Pediatric Emergencies

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

Normal pulse rate ranges
Pediatric pulse rates!
Newborns: 120-160/minute
Adolescents: 60-105/minute

Normal respiration rate ranges
From 30-50/minute in newborns
to 12-20/minute in adolescents

Normal blood pressure ranges
average 99/65 in preschoolers
to average 114/76 in adolescents.

Consider a Child’s head size
A child’s head is proportionately larger than an adult’s until age 4. Because of this, children often fall head first. As a result you should suspect head injury whenever there is a serious MOI. Up to 12-18 months infants will have a soft spot just to the anterior center of the skull called the anterior fontanelle. A sunken fontanelle may indicate dehydration and a bulging fontanelle may indicate elevated intercranial pressure.

Fontanelle
a soft spot on an infant’s anterior scalp formed by the joining of not-yet-fused bones of the skull.

Pediatric Assessment Triangle (PAT)
Pediatric Assessment Triangle (PAT)
is a method of pediatric assessment from two viewpoints. The first is the general impression formed as you approach the child, often referred to as an assessment “from the doorway.” The second is the impression based on the remainder of the primary assessment that is done next to the patient. Each of the three sides of the triangle represents a different patient presentation that should be evaluated:
• Appearance
• Work of breathing
• Circulation to skin

Appearance
For the first side of the triangle, look at the patient’s appearance. Consider the child’s mental status using the “AV” part of AVPU (alertness, verbal response). Is the child acting appropriately? How is the patient’s muscle tone and general interactiveness? Is the child
consolable by a parent or caregiver? Is his look or gaze and speech or cry appropriate? For appearance, you look at mental status us-
ing the “PU” part of AVPU (response to pain or unresponsiveness).

Work of breathing
For the second side of the triangle, observe the patient’s breathing (including airway). Are there any abnormal airway/breathing sounds such as hoarseness, muffled speech, grunting, wheezing, stridor, or crowing? Is there any abnormal body position such as the sniffing
position, tripoding, or refusing to lie down? Are there retractions, nasal flaring, “seesaw” breathing, or head bobbing? For breathing, you start by ensuring that the airway is open and closely observing the quality of the patient’s breathing.

Circulation to skin
For the base of the triangle, look at those signs that might indicate a circulation problem, such as pallor, mottling, or cyanosis (a gray-blue coloration). For circulation, you check for pulse, subtle cyanosis, and capillary refill.

Croup danger zone
The time period that Croup is most found in pediatrics. 6 months to 4 years

croup
Lung Sounds that is a high pitched seal bark sound. Viral Illness that causes inflammation of the upper airway and bronchi.

“Blow-By” Technique
Holding, or having a parent hold, the oxygen tubing or the pediatric nonrebreather mask 2 inches from the patient’s face so that the oxygen will pass over the face and be inhaled. Typically used for infants and children that fear the oxygen mask.

Adolescent
12 to 18 years of age.

Child
1 year of age to puberty.

Epiglottitis
Caused by a bacterial infection that produces swelling of the epiglottis and partial airway obstruction. Should be suspected in any child with stridor.

Fever
An illness usually accompanied by infections. Above-normal body temperature is one of the most important signs of an existing acute illness.

Fontanelle
A soft spot on an infant’s anterior scalp formbed by the joining of not yet fused bones of the skull. Sunken: may indicate dehydration. Bulging: May indicate elevated intracranial pressure.

Forms of Child Abuse
Psychological (emotional) abuse, Neglect, Physical Abuse, Sexual Abuse

Gastronomy Tubes
Tubes placed through the abdominal wall directly into the stomach, used when a patient is not able to be orally fed.

Hyperextension/Flexion of the Neck
Tipping the head too far back or letting it fall forward.

Infant
Birth to 1 year of age.

Lower Airway
Begins at the opening of the trachea and ends at the alveoli. Common disorders affect the large and small bronchiole tubes and the alveoli themselves. Common disorders include asthma, pneumonia, and other respiratory infections. Typically cause difficulty breathing/wheezing lung sounds.

Meningitis
Potentially life-threatening infection of the lining of the brain and spinal cord (the meninges) Commonly seen in children 1 month to 5 years old.

Neglect
The failure of a caretaker to provide for basic needs, such as food, clothing, or love.

Pediatric Assessment Triangle (PAT)
Method of pediatric assessment from both the general impression formed as you approach the child (“from the doorway”) and from the remainder of the primary assessment. Triangle made up of appearance, work of breathing, and the circulation to skin.

Pediatric
Of or pertaining to a patient who has yet to reach puberty.

Physical Abuse
Abuse causing physical damage to the victim.

Preschool
3 to 6 years of age.

Psychological Abuse
Emotionally harming a person by threatening, scaring, humiliating, intimidating, isolating, insulting, or treating him or her as a child; also includes verbal abuse.

Retractions
Pulling in of the skin and soft tissue between the ribs when breathing. This is typically a sign of respiratory distress in the child.

School Age
6 to 12 years of age.

Seizures
A sudden change in sensation, behavior, or movement. Most commonly caused by a feven in infants and children.

Sexual Abuse
Ranges from adults exposing themselves to children to sexual intercourse or sexual torture. Often accompanied by physical or emotional injury.

Shunt
A drainage device that runs from the brain to the abdomen to relieve excess cerebrospinal fluid. Reservoirs will be on either side of the skull.

Toddlers
1 to 3 years of age.

Upper Airway
Starts at the mouth and nose and ends at the trachea. Common disorders affecting this area include foreign body obstructions, trauma, and swelling from burns and infections. (Commonly identified by stridor or difficulty breathing)

In children and infants, their tongues are proportionally larger than the tongue of an adult. What is the potential impact on assessment and care?
tongue is more likely to partially obstruct the airway

Children and infants have smaller airway structures, which could result in…..
the airway being more easily blocked.

The abundant secretions in children and infants can cause…
a blocked airway

Decidous (baby) teeth in children and infants can be…
easily dislodged, which could block the airway

Children and infants have a flat nose and face, which makes it difficult to…
obtain a good face mask seal

The head of a child is heavier relative to body and less-developed neck structures and muscles. What is the potential impact on assessment and care?
Head may be propelled more forcefully than the body, creating a higher incidence of head injury

Infants and some children have fontanelle and open structures (soft spots) palpable on top of their head. What is the significance of both a sunken and bulging fontanelle?
Bulging fontanelle can be a sign of intracranial pressure.
Sunken fontanelle may indicate dehydration

Since children and infants have a thinner, softer brain tissue, they are more susceptible to…….
serious brain trauma

What are the hazards of the children’s/infant’s head being so large in proportion to their bodies?
Head tips forward when supine, causing flexion of the neck, making neutral alignment of spine and airway difficult

The shorter, narrower, and more elastic trachea can result in :
the trachea closing off with hyperextension of the neck

The children/infant’s short neck makes it difficult to…
stabilize or immobilize

What type of breathers are children and infants, and what does it mean?
They are abdominal breathers. they depend on their diaphragm for breathing which makes it difficult to evaluate

What is the significance of children/infant’s faster respiratory rate?
muscles easily fatigue or get tired, causing respiratory distress

Newborns/Infants are typically nose breathers. What is the danger in this?
Nasal obstruction can impair breathing

Since children/infant’s have a larger body surface relative to their body mass, they are more prone to what?
hypothermia

The softer bones in pediatric patients results in …
the bones being more flexible and less eaily fractured
however, traumatic forces may be transmitted to and injure vital organs without fracturing ribs and other bones

The spleen and liver are more exposed in a children’s and infant’s body… which makes injury likely with significant force to………
abdomen

Normal pulse rate for a newborn
120-160

Normal pulse rate for an infant 0-5 months
90-140

Normal pulse rate for an infant 6-12 months
80-140

Normal pulse rate for a toddler 1-3 years
80-130

Normal pulse rate for a preschooler 3-5 years
80-120

Normal pulse rate for a school age child 6-12 years
70-110

Normal pulse rate for an adolescent 13-18 years
60-105

Normal respiration rate for a newborn
30-50

Normal respiration rate for an infant 0-5 months
25-40

Normal respiration rate for an infant 6-12 months
20-30

Normal respiration rate for a toddler 1-3 years
20-30

Normal respiration rate for a preschooler 3-5 years
20-30

Normal respiration rate for a school aged child 6-12 years
15-30

Normal respiration rate for adolescent 13-18 years
12-20

Normal blood pressure for preschoolers 3-5
Systolic: avg 99 Diastolic: avg 65

Normal blood pressure for school age 6-12 years
Systolic: avg 105 Diastolic: avg 69

Normal blood pressure for adolescent 13-18 years
Systolic: avg 114 Diastolic: avg 76

What three things make up the Pediatric Assessment Triangle (PAT)
appearance, work of breathing, and circulation to the skin

“Blow-By” Technique
Holding, or having a parent hold, the oxygen tubing or the pediatric nonrebreather mask 2 inches from the patient’s face so that the oxygen will pass over the face and be inhaled. Typically used for infants and children that fear the oxygen mask.

Adolescent
12 to 18 years of age.

Child
1 year of age to puberty.

Croup
Caused by a group of viral illnesses that result in inflammation of the larynx, trachea, and bronchi. Tissues in the airway (typically upper airway) become swollen and restrict the passage of air. Commonly seen in children 6 months to 4 years old.

Epiglottitis
Caused by a bacterial infection that produces swelling of the epiglottis and partial airway obstruction. Should be suspected in any child with stridor.

Fever
An illness usually accompanied by infections. Above-normal body temperature is one of the most important signs of an existing acute illness.

Fontanelle
A soft spot on an infant’s anterior scalp formbed by the joining of not yet fused bones of the skull. Sunken: may indicate dehydration. Bulging: May indicate elevated intracranial pressure.

Forms of Child Abuse
Psychological (emotional) abuse, Neglect, Physical Abuse, Sexual Abuse

Gastronomy Tubes
Tubes placed through the abdominal wall directly into the stomach, used when a patient is not able to be orally fed.

Hyperextension/Flexion of the Neck
Tipping the head too far back or letting it fall forward.

Infant
Birth to 1 year of age.

Lower Airway
Begins at the opening of the trachea and ends at the alveoli. Common disorders affect the large and small bronchiole tubes and the alveoli themselves. Common disorders include asthma, pneumonia, and other respiratory infections. Typically cause difficulty breathing/wheezing lung sounds.

Meningitis
Potentially life-threatening infection of the lining of the brain and spinal cord (the meninges) Commonly seen in children 1 month to 5 years old.

Neglect
The failure of a caretaker to provide for basic needs, such as food, clothing, or love.

Pediatric Assessment Triangle (PAT)
Method of pediatric assessment from both the general impression formed as you approach the child (“from the doorway”) and from the remainder of the primary assessment. Triangle made up of appearance, work of breathing, and the circulation to skin.

Pediatric
Of or pertaining to a patient who has yet to reach puberty.

Physical Abuse
Abuse causing physical damage to the victim.

Preschool
3 to 6 years of age.

Psychological Abuse
Emotionally harming a person by threatening, scaring, humiliating, intimidating, isolating, insulting, or treating him or her as a child; also includes verbal abuse.

Retractions
Pulling in of the skin and soft tissue between the ribs when breathing. This is typically a sign of respiratory distress in the child.

School Age
6 to 12 years of age.

Seizures
A sudden change in sensation, behavior, or movement. Most commonly caused by a feven in infants and children.

Sexual Abuse
Ranges from adults exposing themselves to children to sexual intercourse or sexual torture. Often accompanied by physical or emotional injury.

Shunt
A drainage device that runs from the brain to the abdomen to relieve excess cerebrospinal fluid. Reservoirs will be on either side of the skull.

Toddlers
1 to 3 years of age.

Upper Airway
Starts at the mouth and nose and ends at the trachea. Common disorders affecting this area include foreign body obstructions, trauma, and swelling from burns and infections. (Commonly identified by stridor or difficulty breathing)

Placed patient on side
If the patient has no possibility of spinal injury

% of infants that sleep through the night at 6 months old
70%

5 airway differences in children vs adults
– larger, rounder occiput
– proportionally larger tongue
– long, floppy epiglottis
– less, well developed rings of cartilage
– narrow, funnel shaped upper airway

a child may begin to show signs of separation anxiety as early as
6 months

a common sign of shock in an infant is
dehydration from vomit and diarrhea

A prolonged asthma attack may result in
Status asthmaticus

adolescent and adult pulse rate
60 to 100

adolescent and adult respiratory rate
12 – 20

adolescents age range
12 – 18 years

basic needs of an infant 0 – 2 months
kept warm, dry, and fed

body temp at which it is considered abnormal
100.4 F (38 C)

Bradypnea in a child means what
Impending cardiatic arrest

cap refill time is most reliable in children younger than
6 years

fontanelle assessment
bulging for increased cranial pressure
sunken in for dehydration

fontanelle’s close at what time
anterior 18 months
posterior 6 months

GCS
eye opening – 1 to 4
verbal – 1 to 5
motor – 1 to 6

Hands on ABCs in a child
Airway
Breathing
Circulation
Disability
Exposure

How do kids compensate with injury or disease
They compensate very well but crash really fast; therefore if a kid is bradycardic it’s bad

How does a child vs adult differ in compensating for decreased perfusion
Adult has vasoconstriction
Child increases the heart rate

how long do infants sleep a day 0 – 2 months
up to 16 hours

How to assess a child’s bp
Children from 1 to 10 years old
70 + (2*childs age in years)

how to assess an infant
let parent hold them
warm your hands and the stethoscope

infant age range
0 – 12 months

infant blood pressure
adult blood pressure
infant – 70 to 95
adult – 90 to 140

infant pulse rate
100 to 160

infant respiratory rate
25 to 50

Is blood pressure assessed in child
Not usually in a child younger than 3 because it is not reliable and if the bp is low the child is crashing

leading cause of death in children worldwide
pneumonia

most common cause of respiratory emergencies in children
asthma

Most important 3 things to monitor in child
Respiratory effort
Skin color and condition
LOC

mottling of the skin
blotchiness that indicates poor perfusion due to vasoconstriction

newborn respiratory rate
30 to 60

PAT (pediatric assessment triangle)
15 to 30 sec assessment:
appearance
work of breathing
circulation of skin

Pediatrics are more prone to the following
Upper airway obstruction
Lower airway disease
Respiratory distress/failure/arrest

preschool respiratory rate
20 to 25

preschool-age pulse rate
80 to 140

preschooler age range
3 – 6 years

S/S of child in respiratory distress
wheezing, grunting
nasal flaring
accessory muscle use
tripod position

S/S: cherry red spots or a purplish rash
N meningitides

S/S: pediatric patient with pale skin, weak radial pulse, delayed cap refill
inadequate perfusion

S/S: poor skin turgor, sunken fontanels, look sleepy, lips and gums will be dry or sunken
dehydration

S/S: stiff neck, irritability, headache, bulging fontanel
meningitis

school age range
6 – 12 years

school-age pulse rate
70 – 120

school-age respiratory rate
15 to 20

skin and subcutaneous fat layer of a pediatric
its thinner and BSA to body mass ratio is larger which both lead to greater heat loss and fluid loss

spinal injuries in pediatrics are likely to be where
most likely to be an injury of the ligaments because of rapid movement of the head

the most ominous sign of impending cardiopulmonary arrest in infants and children is
bradycardia

Thinner skin and subcutaneous layer make a kid more prone to
Hypothermia and deep burns

this age begins to walk and talk
12 – 18 months

this age has a vast imagination that may make treatment difficult
preschooler

This is more common in males, presents in first 2 years of child’s life, often a result from RSV
Bronchiolotis

this makes a 6 – 12 month old more likely to have foreign body aspirations or poisonings
teething starts so they put things in their mouth

TICLS
tone
interactiveness
consolability
look or gaze
speech or cry

toddler age range
1 – 3 years

toddler pulse rate
90 to 150

toddler respiratory rate
25 to 30

What age group do you start assessment from head to feet
School age

what can be a sign of illness, depressed mental status, or delay in development in a 2 – 6 month old
a lack of eye contact

what could cause a toddler to be more likely to aspirate
lack of molars

what factors increase risk of SIDS
mother younger than 20 years old
mother smoked during pregnancy
low birth weight

What is a child’s oxygen demand in comparison to an adults
Twice that of an adult

what is shaken baby syndrome
the shaking tore blood vessels in the brain, resulting in bleeding around the brain and coma or death

what is SIDS and when does it occur
sudden infant death syndrome where death is unexplained; occurs in children < 1year old

What order to assess a child’s vitals
First respirations,
Then pulse,
Finally bp

What to do if you suspect abuse
Report based on your protocols

When to transport a child in a car seat
When less than 40lbs

where to start assessment in preschooler and below and why
feet to head; to develop trust

Why are kids more prone to abdominal injury
Their abdominal muscles are less developed; also their ribs are very flexible

why are pediatric patients more prone to gastrointestinal injuries
abdominal muscles are less developed
liver and spleen are proportionally larger
organs positioned more anteriorly

why is the pediatric brain more susceptible to secondary brain damage than an adults
it requires more oxygen and glucose, also glucose stores are limited in the pediatric patient therefore hypotension and hypoxic events are more dangerous

Labia
Soft tissues that protect the entrance to the vagina. (Page 839)

Perineum
The surface area between the vagina and the anus. (Page 839)

Mons Pubis
Soft tissue that covers the pubic symphysis; area where hair grows as a women reaches puberty. (Page 839)

Vagina
The birth canal. (Page 839)

Ovary
The female reproductive organ that produces ova. (Page 839)

Fallopian Tube
the narrow tube that connects the ovary to the uterus. also called the oviduct. (Page 839)

Ectopic Pregnancy
A dangerous condition when the ovum implants itself in the fallopian tube. (Page 839)

Uterus
Muscular, hollow organ where the fetus develops. (Page 840)

Cervix
A muscular Ring of the uterus at the entrance of the birth canal. (Page 840)

Ovulation
The phase of the female reproductive cycle in which an ovum is released from the ovary. (Page 840)

Peristalsis
Waves of muscular contraction. Moving egg from fallopian tube into uterus. (Page 840)

Embryo
The baby from fertilization to 8 weeks of development. (Page 840)

Fetus
The baby from 8 weeks of development to birth. (Page 840)

Placenta
The organ of pregnancy where exchange of oxygen, nutrients, and wastes occurs between a mother and fetus. (Page 841)

Umbilical Cord
The fetal structure containing the blood vessels that carry blood to and from the placenta. (Page 841)

Amniotic Sac
The “Bag of Waters” that surrounds the developing fetus. allows the fetus to float during development and acts as cushioning. (Page 841)

Supine Hypotensive Syndrome
Dizziness, Drop in blood pressure caused when the mother is in a supine position and the weight of the uterus contents compress the inferior vena cava. Reducing return of blood to the heart and cardiac output. (Page 843)

Labor
The three stages of the delivery of a baby that begin with contractions of the uterus and end with the expulsion of the placenta. (Page 843

Effacement
The process in which the long neck of the cervix must be shortened and thinned before the cervix can fully dilate. (Page 843)

Braxton-Hicks Contractions
Irregular prelabor contractions of the uterus. (Page 843)

Lightening
The sensation of the fetus moving from high in the abdomen to low in the birth canal. (Page 843)

Meconium Staining
Amniotic fluid that is greenish or brownish-yellow rather than clear as a result of fetal defecation; an indication of possible maternal; or fetal distress during labor. (Page 845)

Crowning
When part of the baby is visible through the vaginal opening. (Page 846)

Cephalic Presentation
Appears head first during birth. this is the normal presentation. (Page 846)

Neonate
A newly reborn infants or an infant less than 1 month old. (Page 853)

Breech Presentation
When the baby’s buttocks or both legs appear first during birth. Most common abnormal delivery. (Page 861)

Limb Presentation
When an infant’s limb protrudes from the vagina before the appearance of any other body part. (Page 862)

Prolapsed Umbilical Cord
When the umbilical cord presents first and is squeezed between the vaginal wall and the baby’s head. When this happens, cord is pinched and oxygen supply to the baby may be totally interrupted. (Page 862)

Multiple Birth
When more than one baby is born during a single delivery. (Page 863)

Premature Infants
Any newborn weighing less than 5 1/2 pounds or born before the 37th week of pregnancy. (Page 864)

Placenta Previa
A condition in which the placenta is formed in an abnormal location (Low in the uterus and close to or over the cervical opening) that will not allow for a normal delivery of the fetus; a cause of excessive prebirth bleeding. (Page 867)

Abruptio Placentae
A condition in which the placenta separates from the uterine wall; a cause of prebirth bleeding. (Page 867)

Ectopic Pregnancy
When implantation of the fertilized egg is not in the body of the uterus, occurring instead in the fallopian tube, cervix or abdominopelvic cavity. (Page 867)

Eclampsia
A severe complication of pregnancy that produces seizures and coma. (Page 868)

Preeclampsia
A complication of pregnancy in which the women retains large amounts of fluid and has hypertension. Shy may also experience seizures and/or coma during birth, which is very dangerous to the infant. (Page 868)

Abortion
Spontaneous or induced termination of pregnancy. (Page 868)

Spontaneous abortion
when the fetus and placenta deliver before the 28th week of pregnancy; commonly called a miscarriage. (Page 868)

Miscarriage
Spontaneous abortion. (Page 868)

induced abortion
expulsion of a fetus as a result of deliberate actions taken to stop the pregnancy. (Page 868)

Stillborn
Born Dead (Page 870)

Pediatric
Of or pertaining to a patient who has yet to reach puberty. (Page 878)

Fontanelle
A soft spot on an infant’s anterior scalp formed by the joining of not yet fused bones of the skull. (Page 881)

Retractions
Pulling in of the skin and soft tissue between the ribs when breathing. This is typically a sign of respiratory distress in children. (Page 890)

Croup
Caused by a group of viral illnesses that result in inflammation of that larynx, trachea, and bronchi. It is typically an illness of children 6 months to about 4 years of age that often occurs at night. (Page 910)

Epiglottis
Bacterial infection that produces swelling of the epiglottis and partial airway obstruction. (Page 910)

Meningitis
Potentially life-threatening infection of the lining of the brain and spinal cord. It is caused by either a bacterial or a viral infection and commonly occurs between the ages of 1 month and 5 years. (Page 913)

Sudden Infant Death Syndrome
(SIDS) The sudden unexplained death during sleep of an apparently healthy baby in its first year of life. (Page 917)

Rigor Mortis
Stiffening of the body after death (Page 917)

Disability
A physical, emotional, behavioral, or cognitive condition that interferes with a person’s ability to carry out everyday tasks, such as working or caring for oneself. (Page 950)

Bariatrics
The branch of medicine that deals with the causes of obesity, as well as its prevention and treatment. (Page 953)

Obesity
A condition of having too much body fat, defined as a body mas index of 30 or greater. (Page 953)

Autism Spectrum Disorders
(ASD) Development disorder that affect, among other things, the ability to communicate, report medical conditions, self-regulate behaviors, and interact with others. (Page 954)

Congenital
Disease or condition that is present at birth. Example Congenital heart disease is a common birth defect. (Page 959)

Acquired
Disease or condition that occurs after birth and may be the result of exposure to a virus or bacteria or the result of another medical condition or trauma. (Page 959)

Scope of practice
a set of regulations and ethical considerations that define the scope, or extent and limits, of the EMT’s job. (Page 75)

Standard of care
for an EMT providing care for a specific patient in a specific situation, the care that would be expected to be provided by an EMT with similar training when caring for a patient in a similar situation. (Page 76)

Consent
Permission from the patient for care or other action by the EMT. (Page 76)

Expressed consent
Consent given by adults who are of legal age and mentally competent to make a rational decision in regard to their medical well-being. (Page 76)

Implied Consent
The consent it is presumed a patient or patient’s guardian would give if they could. (Page 77)

In loco parentis
in place of the parents, indicating a person who may give consent for care of a child when the parents are not present or able to give consent. (Page 77)

Liability
Being held by legally responsible. (Page 78)

Assault
Placing a person in fear of bodily harm. (Page 78)

Battery
Causing bodily harm to or restraining a person. (Page 78)

Negligence
A finding of failure to act properly in a situation in which there was a duty to act, that needed care as would reasonably be expected of the “EMT was not provided, and that harm was caused to the patient as a result. (Page 81)

Tort
A civil, not a criminal, offense; an action or injury caused by negligence from which a lawsuit may arise. (Page 82)

res ipsa loquitur
A latin term meaning “The thing speaks for itself” (Page 82)

HIPAA
Health Insurance Portability and Accountability Act, a federal law protecting the privacy of patient specific health care information and providing the patient with control over how this information is used and distributed. (Page 84)

Libel
false or injurious information in written form. (Page 85)

Slander
False or injurious information stated verbally. (Page 85)

Organ Donor
a person who has completed a legal document that allows for donation and tissues in the event of death.

Safe Haven Law
A law that permits a person to drop off an infant or child at a police, fire, or EMS station or to deliver the infant or child to an available public safety personnel. The intent of the law is to protect children who may otherwise be abandoned or harmed. (Page 85)

Characteristics of Newborns and infants birth to 1 year
• Newborns typically have minimal stranger
anxiety and do not mind being separated from
their parents. Older infants often fear
separation.
• Infants are used to being undressed but like to
feel warm, physically and emotionally.
• The younger infant follows movement with his
eyes.
• The older infant is more active, and is
developing a personality.
• Infants do not want to be “suffocated” by an
oxygen mask.

Assessment and care Strategies for Newborns and infants birth to 1 year
• Have the parent hold the infant while you examine him.
• Be sure to keep him warm—warm your hands and stethoscope before touching the infant. As infants can easily become hypothermic, keep the ambulance compartment warm and the
child properly covered during cool or cold weather.
• It may be best to observe breathing from a distance, noting the patient’s work of breathing, the level of activity, and skin color.
• Examine the heart and lungs first and the head last. This is perceived as less threatening to the infant and therefore less likely to start him crying.
• A pediatric nonrebreather mask may be held
near the face to provide “blow-by” oxygen.

Characteristics of Toddlers 1 to 3 years
• Toddlers do not like to be touched or separated from their parents.
• Toddlers may believe that their illness is a punishment for being bad.
• Unlike infants, they do not like having their clothing removed.
• They frighten easily, overreact, and have a fear of needles and pain.
• Toddlers may understand more than they communicate.
• They begin to assert their independence.
• They do not want to be “suffocated” by an oxygen mask.
• Toddlers do not like to be restrained.

Assessment and care Strategies for Toddlers 1 to 3 years
• When appropriate, have a parent hold the child while you examine him.
• Assure the child that he was not bad.
• Remove an article of clothing, examine the area, and then replace the clothing. Do your best to respect the child’s modesty.
• Examine in a trunk-to-head approach to build confidence. (Touching the head first may be frightening.)
• Explain what you are going to do in terms the toddler can understand (taking the blood pressure becomes a squeeze or a hug on the arm).
• Assert control over the situation, but give the toddler the opportunity to make some decisions: “Which arm would you like me to check your blood pressure on?”
• Restrain only when necessary. Restrain well when indicated.

Characteristics of Preschool 3 to 6 years
• Preschoolers do not like to be touched or separated from their parents.
• They are modest and do not like their clothing removed.
• Preschoolers may believe that their illness is a punishment for being bad.
• Preschoolers have a fear of blood, pain, and permanent injury.
• They are curious, communicative, and can be cooperative.
• They do not want to be “suffocated” by an oxygen mask.

Assessment and care Strategies for Preschool 3 to 6 years
• When appropriate, have a parent hold the child while you examine him.
• Respect the child’s modesty. Remove an article of clothing, examine the area, and then replace the clothing.
• Have a calm, confident, reassuring, respectful manner. Beware of teasing a child. Often children do not understand sarcasm.
• Be sure to offer explanations about what you are doing.
• Allow simple decision making. Allow the child the responsibility of giving the history.
• Explain as you examine.
• If desired, hold a pediatric nonrebreather mask near the face to provide “blow-by” oxygen.

Characteristics of School age 6 to 12 years
• This age group cooperates but likes their opinions heard.
• They fear blood, pain, disfigurement, and permanent injury.
• School-age children are modest and do not like their bodies exposed.

Assessment and care Strategies for School age 6 to 12 years
• Allow simple decision making. Allow the child the responsibility of giving the history.
• Explain as you examine.
• Present a confident, calm, and respectful manner.
• Respect the child’s modesty.

Characteristics of Adolescent 12 to 18 years
• Adolescents want to be treated as adults.
• Adolescents generally feel that they are indestructible but may have fears of permanent injury and disfigurement.
• Adolescents vary in their emotional and physical development and may not be comfortable with their changing bodies.
• Adolescents are influenced highly by their peers.

Assessment and care Strategies for Adolescent 12 to 18 years
• Although they wish to be treated as adults, they may need as much support as children.
• Present a confident, calm, and respectful manner.
• Be sure to explain what you are doing.
• Respect modesty. You may consider assessing adolescents away from their parents. Have the physical exam done by an EMT of the same sex as the patient if possible.
• Avoid causing embarrassment in groups. Be sensitive to the adolescent’s dignity.

Lung
heart
neuro

Sunken Fontanelle
may indicate dehydration

Suctioning of a child’s airway for longer than a few seconds at a time
could lead to Vagal Stimulation, and very slow heart rate, and ultimately cardiac arrest.

Suctioning
Temporarily cuts off the body’s oxygen supply of; if it is prolonged, it it especially dangerous to infants and children.

The Tongues of infants and children
are more likely to block the airway because their tongues are proportionately larger.

The Insertion procedure for an Oropharyngeal Airway (OPA)
In an infant or child is done with the tip pointing toward the tongue and throat, which is the same position it will be in after insertion. Flipping it over the tongue may cause a tear in the soft palate.

when assessing the capillary refill of a child 5 years old or younger
peripheral perfusion is considered satisfactory if the color returns in less than 2 seconds.

Loss of Consciousness
is not a sign of a mild airway obstruction in an infant or child. It is a sign of severe respiratory distress.

A child with a severe airway obstruction or severe partial one
cannot cry and is moving very little air.
The cough becomes ineffective.

Hypoxia
Slows heart rate and alters mental status for infants or a children.

BSI/PPE
Always Use the Proper Infection Control Barriers even when Ventilating infants and children.

Guidelines to use when Ventilating Infants and Children
Include avoiding breathing too hard through the pocket mask or using excessive bag pressure and volume, and use properly sized masks to ensure a good mask seal. Also remember that, if ventilation is not successful in raising the patients chest, perform procedures for clearing an obstructed airway, then try to ventilate again.

The Flow-restricted, Oxygen-powered Ventilation device
is contraindicated in infants and children.

Common Causes of shock in a child
Include Infection, trauma, Blood loss, and Dehydration.

Croup
Is not a cause of shock.

Less common causes of shock in a child
Include: Allergic Reactions, Poisoning, and Cardiac events (rare)

is Approximately 8% of the total body weight
The Blood Volume of Infants and children

Children in Shock
Compensate well, appear better than they actually are.
Decompensate very rapidly, go sour quickly.

When child is Bleeding Internally
Avoid waiting for signs of decompensated shock before treating for shock. At this point the Child has lost 30% Blood Loss.

Decreased Urine Output (Less Wet Diapers) and Absence of Tears
are Signs of Shock in Infants and Children

When treating Children for Shock
Elevate the patient’s legs unless there are injuries that would contraindicate it.

Age-Related Changes
After age 30, organ systems lose 1 percent of function each year
Maximum heart rate declines
Older patient with internal bleeding won’t exhibit heart rate as rapid as expected
If unaware, EMT may miss that older patient is in shock

A decrease in sensory function due to aging
could result in a painless but deadly heart attack. You can reduce your chances of misattributing signs and symptoms by determining the patient’s normal or baseline condition.

Communicating with Older Patients
Causes of patient’s communication difficulties
Changes in hearing, vision, memory
Loss of teeth
Loss of brain function (Alzheimer’s most common)
First assume altered mental status result of present injury/illness

Always attempt to communicate with the older patient first
rather than assuming the patient will give an unreliable history and asking others about the patient. Do not assume that confusion is caused by dementia unless someone else who knows the patient can confirm this is a chronic condition.

Make sure the patient can see and hear you.
Speaking loudly, slowly, or very clearly to a patient does not mean speaking down to a patient. Treat the patient with respect and dignity. Begin by calling the patient by a title and last name (for example, “Mrs. Sanchez”). Ask the patient how she would like to be addressed before assuming that you may use her first name. Whenever possible, speak to the patient at eye level. This may involve crouching or even kneeling.

History and Assessment of Older Adult Patient
Assessment of an older patient is very similar to the typical patient assessment; however, EMTs must account for particular issues associated with aging.

Scene Size-up and Safety
Look inside and outside residence for clues to physical and mental abilities
Condition of residence
Half-eaten food
House dirty or clean
Items left out that patient can trip on

Primary Assessment
General impression
Mental status
Airway
Breathing
Circulation
General impression. What is the level of distress? Mental status. This can be challenging because some older people have abnormal mental status as part of their baseline condition. Airway. You may find it difficult to extend or flex the neck due to arthritic bone changes. Also consider dentures. Breathing. Elderly are at risk for FBAO: two major risks are poorly chewed food and dentures. Circulation. Finding a radial pulse is usually no different than for other patients; however, the pulse is often irregular.

because children have a large skin surface area
in proportion to their body mass, they can easily become victims of hypothermia

Avoid inserting a tongue blade into the mouth of a child that has an airway respiratory disease
it could stimulate a Laryngospasm. Administering blow-by oxygen is an appropriate action.

Stridor on inspiration
is an upper airway problem.

Signs of an Airway Disease in a child
Include Breathing effort on exhalation, rapid breathing, and wheezing.

the Early Signs of respiratory distress in a child include
Nasal Flaring; Retraction of the muscles above, below, and between the sternum and ribs; Use of abdominal muscles; stridor; audible wheezing; grunting; and a breathing rate greater than 60.

Slowing or Irregular respiration
is a late sign of respiration distress in a child

Hypothermia
does not cause fever. Causes of the fever in children include upper respiratory and other types infection.

Rectal or Oral Thermometers
aren’t generally used outside of Out-of-hospital setting unless permitted by local medical direction.

When treating an infant child with a high fever
monitor for shivering while cooling with tepid water. Do Not use alcohol because it is a fire hazard and can be absorbed by the skin. Do not cover with a towel soaked in Ice water, which can rapidly cause hypothermia.

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