EMT Test 5 > Pediatrics > Flashcards

Pediatrics Flashcards

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1
Q

Pediatric Age Categories

A
  • Newborns and infants: birth to 1 year
  • Toddlers: 1–3 years
  • Preschool: 3–6 years
  • School age: 6–12 years
  • Adolescent: 12–18 years
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2
Q

Anatomic and Physiologic Differences

A
  • Infants and children differ from adults in psychology, anatomy, and physiology
  • Understanding differences will help you assess and care for young patients
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3
Q

Airway & Respiratory System

A

Child has smaller nose
Child more space is taken up by tongue
Child’s trachea is narrower
Cricoid cartilage is less rigid & less developed
Airway structures are more easily obstructed

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4
Q

Chest and Abdomen

A
  • Less developed, more elastic in young patients
  • Infants and children: abdominal breathers
  • Abdominal organs less protected than in adults
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5
Q

Body Surface***

A

A child’s body surface is larger in proportion to the body mass - not smaller - than an adults**

  • More prone to heat loss through skin
  • More vulnerable to hypothermia
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6
Q

Blood Volume

A

9 pnd newborn <12 ounces
60 pnd Child 2L
125 pnd adult 4L

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7
Q

Think About It

A

• What techniques would you utilize when attempting to assess a crying infant?

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8
Q

Interacting with the Pediatric Patient - pg 883-885

A
  • Identify yourself
  • Let child know that someone has called or will call parents
  • If no life threats, continue at a calm pace during the evaluation process
  • Let child have a nearby toy
  • Kneel at child’s eye level
  • Smile
  • Touch or hold child’s hand or foot
  • Do not use equipment without first explaining what you will do with it
  • Let child see your face
  • Stop occasionally to find out if child understands
  • Never lie to child
  • Keep them warm
  • Work toe to head*
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9
Q

Supporting the Parents or Other Care Providers

A
  • Possible reactions to child’s illness/injury: denial, shock, crying, screaming, anger, self-blame, guilt
  • May interfere with care of child
  • Ask to help by holding/comforting child and giving medical history
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10
Q

Pediatric Assessment Triangle

A

Appearance

  • Mental Status - Alert Verbal
  • muscle tone
  • interacting
  • look & gaze

Work of Breathing

  • abnormal sounds
  • abnormal body position
  • accessory muscle use

Circulation to Skin
-pallor, mottling, cyanosis

First done with a general impression as you enter the room and then hands on

Hands on
Appearance
-PU part of AVPU

Breathing
-is the airway open

Circulation
-cap refill

Pay special attention to mental status - is this normal for the child?

1 fail - respiratory distress
2 fail - resp failure

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11
Q

Primary Assessment: Pediatric Care

A
  • Rapidly identifies critical patient

* Essential component of pediatric assessment

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12
Q

Population with the greatest rise in HIV / Hepatitis

A

adolescents - 12-18 because they think they are invincible

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13
Q

Interviewing the child - presence of adults

A

may have to ask all but one parent to leave at the room so the child can calm down

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14
Q

Findings from the Pediatric Assessment Triangle

A

How serious is the child

Most of the time issues with kids are breathing or circulation problems

retrations / nasal flaring
appearance side is bad work is bad - respiratory failure

good appearance / bad breathing
respiratory distress

poor circulation high RH - cir distress

PAT - 1 a problem -resp distress
PAT - 2 a problem - resp failure

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15
Q

babies are obligate nose breathers

A

.

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16
Q

Forming a general impression with the pediatric pt

A

kid crying afraid of you - not critical

lifeless - critical pt

Mental Status
Interaction
Emotional State
Response to You
Tone & Body Position
Effort of Breathing
Quality of Cry or Speech
Skin Color
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17
Q

You don’t take a BP on a child…

A

younger than 3**

take BP only in children older than 3 pg 891

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18
Q

cap refill - pinch the child’s hand

A

blanch

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19
Q

Cap refill is a good indicator of perfusion in children…

A

younger than 6

book says younger than 5 pg 890

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20
Q

What order to you do the rapid exam in for a child

A

do to toe to head exam instead of a head to toe…

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21
Q

how long does it take the bones of the skull to fuse

A

12-18 months**

Posterior fontanelle closes first (2-4mo) and then the anterior (19mo)

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22
Q

what does a bulging fontanelle and a sunken fontanelle mean

A

Bulging - increased ICP meningitis, trauma

Sunken - dehydrated

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23
Q

How do you put an OPA in for a child

A

opa sweep the tounge to one side

OPA curved side down

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24
Q

How do you estimate the size of an NPA for a child

A

npa about the size of the pinky finger

measure from nostril to the tragus (cartilage at the front of the ear)

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25
Clearing an obstructed airway in an infant
infant - <1yr old 5 back blows & 5 chest thrusts becomes unconscious 30 compressions visualize the airway and clear if you can see the object Attempt artificial ventilation infant obstructed airway stuff
26
Circulation Problems | Common Causes of Shock in Pediatric Patients
* Diarrhea and/or vomiting * Infection * Trauma (especially abdominal injuries) * Blood loss Less Common • Allergic reactions • Poisoning • Cardiac events (rare) Unlike adults cardiac events are not common causes of shock in a child
27
foramen ovale
In the fetal heart, the foramen ovale , also foramen Botalli, ostium secundum of Born or falx septi, allows blood to enter the left atrium from the right atrium. It is one of two fetal cardiac shunts, the other being the ductus arteriosus (which allows blood that still escapes to the right ventricle to bypass the pulmonary circulation). Another similar adaptation in the fetus is the ductus venosus. In most individuals, the foramen ovale closes at birth. It later forms the fossa ovalis.
28
when it comes to infants and children which are most affected by hypothermia
premature | premature is equal to
29
Most common cause of cardiac arrest in child
respiratory problems - pg 909 | on exam
30
differentiating upper airway problems vs lower airway problems
.
31
croup longer onset
Viral Illness occurs 6mo & 4yr of age Upper airway tissues swell larynyx, trachea & bronchi Cooler months of the year - Seal Bark cough - Sick but not overly sick - taking in cool air helps them breath better ``` Mild fever some hoarseness worsens at night Difficulty Breathing nasal flaring, retraction, tugging at throat ``` on the quiz will provide symptoms Position of Comfort - Sitting admin high flow humidified O2
32
Epiglottitis sudden onset
Bacterial infection older kids 4 to 7 yrs Swelling of the Epiglottis / partial airway obstruction ``` stridor sudden onset of high fever cherry red swollen epiglottis - don't visualize tripod position can't swallow drools a lot kids are very sick more ill than the kids with coup pt will sit still but still works hard to breath ``` ALS call High flow O2 from humidified source
33
Should you visualize the mouth of a child with coup or epiglottitis
don't look in mouth with these kids as it could cause lyrngospasm
34
febrile seizure | and tx for Fever
seizure due to high body temp remove childs clothing put on tepid water monitor to shivering follow protocols for fluid admin year 6mo to 6 yrs
35
Meningitis - pg 913 bacterial - worsens in hours viral - worsens in days
potentially life threatening infection of the lining of the brain & spinal for caused by a bacteria or virus and commonly occurs between the ages of 1mo & 5yr. dura mater arachnoid layer pia mater inflamed meningies The Centers for Disease Control and Prevention says that symptoms for viral meningitis either appear quickly or manifest over several days -- usually following a cold, runny nose, diarrhea, vomiting or other signs of infection. Illness from viral meningitis generally lasts seven to 10 days, and the patient typically sees a full recovery. Symptoms are the same for bacterial but worsen in hours not days. Tx: O2
36
meningitis (bacterial)
fever altered mental status sunglasses on lights hurt her eyes can you move your head forward
37
Diarrhea and Vomiting
``` • Maintain open airway • Provide oxygen • Contact medical control if signs of shock are present • Immediate transport ``` dehydration
38
Seizures
* Maintain open airway (not oral airway) * Position on side if no spinal injury * Be alert for vomiting * Provide oxygen * Transport
39
Altered Mental Status
* Be alert for MOI * Be alert for signs of shock * Look for evidence of poisoning * Attempt to get history of diabetes and seizure disorder
40
Poisoning
* Contact poison control center * Consider activated charcoal * Provide oxygen * Transport * Continue to monitor responsiveness
41
Care for Unresponsive | Poisoning Patient
* Ensure open airway * Provide oxygen * Be prepared to provide artificial ventilation * Transport * Rule out trauma
42
Drowning
* Provide artificial ventilation or CPR * Protect airway * Consider spinal immobilization * Protect against hypothermia * Treat any trauma * Transport
43
Sudden Infant Death Syndrome
* No accepted reason why these babies die * Treat as any patient in cardiac or respiratory arrest * Resuscitate unless there is rigor mortis * Give emotional support for parents
44
know whats in the abdominal quadrants
can use a spine board if pad with kids
45
1-800-96a-buse
obligation to report abuse
46
Child abuse:
when did they call 911 did they call right away? the abusers later say how am I going to explain this - why did you wait.....? give away
47
Infants and children with special challenges
be able to use the parents knowledge ``` trach tubes artificial ventilators Central IV linse Gastrostomy and Gastric Feeding Shunts ``` tx - airway, ventillation, O2, transport
48
suctioning with trach tubes
tell the parents that you need their help and show the EMT how it is done
49
walk into a complex child case
ask the parent what can I do for you
50
pediatric calls are stressful because the injuries to the kids are the fault of the parent
.
51
SUIDS
kinds less than 1 year Sudden Infant Death Syndrome (SIDS) is the sudden death of an infant younger than 1 year of age that remains unexplained after a thorough case investigation, including: Performance of a complete autopsy Examination of the death scene Review of the infant’s and family’s clinical histories
52
many of the kids have a upper respiratory infection a couple of weeks prior
.
53
true unexplained vs sleep death
.
54
SUID
``` SIDS Accidental suffocation Unknown Poisoning Metabolic disorders Hypotherima / Hyperthermia Neglect or homicide ```
55
Highest Risk for SUIDS*****
Risk exists from birth up to one year of age with highest incidence between 2-6 months of age
56
What is the most primary cause of cardiac arrest in children
respiratory disease
57
What are the three components of the pediatric assessment triangle**** on quiz
Appearance Work of Breathing Circulation to the Skin
58
rate of PPV infant and child
infant: 12-20 (3 to 5 seconds) older: 10-12 (5 to 6 seconds)
59
causes of shock in children
Diarrhea and/or vomiting Infection Trauma Blood Loss
60
Premature infant
weighs < 5 1/2 ponds or is born before 37 weeks
61
what is the number one cause of death in infants and children
trauma - blunt - accidental falls, burns, entrapment, crushing head is proportionally lgr & heavier in a child the chest is less developed and the ribs are more elastic infants and young children ante abdominal breathers - rely on diaphragm more than adults bones are more flexible
62
what adult piece of equipment can be used to immobilize a child
KED
63
respiratory distress - inside and outside - child
HR increases, blood vessels constrict | DIB, RR, PR increase
64
respiratory failure - inside and outside - child
can't compensate, hypoxic, tires | cyanotic, slow irregular resp, AMS
65
blood loss - inside & outside child
HR, RR increases, blood vessels constrict skin pale, delayed cap refill, AMS
EMT Test 5
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