HAN 416

Lecture 9: Pediatric Anatomy/Physiology

What are some pediatric considerations?

Equipment size, reduced oxygen reserve, communication difficulties, adult anatomy evolution

What are some challenges with pediatric calculations?

People can get frustrated doing these calculations in their head, Examples: Weight estimation, equipment size, medication doses/volumes, fluid columns, ventilatory volume

What is unique about a child's head?

Larger proportionally compared to adults, small faces, flat noses, pay special attention to the fontanelles

What are some airway positioning techniques for children?

neutral position and sniffing position

What is the sniffing position?

towel under occiput for sniffing position (over 3 yrs)

What is the neutral position?

Padding under back for neutral position (under 3 yrs)

How does a heavy head relative to body size affect airway positioning?

Increases risk of blunt head trauma,

What are the characteristics of a child's airway?

Narrower, obligate nose breathers, elliptical shape, higher larynx, omega-shaped epiglottis,

the cricoid ring = narrowest part, tongue takes up more space.

Why is it important to keep nares clear in infants?

To ensure proper breathing.

What is the shape of a child's airway?

Elliptical.

Where is the narrowest part of a child's airway?

Cricoid ring.

What is the difference between lung tissue and rib protection?

Lung tissue is more fragile and pliable ribs offer less protection.

How do infants and children breathe?

Infants and children are diaphragmatic breathers.

What are pediatric patients prone to?

Pediatric patients are prone to gastric distention.

What is a common injury in cases of child abuse?

Rib fractures are not uncommon in cases of child abuse.

Can significant internal injuries be present without any external signs?

Yes, significant internal injuries can be present without any external signs.

What are pulmonary contusions?

Pulmonary contusions are common in patients subjected to major trauma.

How are extremities bones different from adults?

Extremities have softer, more porous bones than adults.

How should sprains and strains be treated?

Treat sprains and strains as fractures and immobilize accordingly.

What can injuries to growth plate cause?

Injuries to growth plate may disrupt bone growth.

How can a child be in shock despite normal blood pressure?

A child may be in shock despite normal blood pressure; shock assessment is based on tissue perfusion.

What does hypotension indicate?

Hypotension is a late sign and indicates imminent cardiopulmonary arrest.

What are some characteristics of an infant's skin?

Thinner, less subcutaneous fat, larger BSA-to-weight ratio

What are some risks associated with an infant's skin?

Greater risk of injury from temperature extremes, dehydration, and hypothermia

What is the Chain of Survival?

A sequence of actions to improve survival from cardiac arrest

How does an infant's respiratory system differ from an adult's?

Require double the metabolic O2, proportionately smaller O2 reserves, and are especially susceptible to hypoxia

What are some metabolic differences in infants?

Limited storage of glycogen and glucose, prone to hypothermia, and significant volume loss can result from vomiting and diarrhea

What are some ways to prevent heat loss in infants?

Newborns and neonates lack the ability to shiver.

Cover their heads and maintain adequate temperature controls in ambulance

What is the algorithm for 2 or more rescuers?

What should be done if a victim has no breathing and a pulse?

Rescue Breaths,

perform 1 rescue breaths every 2-3 seconds= (20-30 breaths/min)

When should CPR be performed?

If victim has no breathing and no pulse

What is the recommended ratio for CPR for 2 rescuers?

15 compressions to 2 breaths

What is the recommended ratio for CPR for 1 rescuer?

1 rescuer = 30:2

what if the patient is breathing and has a pulse?

monitor until emergency responders arrive.

Abnormal breathing = gasping, irregular respiratory pattern, tachypnea, bradypnea, apnea

gasping, irregular respiratory pattern, tachypnea, bradypnea, apnea

Lecture 10: Common Pediatric Emergencies

What to do when pt has abnormal breathing?

Assess breathing: RR & pattern, resp. effort, chest expansion & air movement, lung & airway sounds, O2 sat. by pulse ox.

What is respiratory distress?

Increased work of breathing resulting in adequate gas exchange.

How is respiratory distress classified?

Mild, moderate, and severe.

What are the signs of respiratory distress?

Pallor/mottled skin, Irritability

Increased RR, retractions, abdominal breathing, nasal flaring, inspiratory stridor, grunting, mild tachycardia.

What is respiratory failure?

Decompensated state: hypoxia and/or carbon dioxide retention occurs

What are the signs and symptoms of respiratory failure?

Decreased or absent retractions due to chest wall muscle fatigue, altered mental status due to inadequate oxygenation and ventilation of the brain, abnormally low respiratory rate

What is respiratory arrest?

Patient is not breathing spontaneously and requires bag-mask ventilation

General Treatment of respiratory arrest.

Supplemental oxygen, perform ecg monitoring, establish IV access, manage the airway

What is the first step in removing a foreign body?

Deliver 5 back slaps and 5 chest thrusts.

What should you do if an infant loses consciousness during foreign body removal?

Start CPR.

What should you do if you see an object in the infant's mouth during foreign body removal?

Look inside mouth and remove objects if you see it: proceed with laryngoscopy and removal w/ Magill forceps.

What should you do while continuing compressions and ventilation during CPR?

Assess for a pulse.

What are allergic reactions?

Hypersensitivity to foreign protein/allergen

What is anaphylaxis?

Severe, immediate, systemic hypersensitivity reaction.

Anaphylaxis is: rapid onset (respiratory system), multisystem, life-threatening, shock - poor perfusion (GI symptoms)

What are the symptoms of anaphylaxis?

Rapid onset, multisystem, life-threatening, shock

What are some common causes of anaphylaxis?

Foods, insects, medications

What is the treatment for anaphylaxis?

Epinephrine

Supplemental interventions: antihistamines, nebulizers, steroids, pressors

What is the onset time for epinephrine in a healthy patient?

Typically 90 seconds

What is the onset time for IM epinephrine in anaphylaxis?

3-5 minutes

When should a second dose of epinephrine be considered?

If no change after 5 minutes

What is the dosage of epinephrine for adults?

0.30 mL

What is the dosage of epinephrine for pediatrics?

0.15 mL

What are the desired effects of epinephrine?

Bronchodilator, increased inotropy, chronotropic, vasoconstriction

Why is rapid identification and treatment of anaphylaxis important?

Because it can lead to cardiopulmonary collapse, shock, or arrest

What is croup?

Viral infection of the upper airway

When does croup usually occur?

Fall and winter; worst at NIGHT

What are the symptoms of croup?

cold symptoms, low grade fever, barky cough, stridor, trouble breathing

What is the initial management for croup?

Position of comfort, avoid agitating the child, administer dexamethasone intravenously or intramuscularly

Additional Management of Croup

Nebulized epinephrine assisted ventilation with bag-mask ventilation may be necessary

What is epiglottitis?

Inflammation of the epiglottis and supraglottic tissues

Who is most affected by epiglottitis?

2-7 year olds

What are the symptoms of epiglottitis?

Sick, anxious, sitting in sniffing position, drooling, pallor or cyanosis, high fever or sore throat, symptoms progress rapidly

What is the management for epiglottitis?

Get the child to an appropriate hospital, be prepared with bag-mask device and an ET tube

What is Bacterial Tracheitis?

Bacterial infection and subglottic area of the upper airway

What are the signs and symptoms of Bacterial Tracheitis?

cough, stridor, respiratory distress, history of preceding viral infection

What is asthma?

Most common chronic childhood illness with bronchospasm, mucus production, airway inflammation.

What are the main components of asthma?

Bronchospasm, mucus production, airway inflammation.

What happens if asthma becomes more severe?

Air trapping, inadequate ventilation, worsening of hypoxemia, hypoventilation with respiratory acidosis and resp. failure becomes imminent.

What are the triggers of asthma?

Upper respiratory infections, allergies, exposure to cold, changes in the weather, second hand smoke, animals, exercise.

What are the signs and symptoms of asthma?

Frequent cough, wheezing, general signs of respiratory distress.

What is the initial management for asthma?

Position of comfort, supplemental O2, bronchodilators (albuterol), IM dexamethasone, epinephrine for severe respiratory distress.

What is Respiratory Syncytial Virus (RSV) Infection?

Common and contagious virus that causes bronchiolitis and pneumonia in children

How is RSV transmitted?

Direct/indirect contact with large droplets or contaminated surfaces

Who is most affected by RSV?

Infants, older people, and immunocompromised

How long does RSV survive?

dies on hands within 1 hr, but survives on surfaces for 30 hours,

incubation is 2-8 days

What are the symptoms of RSV?

Sneezing, running nose, nasal congestion, cough, fever

What is the prevention for RSV?

PPE, post-transport vehicle cleaning

What is the treatment for RSV?

Supportive care

What is Pneumonia?

Disease that affects the lower airways and lungs

What are the symptoms of Pneumonia?

Rapid breathing, grunting, wheezing, hypothermia or fever

What causes Pneumonia in infants and toddlers?

Virus

What causes Pneumonia in older children?

Bacteria

What is the treatment for Pneumonia?

Supportive care

What is Pertussis (Whooping Cough)?

Highly contagious respiratory droplet infection

What are the symptoms of Pertussis?

Runny nose, sneezing, coughing, fever

What is the immediate action to take for Pertussis?

Keep the airway patent and seek medical attention immediately