strength of the pulse.
Blood Pressure Use a cuff that covers two thirds
of the arm. If scene conditions make it
difficult to measure blood pressure accurately, do not waste time trying.
Circulation & Skin Signs
Poor color equals…poor circulation…
equals…SICK!
DECIDESICK NOT SICK
Appe
aran
ce Breathing
Circulation/Skin Color
Pediatric Triangle
Short Reportto ALS
Short Reportto ALS
100% O2NRM or BVM
Focused Hx/Physical Exam
AppropriatePosition
Rapid Trans-port/ALS
DetailedPhysical Exam
Ongoing Assess Keep
Warm
*Rapid medical assessment*Baseline vitals*SAMPLE history
Focused Hx/Physical Exam
AppropriateTreatment
AppropriateTransport
DetailedPhysical Exam
Low/ModerateFlow O2
*Focused medical assessment*Baseline vitals*SAMPLE history*OPQRST
Ongoing Assess Keep
Warm
Medical Patients
DECIDESICK NOT SICK
Appe
aran
ce Breathing
Circulation/Skin Color
Pediatric Triangle
Short Reportto ALS
Short Reportto ALS
100% O2NRM or BVM
Focused Hx/Physical Exam
AppropriatePosition
Rapid Trans-port/ALS
DetailedPhysical Exam
Ongoing Assess Keep
Warm
*Rapid medical assessment*Baseline vitals*SAMPLE history
Focused Hx/Physical Exam
AppropriateTreatment
AppropriateTransport
DetailedPhysical Exam
Low/ModerateFlow O2
*Focused medical assessment*Baseline vitals*SAMPLE history*OPQRST
Ongoing Assess Keep
Warm
Medical Patients
DECIDESICK NOT SICK
Appe
aran
ce Breathing
Circulation/Skin Color
Pediatric Triangle
Short Reportto ALS
Short Reportto ALS
Rapid Extrication
Focused Hx/Physical Exam
Spinal Immobilization
Rapid Trans-port/ALS
DetailedPhysical Exam
*Rapid trauma assessment*Baseline vitals*SAMPLE history
Focused Hx/Physical Exam
DetailedPhysical Exam
AppropriateTransport
Extricate/Immobilize
Low/ModerateFlow O2
*Focused trauma assessment*Baseline vitals*SAMPLE history
100% O2NRM or BVM
SpinalStabilization
Ongoing Assess Keep
Warm
Ongoing Assess Keep
Warm
Trauma Patients
DECIDESICK NOT SICK
Appe
aran
ce Breathing
Circulation/Skin Color
Pediatric Triangle
Short Reportto ALS
Short Reportto ALS
Rapid Extrication
Focused Hx/Physical Exam
Spinal Immobilization
Rapid Trans-port/ALS
DetailedPhysical Exam
*Rapid trauma assessment*Baseline vitals*SAMPLE history
Focused Hx/Physical Exam
DetailedPhysical Exam
AppropriateTransport
Extricate/Immobilize
Low/ModerateFlow O2
*Focused trauma assessment*Baseline vitals*SAMPLE history
100% O2NRM or BVM
SpinalStabilization
Ongoing Assess Keep
Warm
Ongoing Assess Keep
Warm
Trauma PatientsTrauma Patients
Sick or Not Sick?
Make a decision within
60 seconds!
Children With Special Needs Children born prematurely who have associated
lung problems Small children or infants with congenital heart
disease Children with neurologic diseases Children with chronic diseases or with functions
that have been altered since birth
Tracheostomy Tube
Artificial Ventilators Provide respirations for children
unable to breathe on their own If ventilator malfunctions, remove
child from the ventilator and begin ventilations with a BVM device.
Ventilate during transport.
Central IV Lines
Gastrostomy Tubes
Shunts Tubes that drain excess fluid
from around brain If shunt becomes clogged,
changes in mental status may occur.
Patient may go into respiratory arrest.
Remember, family does matter…
When a child is ill or injured, you may have several patients, not just one.
Children often mimic the behavior of their caregivers.
Be calm, professional, and sensitive.
Thanks for all that you do!