What is the leading cause of fatal injuries in children under 14 yrs of age?
Trauma
Describe the different "age" groups when referring to the following: Neonate, Infant, Toddler, Preschooler, School-age child & Adolescent.
Neonate: birth - 1 mo of age
Infant: 1 mo-1 yr
Toddler: 1-3 yrs
Preschooler: 3-6 yrs
School-Age: 6-12 yrs
Adolescent: 12-18 yrs
Neonate characteristics:
totally dependent on others for survival. Birth defects & unintentional injuries are common causes of emergencies.
Infant characteristics:
will usually let you undress them, lay them on a warm, flat surface, and touch them with warm hands & equipment (stethoscope, splints). Older infants (>6mos) will cry when separated from caregiver. Assessment should start at feet or trunk and end with the
Toddler characteristics:
~Do not like to be touched, so limit touch to necessary assessment & mgmt needs
~Do not like to be separated from caregiver
~Do not like having their clothing removed
~Do not like having an oxygen mask over their face. To them it is frightening & noisy.
~
Preschooler characteristics:
This age group has concrete thinking & interpret literally what they hear. They also have vivid imaginations and are able to dramatize events. Explain medical procedures slowly & in simple terms. Allow the child to see your equipment in full view before u
School-Age Children Characteristics:
Children age 6 & up are usually more cooperative, even curious. This age group can be easiest to manage. Honesty is very important with school-age children. Modesty & body image also are issues at this age.
Adolescent Characteristics:
Adolescents are concrete thinking but are developing their abstract thinking skills. This age group believes that nothing bad can happen to them or, that they are invincible. They may take risks that lead to trauma. Use a relaxed approach when performing
What are some differences in infants when managing airway?
Infants have proportionally larger tongues than adults. Be careful when assessing airway in a child with altered mental status due to the ease for their airway to become occluded by their tongue.
What can easily cause the tongue to be displaced in an infant?
Pressure on the soft tissue under the chin.
Newborns & infants are what type of breathers?
nose breathers
What are some differences in pediatric patient's heads than in adults?
~They are proportionally larger than adults.
~Infants younger than 6-7 mos typically cannot fully support their own heads
~Infants have a "soft spot" on the head from incomplete close of the skeletal plates
What are some differences in pediatric patient's chest & lungs than in adults?
~The child's ribs are much more pliable than the adult's
~Child's ribs are more horizontal than they are rounded
~Lung tissue is much more fragile
~The chest will move minimally with respiration
~The chest muscles are underdeveloped and used more as acces
What are some differences in pediatric patient's Respiratory System?
~The breathing is inadequate once the respiratory rate reaches 60 breaths per min. or greater in children
~Infants & children <5 yrs will breathe at a rate 2-3 times faster than the adult patient.
What are some differences in pediatric patient's Cardiovascular System?
-The heart rate increases in response to fear, fever, anxiety, hypoxia, activity, and hypovolemia
-In infants & children, bradycardia is a late response to hypoxia. In newborns, bradycardia is the initial response to hypoxia
-Infants & Children have a sma
What are some differences in pediatric patient's Abdomen?
-The child's abdominal musculature is less well developed than the adult's
-Until the child reaches puberty, the liver and spleen are more exposed & less protected.
What are some differences in pediatric patient's Extremities?
-The bones of the extremities in a child fracture more often by bending & splintering (referred to as a green-stick fracture).
-The infant & young child's motor development occurs from the head to the toes.
What are some differences in pediatric patient's Metabolic Rate?
-Infants & children have a much faster metabolic rate, even at rest.
-The cells in their bodies use oxygen & glucose from the bloodstream 2-3 times faster than in adults, and periods of apnea (absence of breathing), hypoventilation (depressed breathing),
What are some differences in pediatric patient's Skin & Body Surface Area?
-A child's skin surface is large compared to his body mass making them more susceptible to hypothermia
-The skin is thinner & much more delicate than in an adult
What are the components & flow of the primary assessment for the pediatric patient?
-Forming a general impression using the Pediatric Assessment Triangle (PAT)
-Assessing the level of consciousness (AVPU)
-Airway assessment
-Breathing Assessment
-Circulatory assessment
-Priority determination
When should your primary assessment on a pediatric patient begin?
at the doorway
What are the 3 components to the Pediatric Assessment Triangle?
1. Appearance
2. Work of breathing
3. Circulation to skin
What are the characteristics to assess under Appearance?
-TONE: muscle tone, movement, resistance, limpness, flaccidity
-INTERACTIVITY & IRRITABILITY: alertness, reactivity to object, sound, or person; grasp & play with a toy
-CONSOLABILITY: child's ability to be consoled by parent/caregiver
-LOOK/GAZE: fix or
What are the characteristics to assess under Work of Breathing?
-Abnormal sounds--stridor, grunting,snoring,wheezing,hoarseness
-Abnormal posture or position--sniffing, tripod position,refusal lie down
-Retractions
-Nasal flaring
-Head bobbing
What are the characteristics to assess under Circulation to Skin?
-Pallor--assess skin & mucous membranes
-Mottling
-Cyanosis
-Petechiae
List the conditions that will present with normal & abnormal PAT findings:
-Respiratory Distress: normal appearance, abnormal work of breathing, and normal circulation to skin
-Respiratory Failure: abnormal appearance, abnormal work of breathing, and normal or abnormal circulation of skin
-Compensated shock: normal appearance, n
What are some possible causes of rapid breathing in a pediatric patient?
Oxygen deficiency (hypoxia), head injury, lung infection, fever which raises the metabolic rate, increasing the need for oxygen, diabetes, aspirin, stress pain/fear, shock
What can coughing, gagging, or gasping indicate?
the child has breathed in a foreign body or body secretions, creating a partial blockage of the airway.
What will crackles indicate?
certain respiratory diseases have caused fluid to accumulate in and around the alveoli
What will wheezing indicate?
caused by medical emergencies that cause narrowing of the lower airway and can also be caused by aspiration of blood, vomitus, or foreign objects.
What will Stridor indicate?
results from severe obstruction in the upper airway problems, if absent, cause is more likely to be an emergency involving the lower portions of the airway.
What are some circulation assessment parameters?
pulse rate & strength, strength of peripheral versus central pulses, warmth & color of hands & feet, urinary output, mental status.
What are some signs of early respiratory distress?
-Increase in respiratory rate above normal for age
-Nasal flaring
-Intercostal retractions on inspiration
-Supraclavicular & subcostal retractions on inspiration
-Neck muscle use
-Audible breathing noises such as stridor,wheezing, grunting
-Seesaw respira
What are some additional signs that could indicate decompensated respiratory failure?
-Resp rate over 60 pm
-Cyanosis
-Decreased muscle tone
-Severe use of accessory muscles to aid in resp
-Poor peripheral perfusion
-Altered mental status
-Grunting
-Head bobbing
List the steps to perform to remove an obstruction in an infant (less that 1 yr):
1. Position patient prone (belly down, back up) on your forearm in a head-down position, supporting infant's head with your hand & supporting your arm on your thigh
2. Deliver 5 sharp back slaps (blows) between the should blades.
3. Transfer the patient t
CROUP:
common infection of upper airway, usually caused by a virus but sometimes by bacteria. Slow onset, accompanied by low-grade fever, most common in children 6 mos-4 yrs. Infection causes swelling beneath the glottis & progressively narrows the airway.
ASTHMA:
long-term inflammatory process that targets the lower airways.
BRONCHIOLITIS:
caused when mucosal layer within the bronchioles in the lungs becomes inflamed by a viral infection. During exhalation, child wheezes loudly.
PNEUMONIA:
is bacterial, viral, mycoplasmal & fungal infection of the lung.
What steps should be taken in the case of a cold-water drowning?
1. Remove the patient from the water
2. Assume that a spinal injury has occurred & provide full immobilization while establishing an airway
3. Clear airway, and provide PPV via a BVM with supplemental oxygen connected to ventilation device if breathing is
MENINGITIS:
the lining of the brain & spinal cord (the meninges) are infected by either bacteria or viruses. These infections can be rapidly fatal, so they must be assessed promptly & treated in a timely & appropriate manner. fever in a child younger than 3 mos shoul
What does ALTE stand for?
Apparent Life-Threatening Event. Defined as "an episode that is frightening to the observer and that is characterized by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic or pale but occasionally erythematous
An ALTE may include a combination of symptoms (often transient) affecting infants, including:
Apnea, skin color change, Changes in muscle tone, unexplained choking or gagging
SUDDEN INFANT DEATH SYNDROME (SIDS):
commonly known as "crib death", defined as the sudden & unexpected death of an infant (under 1 yr of age) in which an autopsy fails to identify the cause of death.
What should you do if you find an infant in respiratory & cardiac arrest (in which SIDS is only one of many possible causes)?
1. Immediately try to resuscitate
2. Encourage the caregivers to talk & tell their story
3. Do not provide false reassurances
4. Transport the infant to the hospital.
5. Deliver the infant into the hands of the emergency department staff.
What is the leading cause of death in children from ages 1-14?
Trauma
What is the primary killer of American children?
the automobile
What are mechanisms of injury & the common patters of injury to expect in infants & children where trauma is concerned?
-Unrestrained children in cars will probably suffer head & neck injuries. Child passengers in front seat may suffer face, neck, or chest injuries from air bag
-Restrained passengers will probably suffer abdominal and/or lumbar injuries from stress applied
What are some common findings in head injuries?
-N/V; altered mental status
-Respiratory arrest (common to serious head injuries)
-Facial & scalp injuries (in infants & children, blood loss can be profound enough to cause hypoperfusion)
What are some common findings in Chest injuries?
internal damage (lung injury, heart wall injury). Suspect serious intrathoracic injuries
What is the only major cause of infant & child death that has increased in the last 30 years?
child abuse
PEDIATRIC NORMAL HR, RR & SYSTOLIC BP:
AGE HR RR
NB - 1 yr 140 bpm 40/min
1 yr - 4 yr 120 bpm 30/min
4 yr - 12 yr 100 bpm 20/min
> 12 yrs 80 bpm 15/min
AGE SYSTOLIC BP
NB - 1 mos 60 mmHg
1 mos - 1 yr 70 mmHg
1 yr - 10 yrs Lower limit of normal: 70 mmHg + (2x yrs of age)
Median normal: 80 mmHg