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What is the leading cause of death in children under 14?
Trauma
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Define neonate.
birth to 30 days old
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What are the airway differences in children?
- tongue is larger
- smaller nose and mouth
- trachea is narrower
- cricoid cartilage is less rigid
- airway is in general more easily obstructed
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What are the anatomical differences in a child's head?
- proportionally larger than adults
- infants cannot support own head
- fontanelles
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What are the anatomical differences in a child's chest and lungs?
- ribs are more pliable
- lung tissue more fragile
- normal for abdominal movement with inhalation
- chest muscles used as accessory muscles
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Infants and children less than 5 y/o breath at a rate of ___ to ___ times faster than adults.
2 to 3
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_______ is a late sign of hypoxia for infants and children.
bradycardia
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For newborns, _______ is the initial response to hypoxia
bradycardia
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What are two organs that are more exposed and less protected in a child's abdomen?
liver and spleen
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What are the three components of the pediatric assessment triangle?
- general appearance
- work of breathing
- circulation to the skin
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What should the EMT do in the case of an unresponsive infant or child with a FBAO? (list the steps)
- place infant on firm flat surface
- provide 30 chest compressions, then look for obstruction and remove if visible
- provide 2 ventilations
- continue ventilations and compressions until object is removed
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What is considered cardiac arrest in a child?
heart rate less than 60 bpm
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What will increased respiratory effort in children look like?
- nasal flaring
- use of intercostals
- stridor
- audible wheezes
- grunting (exerting pressure to get air out)
- breathing rate elevated
- cyanotic
- altered LOC
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What is considered respiratory arrest in children?
breathing rates less than 10/minute
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What are the things that can cause seizures in children?
- sudden onset of high fever (febrile)
- infection
- poisoning
- trauma
- hypoxia
- hypoglycemia
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What are the s/s of meningitis?
- high fever
- lethargy
- irritability
- severe headache
- stick neck
- sensitivity to light
- bulging fontanels
- painful movement
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What is the care for poisoning?
- responsive: contact poison control and administer activated charcoal if advised, provide O2, monitor, transport
- unresponsive: ensure airway, be ready with suction, ALS upgrade, rule out trauma
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What are the common causes of shock in children?
- diarrhea
- vomiting
- dehydration
- trauma
- blood loss
- infection
- abdominal injuries
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What are the s/s of shock in children?
- rapid respiratory rate
- pale, cool, clammy skin
- weak or absent distal pulses
- delayed cap refill
- decreased urine output
- altered LOC
- dry mucous membrane
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All drowning/near drowning require this....
ED evaluation
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Define abuse vs neglect
- abuse: improper or excessive action causing injury or harm
- neglect: giving insufficient attention to someone who has claim to that attention
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List the s/s of abuse in children in young children according to protocol
- clinginess
- bedwetting
- inappropriate sexual knowledge
- aggressive behavior
- nightmares
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Responding to a sudden unexpected death or serious injury in a child, the EMT should...
- insure safety and provide medical aid as needed to save/assist the child
- if child is clearly dead, do not move the body
- ensure law enforcement has been notified
- document all adults and children present
- document all statements and demeanor of speakers
- document all observations of the environment
- consider and record the child's developmental level
- know signs of possible abuse and neglect
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List the signs of abuse in older children according to protocol
- inability to concentrate in school
- drop in grades
- promiscuity
- self-destructive behavior
- comments about suicide
- poor relations with peers
- depression
- eating disorders
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What are some of the complications with a tracheostomy tube?
- bleeding around the hole
- becomes dislodged/blocked by mucous
- infection around tube
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According to appendix E - infant transfer, qualified persons can accept custody of a newborn, which is defined as less than _____ old.
72 hours
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According to appendix E - infant transfer, the EMT should do these things upon the transfer of custody...
- notify dispatch and request ALS response
- medically assess infant and provide care as needed
- determine whether the transferor is the parent while protecting annonymity
- attempt to obtain date and time of birth
- ensure the situation fits within RCW 13.34.360
- attempt to obtain family medical hx
- notify CPS (1-866-END-HARM) within 24 hrs
- if child is not newborn, notify LE and CPS
- if "qualified person" is not present when infant has been transferred, ask transferor to wait for qualified person
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What does neonatal resuscitation consist of?
- chest compressions at 1/3 depth of the chest
- 120 compression/minute
- 3 compressions to 1 ventilation
- rescue breathing rate of 40-60 breaths per minute
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What is epiglottitis and what are the hallmark symptoms?
- inflammation of the eppiglotis
- drooling is a hallmark symptom b/c of painful swallowing
- will also present with fever, hoarse voice, and stridor
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Define and list the symptoms of laryngitis.
- inflammation of the larynx
- hoarse voice or inability to speak
- dry, burning throat
- difficulty swallowing and/or breathing
- fever
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List the steps for relieving choking in a responsive victim 1 year of age or older.
- stand/kneel behind victim and wraps arms around victim
- make fist with one hand
- place fist thumb side against abdomen, in midline, slightly above navel and below breastbone
- grasp fist with other hand and give quick, forceful, upward thrusts
- repeat thrusts until object is expelled or victim becomes unresponsive
- each thrust should be a separate distinct movement
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If a choking victim is pregnant, what should the EMT do?
perform chest thrusts instead of abdominal thrusts
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List the steps for relieving choking in a responsive infant.
- kneel/sit with infant on lap
- hold infant face-down with jaw in hand
- give 5 back blows between shoulder blades
- flip the infant over and give 5 downward chest thrusts with fingertips in the middle of the chest over the lower half of the breastbone at a rate of 1 per second
- repeat until object is removed or infant becomes unresponsive
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List the developmental markers for newborns and infants (1yr).
- minimal stranger anxiety
- like to warm
- dislikes being separated from parents
- dislikes objects near face (use "blow by" for O2)
- EMT should observe breathing rate from a distance
- EMT should evaluate heart and lungs first with head last
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List the developmental markers for toddlers (age 1-3).
- prefer remaining dressed (EMT should remove, examine, replace)
- dislikes being touched
- dislikes being separated from parent
- dislikes objects near face
- afraid of needles, fear of pain
- EMT should reassure child was not "bad"
- EMT should examine trunk to head
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List the developmental markers for preschool age (3-6 y/o)
- dislikes being touched by strangers
- dislikes being separated from parents
- dislikes objects near face
- afraid of blood, pain and permanent injury
- modest and shy
- EMT should reassure child was not bad and replace clothing after exam
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List the developmental markers for school age children (6-12 y/o)
- afraid of pain, blood and permanent injury/ disfigurement
- modest
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List the developmental markers for adolescents (12-18 y/o)
- afraid of permanent injury/disfigurement
- modest
- EMT should treat them as adult
- EMT should assess away from parents or guardians
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