chapter 34, pediatric emergencies 2018notes...1 chapter 34 pediatric emergencies introduction...
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Chapter 34Pediatric Emergencies
IntroductionlPediatric patients differ anatomically, physically, and emotionally
from adults. –Illnesses and injuries, and their responses to them vary based on age or developmental level.
–Important to remember that children are not small ____________________
–Fear of EMS providers and pain can make the child difficult to assess.
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Pediatric EmergencieslCaring for sick and injured children presents special challenges. lEMT-Bs may find themselves ____________________ when
dealing with critically ill or injured children. lTreatment is the same as that for adults in most emergency
situations.Communication With the Patient and the FamilylYou may have more than one patient.
–Caregiver may need emotional help and support.lA calm parent contributes to a ____________________ child.
–An agitated parent means child will act same way.lRemain calm, efficient, professional, and sensitive.Growth and DevelopmentlThoughts and behaviors of children usually grouped into stages
–Infancy: first year of life–Toddler: 1 to ____________________ years–Preschool age: 3 to 6 years–School age: 6 to ____________________ years–Adolescence: 13 to 18 years
InfantlFirst year of lifelThey respond mainly to ____________________ stimuli.
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lFirst year of lifelThey respond mainly to ____________________ stimuli.lCrying is a way of expression.lThey may prefer to be with caregiver.Assessment of InfantslObserve infant from a distance.lCaregiver should hold baby during assessment.lProvide sensory comfort.
–Warm hands and end of stethoscope.lDo painful procedures at ____________________ of assessment.lExplain each procedure to the parent or caregiver before you
perform it. l
Toddlerl1 to 3 years of agelThey begin to walk and explore the environment.lThey may resist ____________________ from caregivers.lBegin your assessment at the feet.lVocabulary grows rapidlyAssessment of ToddlerslMay have stranger anxietylMay resist separation from caregiverlMay have a hard time describing painlCan be ____________________ lPersistent crying can be a symptom of serious illness or injury.l
Preschool Age Childrenl3 to 6 years of agelThey can use simple language effectively.lThey can understand ____________________ .lThey can identify painful areas when questioned.lThey can understand when you explain what you are going to do
using simple descriptions.lBegin assessment at feet, moving to head. Assessment of Preschool Age Children
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Assessment of Preschool Age ChildrenlMuch history must still be obtained from caregivers.lAppeal to child’s imagination to facilitate examination.lNever ____________________ to the patient.lPatient may be easily distracted.l
School Age Childrenl6 to 12 years of agelBeginning to act more like adultslCan respond sensibly to questionslCan help take care of themselvesl____________________ is important. lChildren begin to understand deathAssessment of School Age Children (1 of 2)lAssessment begins to be more like adults’.lTalk to the child, not just the caregiver.lStart with head and move to the feet.lGive the child ____________________ if possible.lAsk only questions that let you control the answer:
–Would you like me to take the BP on the right or left arm?ll
Assessment of School Age Children (2 of 2)lAllow the child to listen to his or her heartbeat through the
stethoscope.lCan understand difference between physical and
____________________ painlGive them simple explanations about what is causing pain and what
will be done about it.lAsk the parent’s or caregiver’s advice about which distraction will
work best.l
Adolescentsl13 to 18 years of age
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Adolescentsl13 to 18 years of agelThey are very concerned about ____________________ image.lThey may have strong feelings about being observed.lPuberty beginslFeel “indestructible”lThey understand pain.Assessment of Adolescents (1 of 3)lRespect an adolescent’s privacy.l____________________ any procedure that you are doing.lCan often understand complex concepts and treatment optionslAllow them to be involved in their own care.lProvide choices, while lending guidance.ll
Assessment of Adolescents (2 of 3)lEMT of same gender should do assessment, if possible.lAllow them to speak openly and ask questions.l____________________ behaviors are common.
–Can ultimately facilitate development and judgment, and shape identity
–Can also result in trauma, dangerous sexual practices, and teen pregnancy
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Assessment of Adolescents (3 of 3)Female patients may be pregnant:lImportant to report this information to receiving facility.lAdolescent may not want ____________________ to know this
information.lTry to interview without the caregiver/parent present.l
Differences Between Pediatrics and AdultsAirway DifferenceslLarger, rounder occiputlLarger ____________________ relative to the mouthlLarger epiglottis
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lLarger ____________________ relative to the mouthlLarger epiglottis lLess well-developed rings of cartilage in the trachealNarrower, lower airwayBreathing Differences (1 of 2)lChildren have oxygen demand twice that of an adult. lInfants use the diaphragm when they breathe.lSustained, labored breathing may lead to respiratory
____________________ .lRespiratory problems are the leading cause of cardiopulmonary
arrest in the pediatric population.l
Breathing Differences (2 of 2)lDuring respiratory distress, the pediatric patient is working harder to
breathe and will eventually go into respiratory failure.lRespiratory failure occurs when the pediatric patient has
____________________ all compensatory mechanisms.lWaste products collect, leading to respiratory arrest, a total
shutdown.l
Circulation Differences (1 of 2)lThe normal heart rate is faster than adults.
–Infants heart can beat 160 beats/min or more.lThe heart rate increases for illness and injury.lPrimary method used to compensate for decreased
____________________ lVasoconstriction keeps vital organs nourished.lConstriction of the blood vessels can affect blood flow to the
extremities.Circulation Differences (2 of 2)lPediatrics are more dependent on actual cardiac
____________________ .–Blood being pumped out of heart in 1 minute
lMay be in shock despite normal blood pressurelA small amount of blood loss can lead to shock.l
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Pediatric Pulse Rates
The Nervous System (1 of 2)lPediatric nervous system is immature, underdeveloped, and not
well protected.–Head-to-body ratio of infant and young child is disproportionately ____________________ .
–Occipital region is larger, which increases the momentum of the head during a fall.
–Subarachnoid space is relatively smaller, leaving less cushioning for brain.
–Brain tissue and cerebral vasculature are fragile and prone to bleeding from shearing forces.
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The Nervous System (2 of 2)lPediatric brain requires higher cerebral blood flow, oxygen, and
glucose.–At risk for secondary brain damage from hypotension and ____________________ events
lSpinal cord injuries are less common.–If injured, it is more likely to be an injury to the ligaments because of a fall.
–For suspected neck injury, perform manual in-line stabilization or follow local protocols.
Gastrointestinal System (1 of 3)lAbdominal muscles are less developed.lLess protection from trauma.lLiver, spleen, kidneys are proportionally ____________________
and situated more anteriorly and close to one another.–Prone to bleeding and injury–There is a higher risk for multiple organ injury.
Gastrointestinal System (2 of 3)lSigns and symptoms of acute abdomen may be vague.lAbdominal walls are underdeveloped.lMay not be able to pinpoint origin of painlTake complaints of abdominal pain ____________________ .
–Large amount of bleeding may occur within abdominal cavity,
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lTake complaints of abdominal pain ____________________ .–Large amount of bleeding may occur within abdominal cavity, without signs of shock.
Gastrointestinal System (3 of 3)lLiver and splenic injuries are common in this age group.lNeeds to be monitored for shock; may include AMS,
____________________ , tachycardia, and bradycardiaMusculoskeletal System (1 of 4)lOpen growth ____________________ allow bones to grow.lAs a result of growth plates, children’s bones are softer and more
flexible, making them prone to stress fracture.lBone length discrepancies can occur if injury to growth plate occurs.
–Immobilize all strains and sprains.Musculoskeletal System (2 of 4)lBones of an infant’s head are flexible and soft.l____________________ (soft spots) are located at front and back
of head.–Will close at particular stages of development
Musculoskeletal System (3 of 4)lFontanelles can be a useful assessment tools
–____________________ indicates intracranial pressurelThoracic cage is highly elastic and pliable.
–Composed of cartilaginous connective tissue–Ribs and vital organs are less protected.
lMuscles and bones grow into adolescence.l
Musculoskeletal System (4 of 4)lThe younger the child, the more flexible the bone structures.
–Sprains are uncommon and femur fractures ____________________ .
lOlder children are prone to long bone fractures due to more risks and activity.
Integumentary System (1 of 2)lThinner skin and less subcutaneous fatlHigher ratio of body surface area to body mass leads to larger fluid
and heat losses.
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lHigher ratio of body surface area to body mass leads to larger fluid and heat losses.
lComposition of skin is thinner and tends to burn more ____________________ and easily with less exposure.
Integumentary System (2 of 2)Thermoregulator system is immature:lMakes pediatric population more prone to ____________________
eventslLack of ability to shiver to generate heatlChildren should be kept warm during transport.lWithout treatment of hypothermic event, patient may lapse into
convulsive seizure activity.Scene Size UplTake note of your surroundings. lScene assessment will supplement additional findings.lObserve:
–Position of the patient–Condition of the home–Clues to child ____________________
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Primary AssessmentlBegins before you touch the patientlForm a general impression.lDetermine a chief ____________________ . lThe Pediatric Assessment Triangle can help. l
Pediatric Assessment Triangle (PAT)lShould take only 15-30 secondsl____________________ lWork of breathinglSkin circulationlRequires no tools or equipmentlObservation only
AppearancelNote LOC, muscle tone, interactiveness.
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AppearancelNote LOC, muscle tone, interactiveness.l____________________ mnemonic helps determine if patient is
sick or not sick.–Tone–Interactiveness–Consolability–Look or gaze–Speech or cry
Work of BreathinglIncreases body temperaturelMay manifest as tachypnea, abnormal airway
____________________ , or retractions of intercostal muscles or sternum
Circulation to the SkinlPallor of skin and mucous membranes may be seen in
compensated shock. lMottling is sign of poor perfusion. lCyanosis reflects decreased level of ____________________ .Stay or Go?From PAT findings, you will decide if the patient is stable or requires
urgent care:lIf unstable, assess ____________________ , treat life threats, and
transport immediately.lIf stable, continue with the remainder of the assessment process.Assessing the ABCslEnsure airway is open and position patient.lBreathing assessment
–Effort–Obstructions–____________________
lCirculation assessment–Rate–Skin color, temp., and capillary refill
Transport DecisionlChildren under ____________________ lbs should be transported
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Transport DecisionlChildren under ____________________ lbs should be transported
in a child safety seat, if the situation allows. lSeat should be secured to the captain’s chair. lCannot be secured to bench seatlChild may have to be transported without a seat, depending on
condition. History Taking (1 of 2)lBased on MOI or NOIlLength of sickness or injurylKey events leading up to injury or illnesslPresence of ____________________ lEffects of illness or injury on behaviorlPatient’s activity levellRecent eating, drinking, and urine outputl
History Taking (2 of 2)lChanges in bowel or bladder habitslPresence of vomiting, diarrhea, abdominal painlPresence of rashesl____________________ historylObtain OPQRSTlObtain name and phone number of caregiver if they are not able to
come to the hospital with you.l
Secondary AssessmentlShould be completed on scene unless severity requires rapid
transportlYoung children should be examined toe to head.lFocused exam on ____________________ patientslRapid scan on potentially critical patientslPhysical exam is basically the same as that of an adultl
Vital Signs by Age RespirationslAbnormal respirations are a common sign of illness or injury.
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RespirationslAbnormal respirations are a common sign of illness or injury.lCount respirations for 30 seconds.lIn children less than 3 years, count the rise and fall of the abdomen.lNote ____________________ of breathing.lListen for noises.
PulselIn infants, feel over the ____________________ or femoral area.lIn older children, use the carotid artery.lCount for at least 1 minute.lNote strength of the pulse.
Blood Pressure (1 of 2)lUse a cuff that covers two thirds of the ____________________
arm.lIf scene conditions make it difficult to measure blood pressure
accurately, do not waste time trying.lUsually not needed if under 3 yoa
Blood Pressure (2 of 2)• Use this formula to determine blood pressure for children ages ____________________ years: •70 + (2 × child’s age in years) = systolic blood pressure
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Skin SignslFeel for temperature and moisture.lCheck capillary refill.
ReassessmentlRepeat the primary assessment.lObtain vitals every ____________________ minutes if stable.lObtain vitals every 5 minutes if unstable.lContinually monitor respiratory effort, skin color and condition, and
level of consciousness.lCheck interventionslCommunicate and documentl
Respiratory Emergencies
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Respiratory EmergenciesRespiratory Emergencies
Signs of Increased Work of Breathingl____________________ flaringlGrunting respirationslWheezing, stridor, other abnormal soundslAccessory muscle uselRetractions/movements of child’s flexible rib cagelIn older children, tripod positionl
Airway Obstruction (1 of 2)lSmall children are always putting objects in their mouths causing
____________________ lIn cases of trauma, teeth may have dislodged into the airway. lInfections such as epiglottitis and croup cause obstructionslBest way to auscultate breath sounds in the pediatric patient is to
listen to both sides of the chest at armpit level.l
Airway Obstruction (2 of 2)lImmediately begin treatment of airway obstruction.
–Encourage ____________________ to clear airway when patient is conscious and forcibly coughing.
–If you see signs of a severe airway obstruction, attempt to clear the airway immediately.
–If an infant is conscious with a complete airway obstruction, perform up to five back blows followed by chest thrusts.
–l
Asthma (1 of 3)lBronchioles become inflamed, swell, and produce excessive
____________________ , leading to difficulty breathing.lOne of the most common illnesses seenlAlmost 5 million US children are affected.lCommon causes for asthma attack include upper respiratory
infection, exercise, exposure to cold air, emotional stress, and
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lCommon causes for asthma attack include upper respiratory infection, exercise, exposure to cold air, emotional stress, and passive exposure to smoke.
Asthma (2 of 3)lAsthma is a true emergency if not promptly treated.Signs and symptoms:lWheezing as patient exhales
–In some cases, airway is completely ____________________ .lCyanosis and respiratory arrest may quickly develop.lTripod position allows for easier breathing.Asthma (3 of 3)lAccording to the Centers for Disease Control and Prevention
(CDC), ____________________ % of children in the United States have asthma and, in 2007 alone, 185 children died of asthma.
Treatment of Asthma (1 of 2)lAdminister supplemental oxygen.lBronchodilator via metered-dose inhaler with a spacer mask device
(if protocol allows)–Often caregivers have administered albuterol.
lIf assisting ventilations, use slow, gentle breaths.–Resist temptation to squeeze bag hard and ____________________ .
Treatment of Asthma (2 of 2)lA prolonged asthma attack may progress into status
____________________ .–A true emergency–Give oxygen and transport immediately.
lPatient may become exhausted from trying to breath.–Manage airway aggressively, administer oxygen, and transport promptly.
PneumonialLeading cause of death in childrenlPneumonia is a general term that refers to an
____________________ to the lungs.lPresentation in pediatric patientlPediatric patient treatment
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lPresentation in pediatric patientlPediatric patient treatmentlDiagnosis of pneumonia must be confirmed in the hospital.l
–l
CrouplViral infection of the larynx, trachea, and mainstem bronchi.lUsually 6 mo. to ____________________ years of age.lGradual onset, low grade fever.lNocturnal dyspnea, stridor, wheezing, “seal bark cough.lTreatment is to give ____________________ oxygen.Epiglottitis l____________________ infection of the epiglottis.lUsually 4 to 7 yoa.lRapid onset, high fever.lStridor, wheezing, pain on swallowing, ____________________ ,
muffled voice.lMay cause complete airway obstruction.lTreatment is to give oxygen and rapid transport.lDo Not Visualize Throat!!!!!BronchiolitislSpecific viral illness of newborns and toddlers, often caused by
____________________ lMore common in premature infants and results in copious secretionlLook for signs of dehydration, shortness of breath, and fever.lTreatmentll
PertussislPertussis (whooping cough) is caused by a bacterium spread via
respiratory droplets.lSigns and symptoms similar to a cold lTo treat pediatric patients, keep the airway patent (open) and
transport.lPertussis is ____________________ , so follow standard
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transport.lPertussis is ____________________ , so follow standard
precautions, including wearing a mask and eye protection.ll
Care of the Pediatric Airway (1 of 2)lPosition the airway.lPosition the airway in a neutral sniffing position.lIf spinal injury is suspected, use ____________________
maneuver to open the airway.Care of the Pediatric Airway (2 of 2)Positioning the airway:lPlace the patient on a firm surface.lFold a small towel under the patient’s ____________________ and
back.lPlace tape across patient’s forehead to limit head rolling.Oropharyngeal AirwayslDetermine the appropriately sized airway.lPlace the airway next to the face to confirm correct size.lPosition the airway.lOpen the ____________________ .lInsert the airway until flange rests against lips.lReassess airway.Nasopharyngeal Airways (1 of 2)lDetermine the appropriately sized airway.lPlace the airway next to the ____________________ to make
certain length is correct.lPosition the airway.lLubricate the airway.Nasopharyngeal Airways (2 of 2)lInsert the tip into the ____________________ naris.lCarefully move the tip forward until the flange rests against the
outside of the nostril.lReassess the airway.Oxygen Delivery DeviceslNonrebreathing mask at 10 to 15 L/min provides approximately
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Oxygen Delivery DeviceslNonrebreathing mask at 10 to 15 L/min provides approximately
____________________ % oxygen concentration.lBlow-by technique at 6 L/min provides more than 21% oxygen
concentration.lNasal cannula at 1 to 6 L/min provides 24% to 44% oxygen
concentration.BVM DeviceslEquipment must be the right size.lBVM device at 10 to 15 L/min provides nearly 100% oxygen
concentration.lVentilate at the proper ____________________ and volume.lMay be used by one or two rescuersPediatricMedical Emergencies
DehydrationlDetermine if child is vomiting and has diarrhea and for how long.l“How many ____________________ diapers has the child had
during the day (6 to 10 is normal)?”l“What fluids is the child taking?”l“What was the child’s weight before the symptoms started?”l“Has the child been normally active?”Shock (1 of 5)lA condition that develops when the circulatory system is unable to
deliver a sufficient amount of blood to the organs–Results in organ failure and eventually ____________________ arrest
l
Shock (2 of 5)lPediatric patients respond differently than adults to fluid loss.
–May respond by increasing heart rate, increasing respirations, and showing signs of pale or ____________________ skin
–l
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l
Shock (3 of 5)lTreat shock by assessing ABCs, intervening as required.
–The order becomes ____________________ if there is obvious life-threatening external hemorrhage or if cardiac arrest is suspected.
–Pediatric patients do not demonstrate a fall in blood pressure until shock is severe.
l
Shock (4 of 5)lTreatment (cont’d)
–Limit your management to simple interventions.–Do not waste time performing field procedures.–Ensure airway is open; prepare for artificial ____________________ .
–Control bleeding. –Give supplemental oxygen by mask or blow-by. –
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Shock (5 of 5)lTreatment (cont’d)
–Continue to monitor airway and breathing.–Position the pediatric patient in a position of comfort.–Keep ____________________ with blankets and heat.–Provide immediate transport.–Contact ALS backup as needed.
l
Emergency Medical Carefor DehydrationlAssess the ABCs.lObtain baseline vital signs.lTreat for shock as neededlALS backup may be needed for ____________________
administration.
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administration.SeizureslResult of disorganized ____________________ activity in the brain
• Subtle in infants, with an abnormal gaze, sucking, and/or “bicycling” motions
• More obvious in older children with repetitive muscle contractions and unresponsiveness
lStatus epilepticus is a continuous seizure, or multiple seizures without a return to consciousness for 30 minutes or more.
Febrile SeizureslFebrile seizures are most common in children from 6 months to 6
years.lFebrile seizures are caused by ____________________ .lThey last less than 15 minutes.lAssess ABCs and begin cooling measures.lProvide prompt transport.Emergency Medical Care of Seizures (1 of 2)lPerform initial assessment, focusing on the
____________________ .lProtect from injurylSecuring and protecting the airway is the priority.lPlace patient in the recovery position.lBe ready to ____________________ .l
Emergency Medical Care of Seizures (2 of 2)lDeliver oxygen by mask, ____________________ , or nasal
cannula.lObtain blood glucose level if authorizedlBegin BVM ventilation if no signs of improvement.lCall ALS for backup if appropriate.l
Altered Level of Consciousness (LOC)lThe first step in treatment is to assess the ABCs and provide proper
care.
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lThe first step in treatment is to assess the ABCs and provide proper care.
lUse the ____________________ scale.lObtain brief history from caregivers.lAfter initial assessment, secure airway.lSupport patient’s vital functions.lProvide prompt transport.l
PoisoninglPoisoning is common in children.lCare will be based on how awake and ____________________ the
child appears.lFocus on the ABCs.lDo not administer activated charcoal unless directed by medical
control.lProvide transport.lChild’s condition could change at any time.Poisoning Emergencies and ManagementlAfter primary assessment, ask caregiver the following:
–What is the ____________________ involved?–Approximately how much was ingested?–What time did the incident occur?–Any changes in behavior or level of consciousness?–Any choking or coughing after the exposure?
l
Fever Emergenciesl____________________ ° or higher is abnormallCommon causes of fever
–Infections–Neoplasm (cancer)–Drug ingestion–Vascular disease–High environmental temperatures
Emergency Care of FeverlPerform assessment of ABCs and care for life threats.lObtain vital signs.
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lPerform assessment of ABCs and care for life threats.lObtain vital signs.lEvaluate for signs and symptoms of shock.lIf child feels very warm, remove ____________________ .lBegin cooling measures en route.
Meningitis lInflammation of the linings of the brain and spinal
____________________ lSigns/Symptoms
-Fever-Altered level of consciousness-Headache-Seizure-Stiff ____________________ -Irritability
People at Greater RisklIndividuals at greater risk for meningitis:
–____________________ –Newborn infants–Compromised immune system by AIDS or cancer–History of brain, spinal cord, back surgery–Children who have had head trauma–Children with shunts, pins, or other foreign bodies in their brain or spinal cord
l
Neisseria Meningitidis(Bacterial Meningitis)lRapid onset of meningitis symptomslOften associated with small pinpoint cherry-red spots or larger
____________________ /black rashlChildren at serious risk for sepsis, shock, and deathlAll suspected cases of meningitis should be considered contagious.
Neisseria Meningitidis(Bacterial Meningitis)
Emergency Medical Careof Meningitis
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Emergency Medical Careof Meningitis lBegin with assessment of ABCs.lCare for life threats.lGive supplemental ____________________ .lAssess vital signs.lKeep patient warm.lMonitor for shock.lIf patient’s vital signs are unstable, call ALS for backup.
Pediatric Trauma
Injury Patterns: Automobile CollisionslThe exact area of impact will depend on the child’s height.lA car bumper dips down when stopping suddenly, causing a
____________________ point of impact.lChildren often sustain high-energy injuries.
Injury Patterns: Sports ActivitieslHead and neck injuries can occur from high-speed collisions during
contact sports.lImmobilize the ____________________ spine.lFollow local protocols for helmet removal.
Head InjurieslCommon injury among childrenlThe head is larger in proportion to an adult.lInfant has softer, thinner ____________________ lNausea and vomiting are signs of pediatric head injury.lBulging fontanelles indicate increased intracranial pressure (ICP)
Chest InjurieslMost chest injuries in children result from blunt trauma.lChildren have soft, flexible ribs.lThe absence of obvious external trauma does
____________________ exclude the likelihood of serious internal injuries.
Abdominal InjurieslAbdominal injuries are very common in children.
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Abdominal InjurieslAbdominal injuries are very common in children.lChildren compensate for blood loss better than adults but go into
shock more ____________________ .lWatch for:
–Weak, rapid pulse–Cold, clammy skin–Poor capillary refill
Injuries to the ExtremitieslChildren’s bones ____________________ more easily than adults’
bones. lIncomplete fractures can occur.lDo not use adult immobilization devices on children unless the child
is large enough.
BurnslMost common burns involve exposure to hot substances.lSuspect internal injuries from ____________________ ingestion
when burns are present around lips and mouth.lInfection is a common problem with burns.lConsider the possibility of child abuse.
Submersion InjurylDrowning or near drowninglSecond most common cause of unintentional death of children in
the United StateslAssessment and reassessment of ____________________ are
critical.lConsider the need for C-spine protection.
Child AbuselChild abuse refers to any improper or excessive action that injures
or harms a child or infant.lThis includes physical abuse, sexual abuse,
____________________ , and emotional abuse.lMore than 2 million cases are reported annually.lBe aware of signs of child abuse and report suspicions to
authorities.
Signs of Child Abuse
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Signs of Child Abuse
Questions Regarding Signs of Abuse (1 of 3)lIs the injury ____________________ for the child’s developmental
stage?lIs reported method of injury consistent with injuries?lIs the caregiver behaving ____________________ ?lIs there evidence of drinking or drug abuse?lWas there a delay in seeking care for the child?l
Questions Regarding Signs of Abuse (2 of 3)lIs there a good relationship between child and caregiver?lDoes the child have multiple injuries at various
____________________ of healing?lDoes the child have any unusual marks or bruises?lDoes the child have several types of injuries?Questions Regarding Signs of Abuse (3 of 3)lDoes the child have burns on the hands or feet involving a
____________________ distribution?lIs there an unexplained decreased level of consciousness?lIs the child ____________________ and an appropriate weight?lIs there any rectal or vaginal bleeding?lWhat does the home look like? Clean or dirty? Warm or cold? Is
there food?l
Child Abuse Warning Signs (1 of 2)lBruises
–Observe color and location. lBurns
–Burns to the penis, testicles, vagina, or buttocks are usually inflicted by someone else.
–Burns that look like a ____________________ are usually inflicted by someone else.lYou should suspect child abuse if the child has cigarettes burns or grid pattern burns.
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lYou should suspect child abuse if the child has cigarettes burns or grid pattern burns.
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Child Abuse Warning Signs (2of 2)lFractures
–Falls from bed are not usually associated with fractures. lShaken baby syndrome
–Infants may sustain life-threatening ____________________ trauma by being shaken or struck.
–Shaking tears blood vessels in the brain, resulting in bleeding around the brain.
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Shaken Baby Syndrome (1 of 2)lInfants may sustain life-threatening head trauma by being shaken or
struck.lLife-threatening conditionlBleeding within the head and damage to the
____________________ spinelInfant will be found unconscious often without evidence of external
trauma.Shaken Baby Syndrome (2 of 2)lShaking tears blood vessels in the ____________________ ,
resulting in bleeding around the brain.lPressure from blood results in an increase in cranial pressure
leading to coma and/or death.NeglectlRefusal or failure to provide life ____________________ lExamples are water, clothing, shelter, personal hygiene, medicine,
comfort, personal safety.lChild may show no signs of physical abuselChild may appear frail, week, and palel
Sexual AbuselChildren of any age or either sex can be victims.l____________________ examination.lDo not allow child to wash, urinate, or defecate.lMaintain professional composure.
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lDo not allow child to wash, urinate, or defecate.lMaintain professional composure.lTransport.Emergency Medical CarelEMT-Bs must report ____________________ suspected cases of
child abuse.lMost states have special forms for reporting. lYou do not have to prove that abuse occurred. lTry to convince a parent to allow transport, regardless of severitylDo not make ____________________ .lTreat injuries as requiredPain Management
• First step is recognizing the patient is in pain.• Look for visual clues and use the Wong-Baker ____________________ pain scale.
• Interventions are limited to positioning, ice packs, and extremity elevation (to decrease pain and swelling to injury site).
• ALS interventions may be needed.• Another important tool is kindness and providing emotional support.
•Disaster Management (1 of 4)lJumpSTART triage system
–Intended for patients younger than age ____________________ years and weighing less than 100 lbs
–Four triage categorieslGreenlYellowlRedlBlack
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Disaster Management (2 of 4)lJumpSTART triage system (cont’d)
–Green: minor not in need of immediate treatmentlAble to ____________________ (except in infants)
–Yellow: delayed treatmentlPresence of spontaneous breathing with peripheral pulse,
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–Yellow: delayed treatmentlPresence of spontaneous breathing with peripheral pulse, responsive to painful stimuli
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Disaster Management (3 of 4)lJumpSTART triage system (cont’d)
–Red: ____________________ responselApnea responsive to positioning or rescue breathing, respiratory failure, or inappropriate painful response
–Black: deceased or expectant deceasedlApneic without pulse, or apneic and unresponsive to rescue breathing
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Disaster Management (4 of 4)
ImmobilizationlAny child with a head or back injury should be immobilized.lYoung children may need padding beneath their
____________________ .lChildren may need padding along the sides of the backboard.Pediatric Immobilization Device
Immobilization in a Child Safety Seat (1 of 2)lAssess child for injuries and seat for visible damage. lIf child is injured or seat is damaged, remove child to another
transport devicelApply padding around child to minimize ____________________ .lMove seat to ambulance and secure according to the
manufacturer’s instructions.Immobilization in a Child Safety Seat (1 of 2)Removing a Child froma Child Safety SeatlRemove both the child and the seat from the vehicle.lPlace immobilization device behind the child.lSlide child into place on device.
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lSlide child into place on device.Sudden Infant Death Syndrome (SIDS)Sudden Infant Death Syndrome (SIDS)lDeath for ____________________ reason in an otherwise healthy
child.lSeveral known risk factors:
–Mother younger than 20 years old–Mother smoked during pregnancy–Low birth weight
Tasks at Scene of SIDSlAssess and manage the patient.lCommunicate with and support the ____________________ .lAssess the scene.Assessment and ManagementlAssess ABCs and provide interventions as necessary.lIf child shows signs of postmortem changes, call medical control.lIf there is no evidence of postmortem changes, begin
____________________ immediately.lIf resuscitation is contraindicated, notify law enforcement and
preserve sceneCommunication and SupportlThe death of a child is very stressful for the family.lProvide support in whatever ways you ____________________ .lUse the infant’s name. lIf possible, allow the family time with the infant; but preserve scene
until after investigationScene AssessmentlCarefully inspect the environment, following local protocols. lConcentrate on:
–Signs of illness–General ____________________ of the house–Family interaction–Site where infant was discovered
Key Points on SIDSlLividity can often look like ____________________ ; so cautious
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Key Points on SIDSlLividity can often look like ____________________ ; so cautious
what you saylNever accuse anyone of child abuselAll non-institutional scenes, where death occurs, are considered
crime scenes until proved otherwiselALWAYS notify law enforcement, stay on scene, and preserve
evidenceApparent Life-Threatening EventlAka: Near SIDSlInfant found not breathing, cyanotic, and unresponsive but resumes
breathing with ____________________ lComplete careful assessment.lTransport immediately.lPay strict attention to airway management.
Death of a Child (1 of 2)lBe prepared to support the family.lFamily may insist on ____________________ efforts.lIntroduce yourself to the child’s caregivers. lDo not speculate on the cause of death.Death of a Child (2 of 2)lAllow the family to see the child and say good-bye. lBe prepared to answer questions posed by caregivers. lSeek professional help for yourself if you notice signs of
____________________ stress.
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