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Flashcards in Pediatrics Deck (65):
1

Pediatric Age Categories

• Newborns and infants: birth to 1 year
• Toddlers: 1–3 years
• Preschool: 3–6 years
• School age: 6–12 years
• Adolescent: 12–18 years

2

Anatomic and Physiologic Differences

• Infants and children differ from adults in psychology, anatomy, and physiology
• Understanding differences will help you assess and care for young patients

3

Airway & Respiratory System

Child has smaller nose
Child more space is taken up by tongue
Child's trachea is narrower
Cricoid cartilage is less rigid & less developed
Airway structures are more easily obstructed

4

Chest and Abdomen

• Less developed, more elastic in young patients
• Infants and children: abdominal breathers
• Abdominal organs less protected than in adults

5

Body Surface***

A child's body surface is larger in proportion to the body mass - not smaller - than an adults**

• More prone to heat loss through skin
• More vulnerable to hypothermia

6

Blood Volume

9 pnd newborn <12 ounces
60 pnd Child 2L
125 pnd adult 4L

7

Think About It

• What techniques would you utilize when attempting to assess a crying infant?

8

Interacting with the Pediatric Patient - pg 883-885

• Identify yourself
• Let child know that someone has called or will call parents
• If no life threats, continue at a calm pace during the evaluation process
• Let child have a nearby toy
• Kneel at child’s eye level
• Smile
• Touch or hold child’s hand or foot
• Do not use equipment without first explaining what you will do with it
• Let child see your face
• Stop occasionally to find out if child understands
• Never lie to child
• Keep them warm
• Work toe to head*

9

Supporting the Parents or Other Care Providers

• Possible reactions to child’s illness/injury: denial, shock, crying, screaming, anger, self-blame, guilt
• May interfere with care of child
• Ask to help by holding/comforting child and giving medical history

10

Pediatric Assessment Triangle

Appearance
-Mental Status - Alert Verbal
-muscle tone
-interacting
-look & gaze

Work of Breathing
-abnormal sounds
-abnormal body position
-accessory muscle use

Circulation to Skin
-pallor, mottling, cyanosis

First done with a general impression as you enter the room and then hands on

Hands on
Appearance
-PU part of AVPU

Breathing
-is the airway open

Circulation
-cap refill

Pay special attention to mental status - is this normal for the child?

1 fail - respiratory distress
2 fail - resp failure

11

Primary Assessment: Pediatric Care

• Rapidly identifies critical patient
• Essential component of pediatric assessment

12

Population with the greatest rise in HIV / Hepatitis

adolescents - 12-18 because they think they are invincible

13

Interviewing the child - presence of adults

may have to ask all but one parent to leave at the room so the child can calm down

14

Findings from the Pediatric Assessment Triangle

How serious is the child

Most of the time issues with kids are breathing or circulation problems

retrations / nasal flaring
appearance side is bad work is bad - respiratory failure

good appearance / bad breathing
respiratory distress

poor circulation high RH - cir distress

PAT - 1 a problem -resp distress
PAT - 2 a problem - resp failure

15

babies are obligate nose breathers

.

16

Forming a general impression with the pediatric pt

kid crying afraid of you - not critical

lifeless - critical pt

Mental Status
Interaction
Emotional State
Response to You
Tone & Body Position
Effort of Breathing
Quality of Cry or Speech
Skin Color

17

You don't take a BP on a child...

younger than 3********
take BP only in children older than 3 pg 891

18

cap refill - pinch the child's hand

blanch

19

Cap refill is a good indicator of perfusion in children...

younger than 6
book says younger than 5 pg 890

20

What order to you do the rapid exam in for a child

do to toe to head exam instead of a head to toe...

21

how long does it take the bones of the skull to fuse

12-18 months**

Posterior fontanelle closes first (2-4mo) and then the anterior (19mo)

22

what does a bulging fontanelle and a sunken fontanelle mean

Bulging - increased ICP meningitis, trauma

Sunken - dehydrated

23

How do you put an OPA in for a child

opa sweep the tounge to one side
OPA curved side down

24

How do you estimate the size of an NPA for a child

npa about the size of the pinky finger

measure from nostril to the tragus (cartilage at the front of the ear)

25

Clearing an obstructed airway in an infant

infant - <1yr old
5 back blows & 5 chest thrusts

becomes unconscious
30 compressions visualize the airway and clear if you can see the object

Attempt artificial ventilation

infant obstructed airway stuff

26

Circulation Problems
Common Causes of Shock in Pediatric Patients

• Diarrhea and/or vomiting
• Infection
• Trauma (especially abdominal injuries)
• Blood loss

Less Common
• Allergic reactions
• Poisoning
• Cardiac events (rare)

Unlike adults cardiac events are not common causes of shock in a child

27

foramen ovale

In the fetal heart, the foramen ovale , also foramen Botalli, ostium secundum of Born or falx septi, allows blood to enter the left atrium from the right atrium. It is one of two fetal cardiac shunts, the other being the ductus arteriosus (which allows blood that still escapes to the right ventricle to bypass the pulmonary circulation). Another similar adaptation in the fetus is the ductus venosus. In most individuals, the foramen ovale closes at birth. It later forms the fossa ovalis.

28

when it comes to infants and children which are most affected by hypothermia

premature
premature is equal to

29

Most common cause of cardiac arrest in child

respiratory problems - pg 909
on exam

30

differentiating upper airway problems vs lower airway problems

.

31

croup

longer onset

Viral Illness
occurs 6mo & 4yr of age

Upper airway tissues swell
larynyx, trachea & bronchi
Cooler months of the year

-Seal Bark cough
-Sick but not overly sick
-taking in cool air helps them breath better

Mild fever
some hoarseness
worsens at night
Difficulty Breathing
nasal flaring, retraction, tugging at throat

on the quiz will provide symptoms

Position of Comfort - Sitting
admin high flow humidified O2

32

Epiglottitis

sudden onset

Bacterial infection
older kids 4 to 7 yrs

Swelling of the Epiglottis / partial airway obstruction

stridor
sudden onset of high fever
cherry red swollen epiglottis
- don't visualize
tripod position
can't swallow
drools a lot
kids are very sick
more ill than the kids with coup
pt will sit still but still works hard to breath

ALS call

High flow O2 from humidified source

33

Should you visualize the mouth of a child with coup or epiglottitis

don't look in mouth with these kids as it could cause lyrngospasm

34

febrile seizure
and tx for Fever

seizure due to high body temp

remove childs clothing
put on tepid water
monitor to shivering
follow protocols for fluid admin

year 6mo to 6 yrs

35

Meningitis - pg 913

bacterial - worsens in hours
viral - worsens in days

potentially life threatening infection of the lining of the brain & spinal for caused by a bacteria or virus and commonly occurs between the ages of 1mo & 5yr.

dura mater
arachnoid layer
pia mater

inflamed meningies

The Centers for Disease Control and Prevention says that symptoms for viral meningitis either appear quickly or manifest over several days -- usually following a cold, runny nose, diarrhea, vomiting or other signs of infection. Illness from viral meningitis generally lasts seven to 10 days, and the patient typically sees a full recovery.

Symptoms are the same for bacterial but worsen in hours not days.

Tx: O2

36

meningitis (bacterial)

fever altered mental status sunglasses on lights hurt her eyes
can you move your head forward

37

Diarrhea and Vomiting

• Maintain open airway
• Provide oxygen
• Contact medical control if signs of shock
are present
• Immediate transport

dehydration

38

Seizures

• Maintain open airway (not oral airway)
• Position on side if no spinal injury
• Be alert for vomiting
• Provide oxygen
• Transport

39

Altered Mental Status

• Be alert for MOI
• Be alert for signs of shock
• Look for evidence of poisoning
• Attempt to get history of diabetes and seizure disorder

40

Poisoning

• Contact poison control center
• Consider activated charcoal
• Provide oxygen
• Transport
• Continue to monitor responsiveness

41

Care for Unresponsive
Poisoning Patient

• Ensure open airway
• Provide oxygen
• Be prepared to provide artificial ventilation
• Transport
• Rule out trauma

42

Drowning

• Provide artificial ventilation or CPR
• Protect airway
• Consider spinal immobilization
• Protect against hypothermia
• Treat any trauma
• Transport

43

Sudden Infant Death Syndrome

• No accepted reason why these babies die
• Treat as any patient in cardiac or respiratory arrest
• Resuscitate unless there is rigor mortis
• Give emotional support for parents

44

know whats in the abdominal quadrants

can use a spine board if pad with kids

45

1-800-96a-buse

obligation to report abuse

46

Child abuse:

when did they call 911
did they call right away?
the abusers later say how am I going to explain this - why did you wait.....? give away

47

Infants and children with special challenges

be able to use the parents knowledge

trach tubes
artificial ventilators
Central IV linse
Gastrostomy and Gastric Feeding
Shunts

tx - airway, ventillation, O2, transport

48

suctioning with trach tubes

tell the parents that you need their help and show the EMT how it is done

49

walk into a complex child case

ask the parent what can I do for you

50

pediatric calls are stressful because the injuries to the kids are the fault of the parent

.

51

SUIDS

kinds less than 1 year
Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant younger than 1 year of age that remains unexplained after a thorough case investigation, including:
Performance of a complete autopsy
Examination of the death scene
Review of the infant’s and family’s clinical histories

52

many of the kids have a upper respiratory infection a couple of weeks prior

.

53

true unexplained vs sleep death

.

54

SUID

SIDS
Accidental suffocation
Unknown
Poisoning
Metabolic disorders
Hypotherima / Hyperthermia
Neglect or homicide

55

Highest Risk for SUIDS*****

Risk exists from birth up to one year of age with highest incidence between 2-6 months of age

56

What is the most primary cause of cardiac arrest in children

respiratory disease

57

What are the three components of the pediatric assessment triangle**** on quiz

Appearance
Work of Breathing
Circulation to the Skin

58

rate of PPV infant and child

infant: 12-20 (3 to 5 seconds)
older: 10-12 (5 to 6 seconds)

59

causes of shock in children

Diarrhea and/or vomiting
Infection
Trauma
Blood Loss

60

Premature infant

weighs < 5 1/2 ponds or is born before 37 weeks

61

what is the number one cause of death in infants and children

trauma - blunt - accidental falls, burns, entrapment, crushing

head is proportionally lgr & heavier in a child

the chest is less developed and the ribs are more elastic

infants and young children ante abdominal breathers - rely on diaphragm more than adults

bones are more flexible

62

what adult piece of equipment can be used to immobilize a child

KED

63

respiratory distress - inside and outside - child

HR increases, blood vessels constrict
DIB, RR, PR increase

64

respiratory failure - inside and outside - child

can't compensate, hypoxic, tires
cyanotic, slow irregular resp, AMS

65

blood loss - inside & outside child

HR, RR increases, blood vessels constrict

skin pale, delayed cap refill, AMS