PEDIATRIC MEDICAL EMERGENCIES

INTRODUCTION

Optimal patient care requires that the EMT-1 be familiar with the most common medical emergencies affecting pediatric patients.  During this lesson we will discuss the following:

·          Respiratory Emergencies

·          Obstruction

·          Croup

·          Epiglottitis

·          Asthma

·           Neurological Emergencies

·          Seizures

·          Meningitis

·                    Fever

·                    Dehydration

·                    Sudden Infant Death Syndrome (SIDS)

·                    Poisoning

 


LESSON OBJECTIVES

At the completion of this lesson the participants will be able to:

1.         State the signs and symptoms and field management of airway obstruction in      pediatric patients.

2.                  Discuss the pathophysiology, signs and symptoms, and field management of

            croup.

3.         Discuss the pathophysiology, signs and symptoms, and field management of       epiglottitis.

4.         Discuss the pathophysiology, signs and symptoms, and field management of       pediatric asthma.

5.         List 10 common causes of pediatric seizures.

6.         Describe the field management of pediatric seizures.

7.         Discuss the pathophysiology, signs and symptoms, and field management of meningitis.

8.                  Verbalize common causes of dehydration in pediatric patients and appropriate field treatment.

9.         Discuss common causes of dehydration in pediatric patients and appropriate field management.

10.       State the EMT-Is role in handling a suspected SIDS victim.

11.       Describe the common household products that may be responsible for accidental poisoning in the pediatric patient.

SKILLS

Pediatric Airway Management

Pharmacology

KEY VOCABULARY

The following terms will be used during this lesson:

·          Idiopathic epilepsy - seizures that occur with no identified cause.

·          Photophobia - sensitivity to light

·          Nuchal rigidity - stiffness of the neck associated with meningeal irritation.

·          Tonic Phase - phase of a seizure characterized by tension or contraction of muscles

·          Clonic - alternating contraction and relaxation of muscles

·          Status epiliepticus - two or more seizures without any intervening periods of consciousness.

·          Febrile - elevated body temperature

KEY CONCEPTS

The following section provides information and space for taking notes on the key

concepts discussed by the instructor.

RESPIRATORY EMERGENCIES

Partial Airway Obstruction

Causes:   

·          Foreign bodies

·          Swelling (infection, allergic response)

·          Trauma

Signs and Symptoms:

·          Stridor, noisy

·          Retractions on inspiration

Field Management of Partial Airway Obstruction:

·        BLS procedure

·          Position of Comfort

·          Oxygen

·          Do not agitate

·        ALS procedure

·          Same as BLS

Complete Airway Obstruction

Causes:

·          Foreign bodies

·          Swelling

·          Trauma

Signs/Symptoms:

·          No noise or cough

·          Increased respiratory difficulty

·          Altered mental status

Field Management of Complete Airway Obstruction:

·        BLS procedures

·          Clear airway

·          Foreign body procedures

·        ALS procedures

·          Magill forcep

·          Foreign body removal

Croup

Pathophysiology:

·          Viral infection common in patients 3 months to 3 years.

·          Inflammation of the larynx and surrounding tissues cause the primary symptoms.

Signs and Symptoms:

·          Barking cough

·          Stridor

·          Accessory muscle use

·          Nasal flaring

Field Management of Croup:

·        BLS procedure

·          Humidified (if available) oxygen

·          Position

·          Transport

·        ALS procedure:

·          Same

Epiglottitis

Pathophysiology:

·          Bacterial infection common in patients 3-7 years.  Swelling of the epiglottis can progress rapidly to complete airway obstruction.

Signs and Symptoms:

·          Severe dyspnea/stridor

·          Tripod position

·          Drooling

·          Dysphagia

·          Difficulty swallowing

Field Management of Epiglottitis:

·        BLS procedure

·          Do not agitate

·          Keep calm

·          Do not examine the airway!

·          Humidified (if available) high flow oxygen

·          Position of Comfort

·          Rapid transport

·        ALS procedure

·          Same as BLS

Asthma

Pathophysiology:

·          The bronchioles become temporarily narrowed and the muscles around the bronchioles spasm, causing difficulty breathing and wheezing.

·          Asthma is the most common chronic pediatric illness.

Signs/symptoms:

·          Dyspnea, wheezing

·          Cyanosis or pallor

·          Cough

·          Nasal flaring

·          Accessory muscle use

Field Management of Asthma:

·        BLS procedure

·          Position of Comfort

·          High flow oxygen

·        ALS procedure

·          Albuterol by hand held nebulizer

NEUROLOGICAL EMERGENCIES

Seizures

Causes:

·          Fever

·          Hypoxia

·          Infections

·          Idiopathic epilepsy

·          Electrolyte imbalance

·          Head trauma

·          Hypoglycemia

·          Toxic ingestion or exposure

·          Tumors

·          Central Nervous System malfunction

Signs/Symptoms:

·          Febrile seizures

·          Tonic/clonic

·          Status Epilepticus

Field Management of Seizures:

·        BLS procedure

·          Protect the airway

·          Protect the child from injury

·          Do not attempt to restrain or “stop” the seizure

·          High flow oxygen

·          Remove restrictive clothing

·          Transport

·          Passive cooling if suspected febrile seizure

·        ALS procedure:

·          Venous access

·          Monitor

·          Glucometer

·          Valium for active tonic/clonic seizures (IV or rectal administration)

Meningitis

Pathophysiology:

·          A bacterial or viral infection of the meninges (lining of the brain and spinal cord).

Signs/symptoms:

·          Fever, vomiting

·          Rash

·          Nuchal rigidity

·          Photophobia

Field Management of Meningitis:

·        BLS procedure

·          High flow oxygen

·          Passive cooling

·          Seizure precautions

·        ALS procedures

·          Venous access

·          Possible glucometer

·          Valium for active seizures

Fever

Pathophysiology:

·          An elevation of the body temperature in response to an infection.  There are many causes, most are not life threatening.  Common sites of infection in pediatric patients are the upper respiratory tract, the gastrointestinal system, and the ears.

Signs/symptoms:

·          Elevation of the temperature above normal

Field Management of Fever:

·        BLS procedure

·          Remove excess clothing

·          Transport

·        ALS procedure

·          Same

Dehydration

Causes:

·          Prolonged illness

·          Diarrhea

·          Vomiting

·          Malnutrition

Signs and Symptoms:

·          Sunken fontanelle

·          Poor skin turgor

·          Sunken eyes

·          Dry mucous membranes

·          Decreased urination

Field Management of Dehydration:

·        BLS procedure

·          High flow oxygen

·          Transport

·        ALS procedure

·          Venous access

·          Fluid challenge 20ml./kg.

SIDS

Definition:

·          Sudden, unexpected death of an infant in the first year of life from an illness of unknown etiology.  The incidence in the U.S. is approximately 2 deaths per 1000 births.  Peak incidence is 2 months to 4 months.  Death usually occurs during sleep and is more common in males than females.

Cause:

·          Unknown - many theories are being investigated

Signs and Symptoms:

·          Normal nutrition and hydration

·          Mottled

·          Frothy fluid, maybe blood tinged, around the mouth and nose

·           Vomitus may be present

Field Management of SIDS:

·        BLS procedure

·          Basic life support

·          Transport

·        ALS procedure

·          Venous access

·          Medications

POISONING

Causes:

·          Curious toddlers can ingest almost any substance.  Common products are household cleansers, medications, cosmetics, and plants.  Over the counter medications such as cough syrup, aspirin, and Tylenol are often ingested.  Toddlers usually find medications that are left out or misplaced. 

Signs and Symptoms:

·          Vary with the poisonous substance - look for particles, chemical irritation, dropped tablets, and partially chewed items.

Field Management of Poisoning:

·        BLS procedure

·          Protect the airway

·          High flow oxygen

·          Do not induce vomiting

·          Position of comfort

·          Transport

·          Seizure precautions if applicable

·        ALS procedure

·          Venous access

·          Monitor

·          Glucometer if altered

·          Valium for seizure activity