Summary of "Chp 35 Pediatric Emergencies"

Summary of Chapter 35: Pediatric Emergencies

This comprehensive chapter covers the assessment, management, and treatment of pediatric emergencies, emphasizing the unique anatomical, physiological, and psychological differences between children and adults. It highlights the importance of tailored approaches for various pediatric age groups and specific emergencies.

Main Ideas and Concepts

Pediatric Patients Are Not Small Adults: Children differ anatomically, physiologically, and emotionally from adults. Their airways are smaller and more easily obstructed; their organs are proportionally different; and their psychological development affects assessment and treatment.
Age-Related Developmental Stages:
- Neonate: 0-2 months
- Infant: 2 months - 1 year
- Toddler: 1-3 years
- Preschooler: 3-6 years
- School-age: 6-12 years
- Adolescent: 12-18 years
Each stage has unique characteristics affecting assessment and care.
Approach to Pediatric Patients:
- Assess infants from a distance; caregivers should hold them during exams.
- Toddlers prefer feet-to-head assessment; easily distracted; may have stranger anxiety.
- Preschoolers have vivid imaginations; communicate simply and honestly.
- School-age children can understand concrete concepts; start head-to-toe exam; give choices.
- Adolescents have adult-like physiology but strong privacy, independence, and body image concerns; same-gender EMTs preferred for sensitive exams.
Anatomical and Physiological Differences:
- Airway: Smaller diameter, shorter, funnel-shaped upper airway, larger tongue, floppier epiglottis, higher glottic opening.
- Respiratory: Infants are nose breathers; normal respiratory rate is higher (20-60/min for newborns).
- Circulatory: Higher normal heart rates (up to 205 bpm in newborns), peripheral vasoconstriction masks shock signs.
- Nervous system: Larger head-to-body ratio, fragile brain tissue, less cushioning, prone to injury.
- Musculoskeletal: Growth plates vulnerable; bones softer and more flexible.
- Integumentary: Thinner skin, less fat, more prone to deeper burns.
- Thermoregulation: Poor ability to regulate temperature; prone to hypothermia.
Scene Size-Up and Initial Assessment:
- Pediatric Assessment Triangle (PAT): Appearance, Work of Breathing, Circulation to Skin—assessed visually from a distance without equipment.
- Use ABCDE approach: Exsanguination, Airway, Breathing, Circulation, Disability, Exposure.
- Treat life threats immediately; assess vital signs with pediatric-specific equipment and techniques.
Vital Signs and Assessment Techniques:
- Use age-appropriate equipment (e.g., blood pressure cuffs covering 2/3 of upper arm).
- Respirations counted for a full minute; observe abdominal breathing in infants.
- Pulse sites vary by age (brachial in infants, carotid/femoral in older children).
- Capillary refill and skin condition are important shock indicators.
- Use modified Glasgow Coma Scale and pain scales (e.g., Wong-Baker Faces).
Common Pediatric Emergencies and Their Management:
- Respiratory Emergencies: Leading cause of cardiac arrest in children; recognize signs of respiratory distress/failure (nasal flaring, retractions, stridor, wheezing).
- Airway Obstruction: Common causes include foreign bodies (batteries, magnets), infections (epiglottitis, croup). Treatment includes encouraging coughing, back blows/chest thrusts (infants), Heimlich maneuver (children).
- Asthma: Bronchial inflammation causing wheezing; treat with oxygen, Bronchodilators, and call ALS.
- Pneumonia: Leading cause of death in children; supportive care and oxygen.
- Croup and Epiglottitis: Viral and bacterial infections causing airway swelling; humidified oxygen for croup, rapid transport for epiglottitis.
- Bronchiolitis and RSV: Viral illness common in infants; supportive oxygen therapy.
- Pertussis (Whooping Cough): Bacterial infection treated with supportive care.
- Shock: Causes include trauma, dehydration, infection, anaphylaxis. Early signs include tachycardia, pale cool skin, delayed capillary refill; treat with oxygen, warming, controlling bleeding, rapid transport.
- Anaphylaxis: Signs include stridor, wheezing, hives, shock; treat with Epinephrine auto-injector and rapid transport.
- Seizures: Common in children, often febrile; protect airway, position patient, call ALS for medication administration.