Vol.5-Ch.4 "Pediatrics" Part 1 (General Details/Differences) Flashcards
What are some leading causes of pediatric deaths?
Pediatric death causes are AGE SPECIFIC and include:
- MVC
- Burns
- Drownings
- Suicides
- Homicides
Children are at _____ risk of injury than adults and they are ____ likely to be adversely affected by the injuries that they suffer?
Children are at HIGHER risk of injury than adults and they are MORE likely to be adversely affected by the injuries that they suffer
Research Studies have shown that:
- Approximately ____% of pediatric calls require ONLY BLS interventions
- Use of a BVM for ventilations over an ET tube has comparably ______ effect on outcome for the pt
Research Studies have shown that:
- Approximately 85% of pediatric calls require ONLY BLS interventions
- Use of a BVM for ventilations over an ET tube has comparably EQUAL OR BETTER effect on outcome for the pt
Newborn VS Neonate
Newborn = FIRST HOURS after birth, generally assessed with just APGAR score
Neonate = BIRTH to 1 MONTH, generally loose 10% of bodyweight from birth while going through adjustment to life but gains it back after 10 days. This stage of development centers on REFLEXES (not much muscle control yet).
The Neonate child should always be kept warm; observe skin color, tone, and resp rate. Crying without tears can indicate dehydration, and lung sounds should be auscultated early in the exam before the pt starts crying.
Infants:
- Age range? (Hint there’s 2 separate ones)
- Development and how to examine
Infants = 1 to 5 MONTHS
At this stage they should have doubled their birth weight and be able to follow movements of others with their eyes. Muscle control begins to develop in a Cephalocaudal Progression, meaning from heat to tail, and trunk to extremities. Concentrate on keeping these patient warm and comfortable and examine them on the parents lap if possible as is with neonates
Infant = 6 MONTHS to 1 YEAR
May start to stand or walk, and explore the world through their mouths; this is why 6months to 1 year old’s are at HIGH RISK for Foreign Body Airway Obstructions. Exams for this age range should start from TOE-TO-HEAD as starting at the head may upset the child
Toddlers:
- Age Range
- Development and how to examine
Toddler = 1 to 3 YEARS
Now they begin to RUN and have gross motor development, they become braver/more stubborn/more adventurous. LANGUAGE development begins though often they understand more then they can speak. Again, do assessment TOE to HEAD and avoid asking questions that they can say “NO!” to.
TIP: Try doing procedures on non-dominant arm/hand so they are less likely to strongly pull away
Preschoolers:
- Age Range
- Development and how to examine
Preschoolers: 3 to 5 Years
They now have FINE and gross motor movement, as well as know how to SPEAK. Now you can begin to ask the children questions FIRST but keep in mind their perception of time is often distorted and they may believe in monsters or the unreal. AVOID BABY TALK, you can use a stuffed animal or let them use a piece of equipment like a stethoscope to show you don’t mean harm. Now start the exam from the CHEST but still do the HEAD LAST. DO NOT trick or lie to the child and explain what you are doing in terms they can understand
School Age:
- Age Range
- Development and how to examine
School Age: 6 to 12 YEARS
Growth spurts may lead to clumsiness. They are now old enough to be trusted to give a history themselves but may still require pertinent DETAILS from the parents. Remember to respect their modesty but giving as stuffed animal or equipment may still help some.
Adolescents:
- Age Range
- Development and how to examine
Adolescents: 13 to 18 YEARS
Although this is typically 13-18 years of age, it BEGINS WITH PUBERTY and therefore can include ages around 11 too depending on development. This age group is often “body conscious” and you must be tactful when dealing with things that may having lasting impact on the body, even scars. DO NOT call them a child and remember that their vitals may start to look like that of adults. Also note that for female patients this is when pregnancy may start to be possible.
What are some differences between pediatric and adult Heads? (x2)
- The head and occiput are proportionally much larger than the body. This can lead to increased risk of head trauma and interfere with the normal airway positioning techniques, so use the following techniques:
a) UNDER 3yo: Place a thin layer of padding under the back to obtain neutral position.
b) OVER 3yo: place a folded sheet under the occiput to obtain a sniffing position - With INFANTS they still have an anterior and posterior FONTANELLES. The posterior closes by 4 months, and the anterior diminishes after 6 but closes after 9-18 months. B/c of this ALWAYS CHECK ANTERIOR fontanelle; it is normal to have a pulse and should be level with the skull. In cases of ICP it may swell, become rigid, and loose its pulse; in cases of dehydration, it may sink in.
What are some differences between pediatric and adult Airways? (x7)
- Narrower airways that are more easily blocked
- Infants are nose breathers, so if blocked by secretions they may not automatically open their mouths to breath
- Tongues are proportionately bigger, easier to obstruct airway
- Trachea is softer and therefore collapses easier if neck and head are hyperextended
- Larynx is HIGHER (C-3/4) and extends into pharynx
- Cricoid Ring is the narrowest part of airway, (below the cords) (often where obstruction occurs)
- They have an Omega (horseshoe) shaped epiglottis that extends at a 45 angle into the airway; this epiglottis cartilage is softer and can be more floppy
Overall take away includes: Keep nares clear in infants less than 6 months. Don’t hyperextend neck, open airway gently to avoid damage to soft tissue. Advanced airway often cause local tissue swelling after placement so try keeping it to manual maneuvers unless they fail.
What are some differences between pediatric and adult Chest and Lungs? (x5)
- The ribs are softer and therefore more energy is transmitted through them and into the internal organs (less protection = increased chances of pulmonary and cardiac contusions in trauma)
- Lungs are more prone to pneumothorax following barotrauma
- Mediastinum will shift more with tension pneumothorax than in an adult
- Since chest walls are thinner, breath sounds from the other lung may be heard over a pneumothorax, leading to a missed diagnosis
- Chest muscles tire more easily and lung tissues are more fragile (compensate less in difficulty breathing)
What are some differences between pediatric and adult Abdomen? (x2)
- The very vascular liver and spleen are proportionately larger
- Abd organs lie much closer together, and since the abd muscle walls are weaker, expect more internal trauma
What are some differences between pediatric and adult Extremities? (x2)
- Since their bones are more porous and softer then treat all “sprains” and “strains” as fractures and immobilize them
- While getting an IO access, be wary of an accidental stick of the growth plate that will damage developmental growth
What are some differences between pediatric and adult Skin and Body Surface Area? (x3)
- Skin is thinner
- Less subcutaneous fat
- Larger BSA-to-weight ratio
As a result, the injure from extreme temp and thermal exposure, loose fluids and heat faster, burn easier and more deeply
What are some differences between pediatric and adult Respiratory? (x2)
- Similar tidal volume but require DOUBLE metabolic oxygen
- Proportionately smaller oxygen reserves
The combined combo leads to much HIGHER RISK of Hypoxia
What are some differences between pediatric and adult Cardiovascular System? (x6)
- Cardiac Output is RATE DEPENDANT
- Proportionately they have MORE circulating blood volume (mL to body size) but they have LESS absolute blood volume (mL total). So less total blood loss (mL) is needed to cause shock but they can compensate better for shock than adults since they have higher volume per body CVS than adult CVSs
- Hypotension is a late sign of shock for all patients but since peds can compensate for longer but the time from decomp to arrest is so quick, a hypotensive ped patient is liable to go into arrest very quickly
- They can be in shock despite normal pressure
- SHOCK ASSESSMENT IS BASED ON CLINICAL SIGNS OF TISSUE PERFUSION
- Suspect shock is TACHYCARDIA is present
What are some differences between pediatric and adult Nervous Systems? (x2)
- Nervous System is more fragile and develops continually throughout childhood.
- Skull and Spinal column are softer and more pliable, therefore they offer less protection to the brain and spinal cord.
What are some differences between pediatric and adult Metabolisms? (x4)
- Limited stores of glycogen and glucose
- Prone to hypothermia b/c of greater BSA-to-Weight ratio
- Significant volume loss can result from vomiting and diarrhea
- LACK ABILITY TO SHIVER
All of the above are major reasons that keeping neonatal and young peds patients WARM
What is the Pediatric Assessment Triangle or PAT assessment tool?
What are the 3 main components?
It is a systematic assessment tool for peds that allows for a rapid “eyes open, hands on” approach without the use of typical medical devices such as a stethoscope, BP cuff, Pulse Ox, etc.
The three main parts are:
- Appearance: focuses on child’s mental status and muscle tone
- Breathing: directs attention to respiratory rate and difficulty
- Circulation: uses skin sign sand color as well as capillary refill as indicators of pts status
What is the main cause of cardiac arrest in infants and young children?
Airway and Respiratory problems aka Hypoxia
When assessing a child breathing what are 3 easy words to describe how you should physically assess if breathing is PRESENT?
LOOK for chest rise and fall
LISTEN for breath sounds
FEEL for air movement
