The document provides guidance on responding to pediatric emergencies. It emphasizes that treatment begins with communication and psychological support of both the child and caregivers. It describes common fears in children during emergencies and strategies for assessment and care according to a child's age and development. Key steps include allowing infants and young children to remain with caregivers, speaking calmly, minimizing pain, and giving age-appropriate explanations. The document outlines anatomical and physiological considerations, vital signs, techniques for airway management and ventilation support, and approaches to specific medical conditions commonly encountered in pediatric emergencies.
3. Communication and
Psychological Support
Treatment begins with communication and
psychological support.
4. 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
5. Responding to Parents or
Caregivers
Communication!
One paramedic speaks with the adults.
Introduce yourself and appear calm.
Be honest and reassuring.
Keep parents informed.
7. Newborns
First hours after birth
Newborn, neonate
Assessed with APGAR scoring system
8. Neonates
Birth to one month.
Tend to lose 10% of birth weight, but
regain in 10 days.
Development centers on reflexes.
Personality begins to form.
Mother, occasionally father, can comfort
child.
9. Neonates, continued
Common illnesses include jaundice,
vomiting, and respiratory distress.
Do not develop fever with minor illness.
Allow patient to remain in caregiver’s
lap.
10. Infants
Ages 1 to 12 months.
Follow movements.
Muscle development develops in
cephalo-caudal progression.
Allow patient to remain in caregiver’s
lap.
11. Infants and young children
should be allowed to remain
in their mothers’ arms.
12. Toddlers
Ages 1 to 3 years.
Great strides in motor development.
May stray from parents more frequently.
Parents are the only ones who can
comfort them.
Language development begins.
Approach child slowly.
13. Toddlers, continued
Examine from head-to-toe.
Avoid asking “yes” or “no” questions.
Allow child to hold a favorite blanket or
item.
Tell child if something will hurt.
14. Preschoolers
Ages 3 to 5 years.
Increase in fine and gross motor skills.
Children know how to talk.
Fear mutilation.
Seek comfort and support from within
home.
Distorted sense of time.
16. School-Age Children
Ages 6–12 years.
Active and carefree age group.
Growth spurts are common.
Give this age group responsibility of
providing history.
Respect modesty.
17. A small toy may calm a child
in the 6–10 year age range.
18. Common Illness and Injuries
in School-Age Children
Drowning Fractures
Auto accidents Sports injuries
Bicycle accidents Child abuse
Falls Burns
19. Adolescents
Ages 13 to 18.
Begins with puberty, which is very child-
specific; 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.
20. Common Adolescent Illness
and Injuries
Mononucleosis Drug and alcohol
Asthma problems
Auto accidents Suicidal gestures
Sports injuries Sexual abuse
21. The approach to the
pediatric patient should
be gentle and slow.
25. a. In the supine position, an infant’s or child’s
larger head tips forward, causing airway
obstruction.
b. Placing padding under the patient’s back and
shoulders will bring the airway to a neutral or
slightly extended position.
27. Scene Size-Up
Conduct a quick scene size-up.
Take BSI precautions.
Look for clues to mechanism of injury or
nature of illness.
Allow child time to adjust to you before
approaching.
Speak softly, simply, at eye level.
28. The basic steps in pediatric assessment.
Notice the components and signs in the
Pediatric Assessment Triangle.
39. History
Nature of illness/injury
Length of time ill or injured
Presence of fever
Effects of illness/injury on behavior
Bowel/urine habits
Presence of vomiting/diarrhea
Frequency of urination
48. If available, noninvasive monitoring,
including pulse oximetry and
temperature measurement, should be
used in prehospital pediatric care.
49. Ongoing Assessment
Reassess the patient since conditions can
change rapidly.
Reassess every 15 minutes in stable
patients.
Reassess every 5 minutes in unstable
patients.
57. If the infant becomes unresponsive,
perform a tongue-jaw lift and look
for a foreign body.
58. Suctioning
Decrease suction pressure to less than
100 mm/Hg in infants.
Avoid excessive suctioning time—less
than 15 seconds per attempt.
Avoid stimulation of the vagus nerve.
Check the pulse frequently.
65. 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.
66. Ventilation
Avoid excessive bag pressure and volume.
Obtain chest rise and fall.
Allow time for exhalation.
Flow-restricted, oxygen-powered devices are
contraindicated.
Do not use BVMs with pop-off valves.
Apply cricoid pressure.
Avoid hyperextension of the neck.
67. In placing a mask on a child, it should fit on the
bridge of the nose and cleft of the chin.
68. In Sellick’s maneuver, pressure is placed
on the cricoid cartilage, compressing the
esophagus, which reduces regurgitation
and helps bring the vocal cords into view.
71. 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.
72. Pediatric Endotracheal
Tube Size
Use a resuscitation tape that estimates
ET tube size based on height.
Estimate the correct diameter, based on
the child’s little finger.
74. Indications
Need for prolonged artificial ventilation
Inadequate ventilatory support with a
BVM
Cardiac or respiratory arrest
Control of an airway in a patient without
a cough or gag reflex
Providing a route for drug
administration
Access to the airway for suctioning
90. Rapid Sequence Intubation
Indicated in pediatric patients when
intubation is difficult due to
combativeness or clenched teeth.
Neuromuscular compliance is gained by
the use of a paralytic.
93. Intraosseous Infusion Indications
Children less than 6 years of age
Existence of shock or cardiac arrest
Unresponsive patient
Unsuccessful peripheral IV
94. Intraosseous Infusion
Contraindications
Fracture in the bone chosen for IO
Fracture of the pelvis or extremity
fracture of bone, proximal to the chosen
site
100. Electrical Therapy
Initial dose is 2 joules per kilogram of
body weight.
If unsuccessful, increase to 4 joules per
kilogram.
If still unsuccessful, focus on correcting
hypoxia and acidosis.
Transport to a pediatric critical care unit,
if possible.
102. One paramedic stabilizes the car seat in
an upright position and applies and maintains
manual inline stabilization throughout the
immobilization process.
103. A second paramedic applies an appropriately
sized cervical collar. If one is not available,
improvise using a rolled hand towel.
104. The second paramedic places a small
blanket or towel on the child’s lap, then
uses straps or wide tape to secure the
chest and pelvic area to the seat.
105. The second paramedic places towel rolls on both sides of
the child’s head to fill voids between the head and seat.
He then tapes the head into place, taping over the chin,
which would put pressure on the neck. The patient and
seat can be carried to the ambulance and strapped to the
stretcher, with the stretcher head raised.
130. Many diabetic children have home glucometers
to test their blood glucose levels. Older
children know what the readings mean
and will be curious about any blood
glucose testing device that you may use.
131.
132. Poisoning and Toxic Exposure
Accidental poisoning is a common
childhood emergency.
Leading cause of preventable death in
children.
133. Some of the poisons commonly
ingested by children.
146. An abused child. Note the marks on the
legs associated with beatings with an
electric wire. The burns on the buttocks
are from submersion in hot water.
147. Burn injury from placing a
child’s buttocks in hot water
as a punishment.
149. The effects of child abuse,
both physical and mental,
can last a lifetime.
150. Infants and Children with
Special Needs
Common home-care devices
Tracheostomy tubes
Apnea monitors
Home artificial ventilators
Central intravenous lines
Gastric feeding and gastrostomy tubes
Shunts
151. Tracheotomy tubes.
• Top: Plastic tube
• Bottom: metal tube with
inner cannula
152. Summary
Roles of the Paramedic in Pediatric Care
Growth and Development
Assessment
Airway Adjuncts and Intravenous
Access
Medical Emergencies
Traumatic Injuries
Child Abuse and Neglect
Notas do Editor
Keep in mind, children are not small adults, they have special considerations and needs. They often can’t tell you what is wrong. And their small size makes IV, ET and immobilization more difficult. In addition, incidents involving children are very stressful for the parents as well as the responders. What are some causes of pediatric deaths? MVA, Burns, Drownings, Suicides and Homicides. #1 cause is head injury, #2 is blunt chest trauma
You must consider pts emotional and physiologic development. Don’t forget parents must give informed consent for treatment!
Parents or caregivers will be your primary source of information. Some older children may be able to give history. Allow them to be apart of treatment decisions.
Often, calls involving children are chaotic. Children detect fear and anxiety from their parents. It is up to you to reduce their anxiety in order to treat them. How do you deal with these calls? Backboarding IVs Oxygen mask
One paramedic speaks with adult, second paramedic focuses on child Some parents may be destraught and interfear with care Be alert for patterns of abuse. In such cases caregiver may try to block care (we will cover this later)
Keep child warm Observe skin color, tone and respitratory activity Tenting or lack of tears while crying may denote dehydration Use a pacifier to calm pt while assessing, check lung sounds first while child is quiet Any illness the involves fever should be agressively worked up since it is difficult to distinguish between minor and severe illnesses.
By 12 months, infants can usually stand or walk on their own Extreme danger of foreign body airwy obstruction Other illnesses and injuries are what? mva, sids, vomiting, diarrhea, dehydration, meningitis, croup, poisonings falls and other household injuries, febrile seizure Hate to be laid on back Cling to mother, father will often do, there allow pt to remain in parents lap
Not only do vitals differ from adults, their bodies are well suited to growth and their organs are healthier and therefore they have a greater ability to compensate for illness or injury. Their tissues are softer and more flexible.
“ assessment from the doorway” Triangle – “sick” child Appearance – Mental Status and muscle tone (response to EMT, interaction with surrondings) Breathing – Quality of cry, sternal retractions, flared nostrils, general respiratory effort Circulation – Skin color, cap refill. AVPU – never shake and infant or child Airway – can you maintain with head positioning and suctioning? Or do you need to intubate Remember, Airway and Resp problems are the most common cause of cardiac arrest in infants and young children
Look for fast or slow resp rate as well as resp effort Slow heart rate is generally indicative of hypoxia and is an ominous sign of impending cardiac arrest The presence of peripheral pulses is a good of end organ perfusion
Children don’t usually suffer sudden cardiac arrest. Rather it’s a progressive deterioration, therefore you need to determine wether the patient is improving or deteriorating
Ask about any chronic illnesses, if the child is under the care of a doctor and what for
Do a toe to head exam for younger pts If unresponsive do complete rapid assessment, if minor perform exam focused on affected area
Cap refill – under 6 sole of foot on infant Hydration – skin turger, tears and saliva, fontanelles Pulse ox – hypothermia or shock will alter readings due to peripheral vasocinstriction
Infants under 4 will grasp objects place in palm
Pulse - Anxiety will increase pulse and resp in child monitor pulse for a full 60 sec BP - Hypotension is a late sign of shock
Broslow tape
Continuous O2 sat monitor to guard against cardiopulm arrest
Reasses resp effort, skin color, mental status and pulse ox
Determine if pt airway complete obstruction Remember, you can also use direct laryngoscopy in unresp
Remember Never attempt blind finger sweep
Check pulse – stop if bradycardia ensues
Can also use bulb syringe in infants with deminised LOC and excess secretions
Blow by
Use only for prolonged resucitation, can cause complications such as soft tissue damage, vomiting, vagus stimuli Children often improve greatly with just the aplication of 100% O2
Visualization of the tube is better
It is very difficult to obtain a straight visual plain into glottis, there fore straight blade is preferred. Narrowest part of airway is at cricoid, not vocal cords A misplaced or missized tube can quickly cause hypoxia and death How do you select the proper tube size? The same size as the patient’s little finger (test question)
Remember, stylet is rarely needed
EOA and PtL can not be used in children, LMA can but does not protect against aspiration
For 2 minutes
Do not attempt if head or face trauma And only if ET tube is alredy in place. Why?
Succinylcholine neuromuscular blocker, paralytic of short duration Also need sedative such as versed, valium Pancurium and vecuronium much longer lasting
Remember, look at the total child, mental status, skin color and temp, resp effort, urine output Venous access and fluid resusitation is the primary treatment after resp correction
1-3 cm below tibal tuberosity Twisting motion until feel pop stands on own Withdraw marrow or free flow of fluid (test question)
Too much can cause heart filure and pulm edema Too little can be ineffective Use buretrol or other fluid limiting device Dose for shock is 20ml/kg while monitoring for signs of improved perfusion (test question)
Remember, cardiopulm arrest is almost always due to resp problem sauch as drowning, choking or smoke inhalation. Airway ventilation and fluid replacement first Epi doses (test question)
VF is much less common in children 2J/kg (test question)
Remember, childs larger head can be vulnerable to cspine inj. Also, may have cord injury without vertibral injury Have parent stay with child to keep calm
Can also use KED upside down
The majority of childhood emergencies involve the respiratory system. Remember the triangle, if a child looks “ill”, must immediately intervene, if a child is alert and talking then everything will be all right. There are three categories of respiratory compromise. Each category quickly progresses to the next so you must be able to recognize he symptoms Distress – increased work of breathing, normal mentation, fast breathing and heartrate, retractions and nasal flaring. Cyanosis improves with oxygenation Failure – respiratory system is not able to meet the demands of the body, lethargoc, slow breathing and heartrate, central cyanosis Arrest – coma, agonal resps and asystole
Infections – Has everyone had chickenpox? Other illnesses include meningitis, pneumonia, septicemia s/s include fever, tachycardia, tachypnea, seizure, stiff neck, dehydration Whenever you find a infant r child in resp arrest, assume complete upper airway obstruction until proven otherwise Croup – is a viral infection which causes subglotic edema.occurs in children 6 months to 4 years. Barking cough. Stridor Treatment is humidified o2, cool air or humid bathroom may help child. In severe cases, can admin acemic epi and steroids (test question) Epigglottis – bacterial, 3 to 7 years old, sore throat, dyspnea, fever, drooling. Give humidified o2, et is contraindicated unless complete obstruction. Consider needle cric Status Asthmaticus – is a prolonged asthma attack which cannot be brokn with epinephrine (test question) Bronchiolitis – not bronchitis, s/s similar to asthma, but less than 2 years, spreads through day care Albuterol dosage – 0.03 ml/kg
(test question)
Congenital – cyanic spells with dyspnea Cardiomyopathy – disease or dysfunction of heart muscle, chf, treatment is supportive Neurologic – seizures, status epilep refers to two or more seizures without a period of consciousness. (test question) What are causes?can give valium rectally Meningitis – s/s headache, seizures, stiff neck, bulging fontanelles and pinpoint rash (test question) Gastro – gastroenteritis, dehydration due to vomiting, fluid bolus, what is dose?
Childs blood vessels constrict ver efficiently but they decompensate quickly Slight increase in heart rate is first sign
Dysrythmias in children are uncommon Tachycadias such as svt and vtach are even more rare. Usually caused by congenital defect can be post resuscitation of drowning
Use D25
Be alert for new onset diabetes
Larger head causes nek injuries Burns – protect airway from swelling
Also rule of palms 1% Note that children and infants who are burned are more likely to suffer more significant fluid loss than adults because Their body surface area is larger in proportion to their body volume (test question)
Occurs most often in fall and winter months. More prevelant in low birth weight, young mothers, and mothers without prenatal care. May have had mild upper resp infection prior. Place infant on back or side to sleep. Take out blankets and soft bedding, do not smoke around child and do not over heat. Undertak aggressiv care to assure to family that everything possibe is being done. Have someone assigned to the parents to explain everything and always use the baby’s name.
Remember in NYS, EMTs are now mandated reporters. We talked about this subject early in the course so I won’t spend much time. Types of abuse include, psychological, physical, sexual and neglect
Suspect abuse if multiple injuries in different stages of healing, especially burns and bruises injuries on scattered areas of body rns or bruises in patterns suggestive of abuse intra obd trauma any injury that does not fit description of cause given vague parental accounts or that change accusations that the child injured himself intentionaly delay in seeking help child dressed inappropriately
Suspect neglect if extreme malnutrition multiple insect bites long standing skin infections extreme lack of cleanliness verbl or socil skills far belo norm for age lack of appropriate medical care
Trach tube – most common problem is they need suction of mucous plug, use a little steril water to losen first Apnea monitor – ped cpr Ventilator – power goes out Feeding tube – don’t lay down, if obstructed may back up into esophagous cause aspirtion Has any one had experience with special need child?
