Northwest Community Healthcare Paramedic Program Lifespan development PEDIATRIC ASSESSMENT Peds Trauma Connie J. Mattera, M.S., R.N., EMT-P Reading assignment: Aehlert Vol. 2: pp. 71-132,167-181,184-189,532-533 Companion DVD-Chapter 35 SOPs: Peds section, CPR table; Pediatric drug index Procedure Manual : Length-based tape; Pediatric intubation; Pediatric IV insertion KNOWLEDGE OBJECTIVES: Upon completion of the assigned readings, class, and homework questions , each participant will independently do the following with at least an 80% degree of accuracy and no critical errors: 1. integrate pathophysiological principles and assessment findings to formulate a field impression and implement a treatment plan for the pediatric patient. 2. discuss the paramedic's role in the reduction of infant and childhood morbidity and mortality from acute illness and injury. 3. identify methods/mechanisms that prevent injuries to infants and children. 4. describe techniques for successful assessment of infants and children. 5. describe techniques for successful treatment of infants and children. 6. identify the common responses of families to acute illness and injury of an infant or child. 7. describe techniques for successful interaction with families of acutely ill or injured infants and children. 8. determine appropriate airway adjuncts for infants and children. 9. discuss complications of improper use of airway adjuncts in infants and children. 10. discuss appropriate ventilation devices for infants and children. 11. discuss complications of improper use of ventilation devices with infants and children. 12. discuss appropriate tracheal intubation equipment for infants and children. 13. identify complications of improper tracheal intubation procedure in infants and children. 14. list the indications and methods for gastric decompression for infants and children. 15. define respiratory distress. 16. define respiratory failure. 17. define respiratory arrest. 18. discuss the common causes of hypoperfusion in infants and children. 19. identify the major classifications of pediatric cardiac rhythms. 20. discuss the primary etiologies of cardiopulmonary arrest in infants and children. 21. discuss age-appropriate vascular access sites for infants and children. 22. discuss the appropriate equipment for vascular access in infants and children. 23. identify complications of vascular access for infants and children. 24. describe the primary etiologies of altered level of consciousness in infants and children. 25. identify common lethal mechanisms of injury in infants and children. 26. discuss anatomical features of children that predispose them or protect them from certain injuries. 27. describe aspects of infant and children airway management that are affected by potential cervical spine injury. 28. identify infant and child trauma patients who require spine motion restriction. 29. discuss fluid management and shock treatment for infant and child trauma patients. 30. determine when pain management and sedation are appropriate for infants and children. CJM: F17 NCH Paramedic Program Pediatric Lifespan Development/ Assessment/Trauma Connie J. Mattera, M.S., R.N., EMT-P Children present a special challenge because seriously ill Be prepared: Children cry loudly! or injured pediatric patients are not as common as adults. Younger children have limited language skills and a Skilled EMS personnel, who competently manage adult decreased ability to communicate. Look at their crises, become nervous when faced with a critically ill or faces for clues to their well-being. injured child. Keep voice at even, quiet tones, don't yell. They tend to respond to our facial expressions and tone of Factors for successful outcomes voice more than to what we actually say. EMS agencies need to be prepared through education Use toys or penlight as distracters; make a game of & having proper equipment. assessment. Use non-medical techniques such as Properly trained personnel must be available with pacifiers, toys, or books to calm children. predesignated responsibilities. Keep a small child with their caregiver(s) if possible; Care givers must appreciate a child's responses to do assessment on a stable child while being held. injury - physiologic and psychologic. Allow parents to remain with child and offer comfort. The developmental stages/needs of children based on Only one person should give instructions their physical, cognitive, and psychosocial growth and Get down on their eye level if possible. Speak slowly, development must be understood. communicate in words they understand. Caregivers must have knowledge of mechanisms and Make as many observations as possible before unique injury patterns in children. touching and upsetting the child or inflicting pain. Children are not mini-adults. There is no “average Stages of emotional maturity- don’t overestimate size” child as there is in adults. Assessments and Psychosocial development see detailed handout chart interventions must be based on the individuality of each child in terms of age, size, psycho-social development Neonates: and metabolic status. Unconcerned about strangers No language but a cry – typically caused by hunger, Age definitions irritation, boredom, pain; persistent crying may indicate Newborn First mins to hrs following birth physiological distress. Neonate Birth to in first 28 days of life Handle gently, supporting head and neck. Infant 1 to 12 months Respond to soothing voice, gentle hands and pacifier Toddler 1 to 3 years unless hungry or in pain, then may be inconsolable. School age: 6 to 12 years Adolescent: Puberty to adult (18 years) Not modest, may mind being undressed in a cold environment; may become frankly hypothermic if left uncovered during exam or therapy. Use PEDS SOPs for children 12 years and younger Begin exam with chest and abdomen; difficult to Anatomy and physiology differences – examine if crying; progress to head (and extremities). Lifespan development By 3-4 months: Average growth and developmental milestones Establishes attachment to parents Ave birth wt is 3500 gm (7 lb. 8 oz.); length 19.5 - 20" Can be quieted easily (more Weight should double by six months readily by primary caretaker Should triple by one year: ave 22 lbs., 30" Smiles readily 3 years: 30 - 35 lbs. By 4-6 months: 4 years: 16 kg (40 lbs.) - ¼ of adult weight; length 40" 10 years: 35 kg or ½ of adult weight Is learning to treat individuals differently Size estimation in the field: Most accurately done by Laughs out loud and may show displeasure if facial measuring child’s length with a Broselow tape (2011A contact is broken edition) to determine tube sizes, drug doses, and About 6 mos begins to be anxious around strangers defibrillation joules. Lean body size may also be estimated by using the following formula: By 8-9 months: 2 x age in years + 10 = weight in kg. Protests when primary caregiver leaves Shows happy feelings when interacting with people Starts to experiment with independence (crawls Communications guidelines away from parents, cries, then comes back Children are unpredictable by adult standards. You must know psycho-social growth and developmental stages to communicate with them effectively. See chart. NCH Paramedic Program Pediatric Assessment/Trauma page 2 Connie J. Mattera, M.S., R.N., EMT-P Infants: Implications for care Exam still begins with chest and abdomen; involve The baby will reject the attention of strangers. Make caregivers whenever possible first contact with the infant in the mother's lap until School-age (6 to 12 years) the child views you as a safe person. Enjoys interaction with peers, make friends easily Will probably not object to being undressed but will Recognizes the need for rules object violently from being removed from their Shows self-esteem and self-confidence primary caregiver and placed on a table or cart for Feels good about accomplishments examination Has a vivid imagination, and in play often stages Distract infant with verbal stimulation and examine dramatic scenes using favorite toys while sitting in mother's lap Usually cooperative Crying gradually decreases throughout infancy Still afraid of pain, separation of parents, permanent Begin exam with chest and abdomen injury; more aware and afraid of death Foreign body airway obstruction risk begins at about 6 months and increases with age. Usually modest; defer genital exam unless necessary Needs friendly reassurance, likes unambiguous Toddlers: One and two year olds explanation of procedures and equipment Exhibits the beginnings of autonomy (showing Address preoccupations about death when clothing or food preference appropriate Independent, strong-willed; favorite word is "NO" Generally examined like an adult, best in presence of Explores the environment, using the parent or parents primary caretaker as a secure attachment Adolescents (13 to 15 years) May use a transitional object - a doll, blanket, or thumb to calm himself or help himself go to sleep Enjoys close interaction with peers and develops Learns to soothe self verbally and deal with intimate relationships, especially with friends of the emotional issues with words same sex Demonstrates interest and enjoyment in play Is industrious, demonstrates a sense of mastery and Demonstrates a wide variety of emotions feelings, progressively takes responsibility for own work and moods, including protest, anger, pleasure, joy, (homework, chores) assertiveness, and warmth Demonstrates self-confidence and