Transcript
ChapterChapter
Infants andInfants and
ChildrenChildren
Twenty-FiveTwenty-Five
ChapterChapter
Pediatric respiratory emergencies
Other pediatric medical emergencies
Pediatric trauma
Twenty-FiveTwenty-FiveCORE CONCEPTSCORE CONCEPTS
Newborns and Infants: Birth to 1 YearNewborns and Infants: Birth to 1 Year
Very little anxiety fromVery little anxiety fromexposure to strangers.exposure to strangers.
Dislike separation from Dislike separation from parents.parents.
(Continued)(Continued)
Newborns and InfantsNewborns and Infants
Dislike feeling of oxygen maskDislike feeling of oxygen maskon face.on face.
Need warmth:Need warmth:• Warm hands and stethoscopeWarm hands and stethoscope
(Continued)(Continued)
Newborns and InfantsNewborns and Infants
Obtain respiratory rate fromObtain respiratory rate froma distance.a distance.
If listening to lungs, do it earlyIf listening to lungs, do it early(before child becomes upset)(before child becomes upset)..
Examine head last to Examine head last to build confidence.build confidence.
Newborns and InfantsNewborns and Infants
Toddler: 1 to 3 YearsToddler: 1 to 3 Years
DislikeDislike Being touchedBeing touched Separation from parentsSeparation from parents Removal of clothingRemoval of clothing
(remove, examine, replace)(remove, examine, replace)
Feeling of oxygen mask Feeling of oxygen mask on face on face
(Continued)(Continued)
ToddlersToddlers
Think illness/injury is punishment.Think illness/injury is punishment. Afraid of needles, pain.Afraid of needles, pain. Examine trunk first, head last. Examine trunk first, head last.
ToddlersToddlers
Preschool: 3 to 6 YearsPreschool: 3 to 6 Years
DislikeDislike Being touchedBeing touched Separation from parentsSeparation from parents Removal of clothingRemoval of clothing
(remove, examine, replace)(remove, examine, replace)
Feeling of oxygen mask Feeling of oxygen mask on face on face
(Continued)(Continued)
PreschoolersPreschoolers
Think illness/injury is punishment.Think illness/injury is punishment. Afraid of blood, pain,Afraid of blood, pain,
permanent injury.permanent injury. Modest.Modest. Have magical thoughts.Have magical thoughts.
PreschoolersPreschoolers
School Age: 6 to 12 YearsSchool Age: 6 to 12 Years
Afraid of blood and pain.Afraid of blood and pain. Afraid of permanent injuryAfraid of permanent injury
and disfigurement.and disfigurement.
Modest.Modest.
School-Age ChildSchool-Age Child
Adolescent: 12 to 18 YearsAdolescent: 12 to 18 Years
Afraid of permanent injuryAfraid of permanent injuryand disfigurement.and disfigurement.
Modest.Modest. Treat as an adult.Treat as an adult. Examine in private if possibleExamine in private if possible
(away from adults)(away from adults)..
AdolescentAdolescent
Airway Differences between Airway Differences between Adults and ChildrenAdults and Children
Small airways are more easily Small airways are more easily blocked. blocked. Child's tongue is larger.Child's tongue is larger. Infants are nose breathers.Infants are nose breathers.
• Suctioning nasopharynx improvesSuctioning nasopharynx improves breathing significantly.breathing significantly.
(Continued)(Continued)
Airway Differences betweenAirway Differences betweenAdults and ChildrenAdults and Children
Put child’s head in neutral position,Put child’s head in neutral position,not hyperextended.not hyperextended.
Children can compensate Children can compensate (breathe (breathe
faster/harder)faster/harder) for a while, then for a while, then get worse rapidly.get worse rapidly.
Airway Differences betweenAirway Differences betweenAdults and ChildrenAdults and Children
Opening the airway Use head-tilt,Opening the airway Use head-tilt,chin-lift procedure chin-lift procedure withoutwithout hyperextension. hyperextension.
Ensure small enough catheter.Ensure small enough catheter. Do not insert too deeply.Do not insert too deeply. Suction as briefly as possible.Suction as briefly as possible.
SuctioningSuctioning
Treating Mild Airway Treating Mild Airway ObstructionObstruction
Place in position of comfort (parent’s lap okay).
Administer high-concentration oxygen.
Transport without agitating.
Severe Airway Severe Airway ObstructionObstruction
No crying or speechInitial difficulty breathing that
worsensCough becomes weak and ineffectiveAltered mental status,
unconsciousness
INFANTS
Back blows andchest thrusts
CHILDREN
Abdominalthrusts
Remove visible foreign body.
Clearing Foreign BodyClearing Foreign BodyObstructionsObstructions
Attempt artificial ventilation with BVM.
Use correct size.Use correct size. Use tongue depressor to hold down tongue.Use tongue depressor to hold down tongue.
Insert right side upInsert right side up ((not upside downnot upside down))..
Oral AirwaysOral Airways
Use proper size.Use proper size. Insertion technique is sameInsertion technique is same
as for adult.as for adult.
Nasal AirwaysNasal Airways
Nonrebreather MaskNonrebreather Mask
Hold tubing 2 inches from face,Hold tubing 2 inches from face,
OROR Insert tubing into paper Insert tubing into paper
cup. Do not use cup. Do not use styrofoam cup.styrofoam cup.
Blow-By TechniqueBlow-By Technique
Use proper size mask and bag.Use proper size mask and bag. If trauma is involved, use jawIf trauma is involved, use jaw
thrust (not head tilt).thrust (not head tilt).
If unable to maintain mask sealIf unable to maintain mask sealwith one hand, use two.with one hand, use two.
(Continued)(Continued)
Artificial VentilationArtificial Ventilation
Mouth-to-Mask VentilationMouth-to-Mask Ventilation
Bag-Mask Device:Bag-Mask Device:• Squeeze bag slowly/evenly until chest rises.Squeeze bag slowly/evenly until chest rises.• From birth to puberty (about 12 years old), From birth to puberty (about 12 years old),
ventilate 12–20 times a minute, each lasting ventilate 12–20 times a minute, each lasting 1 second.1 second.
• If the patient has reached puberty, ventilate If the patient has reached puberty, ventilate 10–12 times a minute, each lasting 1 second.10–12 times a minute, each lasting 1 second.
• Use oxygen reservoir to provide 100% Use oxygen reservoir to provide 100% oxygen.oxygen.
•
Artificial VentilationArtificial Ventilation
• Mental statusMental status• BreathingBreathing• ColorColor
Observe:Observe:
Observe:Observe:• Quality of cry or speechQuality of cry or speech• Emotional stateEmotional state• Response to your presenceResponse to your presence• Tone and body positionTone and body position
(Continued)(Continued)
Assessment: General ImpressionAssessment: General Impression
Observe:Observe:• Interaction with environmentInteraction with environment
and parentsand parents• Normal behavior for age?Normal behavior for age?• Playing or moving around?Playing or moving around?• Attentive?Attentive?• Eye contact?Eye contact?• Recognize and respond to parents?Recognize and respond to parents?
Assessment: General ImpressionAssessment: General Impression
As soon as you see patient, check:As soon as you see patient, check:• Mechanism of injuryMechanism of injury• SurroundingsSurroundings• Healthy or sick appearanceHealthy or sick appearance
(Continued)(Continued)
Approach to EvaluationApproach to Evaluation
Assess respirations:Assess respirations:• Chest expansion and symmetryChest expansion and symmetry• Effort of breathingEffort of breathing• Nasal flaringNasal flaring• RetractionsRetractions
(Continued)(Continued)
Approach to EvaluationApproach to Evaluation
Assess respirations:Assess respirations:• Crowing or noisy respirationsCrowing or noisy respirations• StridorStridor• GruntingGrunting• Respiratory rateRespiratory rate
Assess perfusion:Assess perfusion:• Skin color (CTC)Skin color (CTC)
(Continued)(Continued)
Approach to EvaluationApproach to Evaluation
When you reach child,When you reach child,
• Breath soundsBreath sounds present or absent?present or absent?• Stridor?Stridor?• Wheezing?Wheezing?
continue breathing assessmentcontinue breathing assessmentusing stethoscope:using stethoscope:
(Continued)(Continued)
Approach to EvaluationApproach to Evaluation
Assess circulation:Assess circulation:• Brachial or femoral pulseBrachial or femoral pulse• Peripheral pulsesPeripheral pulses• Capillary refillCapillary refill• Blood pressure Blood pressure (if over age 3)(if over age 3)
• Skin color, temperature, conditionSkin color, temperature, condition
Approach to EvaluationApproach to Evaluation
Generally start at trunk andGenerally start at trunk andevaluate head last.evaluate head last.
Alter order of steps to fit situation.Alter order of steps to fit situation. Avoid making child more anxious. Avoid making child more anxious.
Detailed Physical ExamDetailed Physical Exam
PPEDIATRICEDIATRICRESPIRATORYRESPIRATORYEMERGENCIESEMERGENCIES
Patient Patient ASSESSMENTASSESSMENT
Partial Airway ObstructionPartial Airway Obstruction
Signs and SymptomsSigns and Symptoms
Stridorous, crowing, or noisyStridorous, crowing, or noisyrespirationsrespirations
Retractions on inspirationRetractions on inspiration Pink mucous membranes and Pink mucous membranes and nail beds nail beds AlertAlert
Patient Patient CARECARE
Partial Airway ObstructionPartial Airway Obstruction
Emergency Care StepsEmergency Care Steps
Allow position of comfortAllow position of comfort(parent’s lap okay)(parent’s lap okay)..
Do not lay child flat.Do not lay child flat. Offer high-concentration oxygen.Offer high-concentration oxygen. Transport without agitating.Transport without agitating.
(Do not assess blood pressure.)(Do not assess blood pressure.)
Patient Patient ASSESSMENTASSESSMENT
Complete Airway ObstructionComplete Airway Obstruction
Signs and SymptomsSigns and Symptoms
No crying or speechNo crying or speech Initial breathing difficulty that worsensInitial breathing difficulty that worsens Cough becomes weak and ineffectiveCough becomes weak and ineffective Altered mental status, unconsciousnessAltered mental status, unconsciousness
Patient Patient CARECARE
Complete Airway ObstructionComplete Airway Obstruction
Emergency Care StepsEmergency Care Steps
Clear airway with infant/childClear airway with infant/childforeign body procedures.foreign body procedures.
Attempt artificial ventilation withAttempt artificial ventilation withBVM. Assure good seal between BVM. Assure good seal between mask and face.mask and face.
Upper airway obstructionUpper airway obstruction• Stridor on inspirationStridor on inspiration
Lower airway diseaseLower airway disease• Wheezing and respiratory effort on Wheezing and respiratory effort on exhalation OR rapid breathing exhalation OR rapid breathing without stridorwithout stridor
Respiratory EmergenciesRespiratory Emergencies
Tell new EMT-Bs that pediatric care experts emphasize that the priority of children in respiratory distress is “AAA,” not just “ABC.” In other words, if you manage the patient’s airway and oxygenate, circulation improvement will follow!
PPRECEPTOR RECEPTOR PPEARLEARL
Patient Patient ASSESSMENTASSESSMENT
Early Respiratory DistressEarly Respiratory Distress
Signs and SymptomsSigns and Symptoms
Nasal flaringNasal flaring RetractionsRetractions
• Between ribs Between ribs (intercostal)(intercostal)
• Above clavicles Above clavicles (supraclavicular)(supraclavicular)
• Below ribs Below ribs (subcostal)(subcostal)
(Continued)(Continued)
Patient Patient ASSESSMENTASSESSMENT
Early Respiratory DistressEarly Respiratory Distress
Signs and SymptomsSigns and Symptoms
StridorStridor Retractions of neck, Retractions of neck, abdominal muscles abdominal muscles Audible wheezingAudible wheezing GruntingGrunting
(Continued)(Continued)
Patient Patient ASSESSMENTASSESSMENT
Early Respiratory DistressEarly Respiratory Distress
Signs and SymptomsSigns and Symptoms
Respiratory rate > 60/minuteRespiratory rate > 60/minute CyanosisCyanosis Decreased muscle toneDecreased muscle tone Excessive use of accessory musclesExcessive use of accessory muscles
Patient Patient ASSESSMENTASSESSMENT
Respiratory DistressRespiratory Distress
Signs and SymptomsSigns and Symptoms
Poor peripheral perfusionPoor peripheral perfusion Altered mental statusAltered mental status GruntingGrunting
Patient Patient ASSESSMENTASSESSMENT
Respiratory ArrestRespiratory Arrest
Signs and SymptomsSigns and Symptoms
Respiratory rate < 10/minuteRespiratory rate < 10/minute Little or no muscle toneLittle or no muscle tone UnconsciousnessUnconsciousness Slow/absent heart rateSlow/absent heart rate Weak/absent pulseWeak/absent pulse
Signs of Respiratory DistressSigns of Respiratory Distress
Patient Patient CARECARE
Respiratory EmergenciesRespiratory Emergencies
Emergency Care StepsEmergency Care Steps
Administer high-concentration oxygen.Administer high-concentration oxygen. Ventilate if respiratory distress is severe:Ventilate if respiratory distress is severe:
• Altered mental statusAltered mental status• Cyanosis not improving with oxygenCyanosis not improving with oxygen• Poor muscle tonePoor muscle tone• Respiratory failureRespiratory failure• Respiratory arrestRespiratory arrest
PPEDIATRICEDIATRICTRAUMATRAUMA
TraumaTrauma
In the United States, injuries kill In the United States, injuries kill more children and infants thanmore children and infants than
any other cause of death.any other cause of death.
• Unrestrained passenger head andUnrestrained passenger head and neck injuries neck injuries
Motor vehicle crashesMotor vehicle crashes
• Restrained passenger abdominalRestrained passenger abdominal and lower spine injuries and lower spine injuries
(Continued)(Continued)
Blunt TraumaBlunt Trauma(Most Common Type of Injury)(Most Common Type of Injury)
Motor vehicle crashesMotor vehicle crashes• Struck while riding bicycleStruck while riding bicycle
(head, spine, abdominal injuries)(head, spine, abdominal injuries)
• Pedestrian struck by vehiclePedestrian struck by vehicle(abdominal, femur, head injuries)(abdominal, femur, head injuries)
(Continued)(Continued)
Blunt TraumaBlunt Trauma
Falls from heightFalls from height• Head and neck injuriesHead and neck injuries
Diving into shallow waterDiving into shallow water• Head and neck injuriesHead and neck injuries
BurnsBurns Sports injuriesSports injuries Child abuseChild abuse
Blunt TraumaBlunt Trauma
HeadHead• Airway maintenance is critical.Airway maintenance is critical.• Head injury is common.Head injury is common.• Can result in respiratory arrest.Can result in respiratory arrest.• Nausea and vomiting are common.Nausea and vomiting are common.
(Continued)(Continued)
Blunt TraumaBlunt TraumaSpecific Types of InjurieSpecific Types of Injuriess
ChestChest• Children’s ribs are less rigid thanChildren’s ribs are less rigid than
adults’ ribs.adults’ ribs.
• Result in injury to internal organsResult in injury to internal organswithout external wounds.without external wounds.
(Continued)(Continued)
Blunt TraumaBlunt TraumaSpecific Types of InjuriesSpecific Types of Injuries
AbdomenAbdomen• More commonly injured in childrenMore commonly injured in children
than adults.than adults.• May be subtle and difficult to detect.May be subtle and difficult to detect.• Under stress, children swallow airUnder stress, children swallow air
(may cause gastric distention, impede (may cause gastric distention, impede
breathing)breathing)..(Continued)(Continued)
Blunt TraumaBlunt TraumaSpecific Types of InjuriesSpecific Types of Injuries
ExtremitiesExtremities• Managed the same as adultsManaged the same as adults
Blunt TraumaBlunt TraumaSpecific Types of InjuriesSpecific Types of Injuries
Pneumatic Antishock GarmentPneumatic Antishock Garment• Use only if:Use only if:
• Child fits in garment.Child fits in garment.• Trauma occurs with hypoperfusionTrauma occurs with hypoperfusion and pelvic instability.and pelvic instability.
• Do not inflate abdominal compartment.Do not inflate abdominal compartment.
TraumaTraumaOther ConsiderationsOther Considerations
(Continued)(Continued)
BurnsBurns• Cover with sterile dressingCover with sterile dressing
(sterile sheet works well)(sterile sheet works well)..• Follow local protocol with regard toFollow local protocol with regard to
transport to burn center.transport to burn center.
TraumaTraumaOther ConsiderationsOther Considerations
Patient Patient CARECARE
TraumaTrauma
Emergency Care StepsEmergency Care Steps
Establish and maintain airway withEstablish and maintain airway withjaw thrust.jaw thrust.
Suction and ventilate as needed.Suction and ventilate as needed. Provide high-concentration oxygen.Provide high-concentration oxygen. Immobilize spine.Immobilize spine. Transport.Transport.
Diarrhea, vomiting, dehydration Trauma and blood loss Infection Abdominal injuries
CausesCauses
Allergic reactions Poisoning Cardiac problems
UncommonUncommonCausesCauses
Shock (Hypoperfusion)Shock (Hypoperfusion)
Tell new EMT-Bs that one way to remember how little blood children have is to envision that an infant’s total blood volume would fill only a soda can and a school age child’s a six-pack.
PPRECEPTOR RECEPTOR PPEARLEARL
Patient Patient ASSESSMENTASSESSMENT
Shock (Hypoperfusion)Shock (Hypoperfusion)
Signs and SymptomsSigns and Symptoms
Rapid breathingRapid breathing Pale, cool, clammy skinPale, cool, clammy skin Weak/absent peripheral pulsesWeak/absent peripheral pulses Delayed capillary refillDelayed capillary refill
(Continued)(Continued)
Patient Patient ASSESSMENTASSESSMENT
Shock (Hypoperfusion)Shock (Hypoperfusion)
Signs and SymptomsSigns and Symptoms
Decreased urine outputDecreased urine outputInspect diaper/ask parents when last changed.Inspect diaper/ask parents when last changed.
Changes in mental statusChanges in mental status Lack of tears when cryingLack of tears when crying
Signs of Shock (Hypoperfusion)Signs of Shock (Hypoperfusion)
Patient Patient CARECARE
Shock (Hypoperfusion)Shock (Hypoperfusion)
Emergency Care StepsEmergency Care Steps Assure airway and giveAssure airway and give
high-concentration oxygen.high-concentration oxygen. Ventilate as needed.Ventilate as needed. Control bleeding.Control bleeding. Elevate legs.Elevate legs. Keep warm.Keep warm. Transport promptly.Transport promptly.
Patient Patient CARECARE
Near Drowning (submersion)Near Drowning (submersion)
Emergency Care StepsEmergency Care Steps
Ventilation is top priority.Ventilation is top priority. Consider possibilities of trauma,Consider possibilities of trauma,
hypothermia, and drug ingestionhypothermia, and drug ingestion(especially alcohol in teenagers)(especially alcohol in teenagers) ..
Transport. Transport. (Some patients deteriorate (Some patients deteriorate minutes/hours later.)minutes/hours later.)
AbuseAbuse
Improper or excessive action so as to Improper or excessive action so as to injure or cause harminjure or cause harm
NeglectNeglect
Giving insufficient attention or respect Giving insufficient attention or respect to someone who has a claim to that to someone who has a claim to that attentionattention
KKEY TERMSEY TERMS
Physical abuse and neglect arePhysical abuse and neglect areforms of child abuse EMT-B forms of child abuse EMT-B
is most likely to suspect.is most likely to suspect.
EMT-B must be aware of EMT-B must be aware of condition in order tocondition in order to
recognize it.recognize it.
Tell new EMT-Bs that the ED physician is required to report cases of child abuse. Therefore, they should complete the PCR with factual information that they observed about the child’s home environment, the condition of the home, the reaction of the parents or other caretakers, the child’s hygiene, and general interaction of all family members involved, and call it to the attention of the physician.
PPRECEPTOR RECEPTOR PPEARLEARL
Patient Patient ASSESSMENTASSESSMENT
AbuseAbuse
Signs and SymptomsSigns and Symptoms
Multiple bruises in different stagesMultiple bruises in different stagesof healingof healing
Injury inconsistent withInjury inconsistent withmechanism describedmechanism described
Repeated calls to same addressRepeated calls to same address(Continued)(Continued)
Patient Patient ASSESSMENTASSESSMENT
AbuseAbuse
Signs and SymptomsSigns and Symptoms
Fresh burnsFresh burns Apparent lack of enough concernApparent lack of enough concern in parents in parents Conflicting storiesConflicting stories Child’s hesitancy to describe howChild’s hesitancy to describe how injury occurred injury occurred
Patient Patient ASSESSMENTASSESSMENT
NeglectNeglect
Signs and SymptomsSigns and Symptoms
Lack of adult supervisionLack of adult supervision Apparent malnourishmentApparent malnourishment Unsafe living environmentUnsafe living environment Untreated chronic illnessUntreated chronic illness
Head injuries are most lethalHead injuries are most lethal(shaken baby syndrome)(shaken baby syndrome)..
Do not accuse anyone in the field.Do not accuse anyone in the field.
(Continued)(Continued)
Handling Abuse and NeglectHandling Abuse and Neglect
Required reportingRequired reporting• Follow state laws and local regulations.Follow state laws and local regulations.• Document objective information: Document objective information: what what
you SEE and HEAR, not what you merely THINK you SEE and HEAR, not what you merely THINK..
Handling Abuse and NeglectHandling Abuse and Neglect
PPEDIATRICEDIATRICMEDICAL MEDICAL
EMERGENCIESEMERGENCIES
SeizuresSeizures
Rarely life-threatening inRarely life-threatening inchildren, but EMT-B should children, but EMT-B should take seriously.take seriously.
May be brief or prolonged.May be brief or prolonged. May cause injuries.May cause injuries.
Fever Infection Poisoning Hypoglycemia Trauma Hypoxia Idiopathic
CausesCauses
(unknown cause)(unknown cause)
SeizuresSeizures
Patient Patient ASSESSMENTASSESSMENT
Child after SeizureChild after Seizure
Signs and SymptomsSigns and Symptoms
Has child had seizures before?Has child had seizures before? If yes, was this typical seizure?If yes, was this typical seizure? Was antiseizure medication taken?Was antiseizure medication taken?
Patient Patient CARECARE
SeizuresSeizures
Emergency Care StepsEmergency Care Steps
Establish airway.Establish airway. Position on left side if no spine trauma.Position on left side if no spine trauma. Have suction ready.Have suction ready. Give oxygen. Ventilate if respiratoryGive oxygen. Ventilate if respiratory
distress/arrest.distress/arrest. Transport.Transport.
Hypoglycemia Poisoning Postseizure Infection Head trauma Hypoxia Shock
CausesCauses
Altered Mental StatusAltered Mental Status
Patient Patient CARECARE
Altered Mental StatusAltered Mental Status
Emergency Care StepsEmergency Care Steps
Establish airway.Establish airway. Ventilate and suction as needed.Ventilate and suction as needed. Transport.Transport.
Patient Patient CARECARE
Poisoning: Responsive PatientPoisoning: Responsive Patient
Emergency Care StepsEmergency Care Steps
Contact medical direction.Contact medical direction. Give activated charcoal as directed.Give activated charcoal as directed. Administer oxygen.Administer oxygen. Transport and monitor patient.Transport and monitor patient.
Patient Patient CARECARE
Poisoning: Unresponsive PatientPoisoning: Unresponsive Patient
Emergency Care StepsEmergency Care Steps
Rule out trauma.Rule out trauma. Establish airway.Establish airway. Administer oxygen; ventilate Administer oxygen; ventilate as needed. as needed. Contact medical direction.Contact medical direction. Transport.Transport.
FeverFever
Many things can cause fever.Many things can cause fever. Meningitis is one of worst. MayMeningitis is one of worst. May
appear as fever with rash.appear as fever with rash.
Transport.Transport. Be prepared for seizures.Be prepared for seizures.
Sudden Infant DeathSudden Infant DeathSyndrome (SIDS)Syndrome (SIDS)
Sudden death occurs withoutSudden death occurs without identifiable cause in infant identifiable cause in infant < 1 year old. < 1 year old. Cause is not well understood.Cause is not well understood. Most common time of discoveryMost common time of discovery is early morning. is early morning.
Patient Patient CARECARE
SIDSSIDS
Emergency Care StepsEmergency Care Steps
Try to resuscitate unless rigorTry to resuscitate unless rigor
mortis is present.mortis is present. Avoid comments that blame parents.Avoid comments that blame parents. Expect parents to feel remorse and guilt.Expect parents to feel remorse and guilt.
IINFANTS ANDNFANTS ANDCHILDREN WITHCHILDREN WITHSPECIAL NEEDSSPECIAL NEEDS
Premature babies with lung diseasePremature babies with lung disease Heart diseaseHeart disease Neurologic diseaseNeurologic disease Chronic disease or altered functionChronic disease or altered function
since birthsince birth
Children with Special NeedsChildren with Special Needs
Tracheostomy tubeTracheostomy tube Central intravenous linesCentral intravenous lines Gastrostomy tubesGastrostomy tubes ShuntsShunts
Technologically DependentTechnologically DependentChildren Children (“High-Tech Kids”)(“High-Tech Kids”)
ObstructionObstruction BleedingBleeding Air leakAir leak Dislodged tubeDislodged tube InfectionInfection
Tracheostomy TubeTracheostomy TubeComplicationsComplications
Patient Patient CARECARE
Tracheostomy Tube
Emergency Care StepsEmergency Care Steps
Maintain open airway.Maintain open airway. Suction.Suction. Maintain position of comfort.Maintain position of comfort. Transport.Transport.
Parents are usually veryParents are usually veryfamiliar with equipment.familiar with equipment.
Home Artificial VentilationHome Artificial Ventilation
Patient Patient CARECARE
Home Artificial VentilationHome Artificial Ventilation
Emergency Care StepsEmergency Care Steps
Assure airway.Assure airway. Artificially ventilate withArtificially ventilate with
high-concentration oxygen.high-concentration oxygen. Transport.Transport.
IVs that are very long IVs that are very long • Tip in vein near heartTip in vein near heart
ComplicationsComplications• Cracked lineCracked line• InfectionInfection• Clotting offClotting off• BleedingBleeding
Central Intravenous LinesCentral Intravenous Lines
Patient Patient CARECARE
Central Intravenous Lines
Emergency Care StepsEmergency Care Steps
If bleeding, apply pressure.If bleeding, apply pressure. Transport.Transport.
ShuntShuntTube running from brain to abdomenTube running from brain to abdomento drain excess cerebrospinal fluidto drain excess cerebrospinal fluid
Gastrostomy TubeGastrostomy TubeTube placed directly into the stomach for a Tube placed directly into the stomach for a child who cannot be fed by mouthchild who cannot be fed by mouth
KKEY TERMSEY TERMS
Patient Patient CARECARE
ShuntShunt
Emergency Care StepsEmergency Care Steps
Assure airway and ventilate as needed.Assure airway and ventilate as needed. Transport.Transport.
Patient Patient CARECARE
Gastrostomy Tube
Emergency Care StepsEmergency Care Steps
Assure patent airway.Assure patent airway. Suction as needed. Suction as needed. Provide high-concentration oxygen.Provide high-concentration oxygen. Transport patient sitting or lying onTransport patient sitting or lying on
right side with head elevated.right side with head elevated.
1. Describe two characteristics of a 1. Describe two characteristics of a
typical child in each of the fivetypical child in each of the fiveage groups.age groups.
2. Describe the management of pediatric2. Describe the management of pediatric respiratory distress.respiratory distress.3. How do children compensate for 3. How do children compensate for blood blood loss compared to an adult?loss compared to an adult?4. What are some indications of4. What are some indications of child abuse? child abuse?
RREVIEW QUESTIONSEVIEW QUESTIONS
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