Ch. 22-Pediatric and Geriatric Emergencies

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Ch. 22-Pediatric and GeriatricEmergencies
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22.1 Assessing the Child

• Special Assessment Techniques
• Does the child look sick?
• Is the child in shock?
• Is the child in extreme pain?
• How is the child breathing?

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Obtaining a History

• Do not let upset parents and a screaming child
  unnerve you take the time you need to get the
  information you need.
• Get information from parents or other witnesses,
  not the child.
• Ask when symptoms developed, how they progressed,
  and what care has already been given.
• If there was an accident, determine the details
  of the accident, the mechanism of injury, and
  what first aid care has already been given.

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Taking Vital Signs

• Respirations
• Pulse
• Temperature
• Neurological assessment

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PROGRESS CHECK

• 1. When assessing a child, you should position
  yourself ____________.
• (above the child/below the child/at the childs
  eye level)
• 2. During assessment, check the most painful part
  ____________.
• (quickly/last/first)
• 3. You should check a childs vital signs more
  ____________ than you do an adults.
  (frequently/thoroughly/quickly)
• 4. A child breathes ____________ than an adult.
  (slower/faster/more deeply)
• 5. Check a childs respiratory rate by placing
  your hand on the childs ____________.
  (chest/stomach/back)
• 6. Take an infants pulse at the ____________
  pulse. (carotid/radial/brachial)

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Vocabulary

• Croup- A viral infection that causes swelling
  beneath the glottis and progressive narrowing of
  the airway
• Epiglottitis- A bacterial infection that causes
  swelling of the epiglottis and blocking of the
  airway
• Sudden infant death syndrome (SIDS)- Sudden death
  of an apparently healthy infant, usually while
  asleep

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Asthma care includes

• 1. Allow the child to assume the position of
  greatest comfortalmost always sitting or
  semisitting. Additionally, give an asthma victim
  plenty of fluids, which help loosen and thin
  mucus in the air passages.
• 2. Be calm and reassuring.
• 3. Activate the EMS system or take the child to a
  medical facility.
• 4. If allowed as part of your training, assist
  the patient with his/her inhaler. Even retrieving
  an inhaler and bringing it to the patient is
  valuable.

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Cardiac Arrest

• The signs and symptoms of cardiac arrest in a
  child include
• Unresponsiveness
• Seizure (early in onset of arrest due to hypoxia)
• Gasping or absent respiratory sounds
• Absence of chest movement
• Pale or blue skin
• Absent pulse

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Seizures

• 1. Turn the child onto his or her side to prevent
  the tongue from relaxing and shifting backward,
  blocking the air passage.
• 2. Do not hold the child down, but place the
  child where he or she will not fall or strike
  something. A rug on the floor is excellent so is
  a crib with padded sides.
• 3. Loosen tight or restrictive clothing.
• 4. Sponge a feverish child with lukewarm water.

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Shock

• The signs and symptoms of shock in a child
  include
• Paleness
• Cold, moist skin
• Low blood pressure
• A rapid, thready pulse
• Lack of vitality
• Extreme anxiety
• Unconsciousness
• To care for shock, activate the EMS system, have
• the child lie flat, keep the child warm and as
  calm as
• possible, and monitor vital signs frequently.

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PROGRESS CHECK

• 1. Injuries of the extremities in a child can
  also damage the ____________.
• (bone marrow/growth plates/large ball-and-socket
  joints)
• 2. An infant has a proportionally large
  ____________, which can block the airway.
  (tongue/epiglottis/larynx)
• 3. Most children involved in trauma have an
  enlarged ___________, which can interfere with
  breathing. (tongue/larynx/stomach)
• 4. A characteristic seal bark cough is a sign
  of ____________.
• (asthma/croup/epiglottitis)
• 5. A child who is drooling, having difficulty
  speaking, and having difficulty swallowing
  probably has _________. (asthma/croup/epiglottitis
  )
• 6. Seizures in a child can be caused by
  _________, which rarely causes seizures in an
  adult. (head injury/oxygen deficiency/fever)
• 7. ____________, which does not usually cause
  shock in older victims, can
  cause shock in an infant.
• (Blood loss/Loss of body heat/Major trauma)

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Sudden Infant Death Syndrome

• 1. Even if the child is obviously dead, have
  someone activate the EMS system and immediately
  begin infant CPR.
• 2. Be aware of the parents extreme distress the
  best first aid is to make them feel that
  everything possible has been done for their
  child. Leave no room for ifs and maybes.
  Parents will often feel guilt. Be careful not to
  make judgmental statements that add to guilt.
• 3. After the ambulance arrives, encourage the
  parents to accompany their baby in the ambulance
  and arrange for someone to stay with other
  children at the home.

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Identifying Child Abuse

• The child is fretful, frightened of parents,
  afraid to go home, wary of adults, or apathetic
  (a child who does not cry, despite injuries)
• Abrasions, lacerations, incisions, bruises,
  broken bones, or multiple injuries in various
  stages of healing
• Injuries on both the front and the back or on
  both sides
• Unusual wounds, such as circular burns
• Injuries to the head, back, and abdomen,
  including the genitals
• Pain, itching, bruises, or bleeding in the
  genital, vaginal, or anal areas
• Injuries that do not match the mechanisms of
  injury described by the parents or caregivers

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First Aid Care for Child Abuse

• 1. Calm the parents let them know by your
  actions that you are there to help and render
  first aid care. Speak in a low, firm voice.
• 2. Focus attention on the child speak softly to
  the child, using the first name. Never ask the
  child to recreate the situation while in the
  crisis environment or with the suspected abuser
  still present.
• 3. Conduct a thorough, head-to-toe exam care for
  injuries appropriately.
• 4. It is not your responsibility to confront any
  adult with the charge of child abuse be
  supportive and nonjudgmental while at the scene.
• 5. Always report your suspicions of child abuse
  to the proper authorities, and maintain total
  confidentiality with others regarding the
  incident.

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PROGRESS CHECK

• 1. Sudden infant death syndrome occurs when an
  apparently ____________ infant dies while
  sleeping. (distressed/healthy/ill)
• 2. Even if a victim of SIDS is obviously dead,
  you should ____________.
• (begin infant CPR/treat for shock/do a primary
  survey)
• 3. An abuser often shows ____________ toward the
  child.
• (compassion/guilt/hostility)
• 4. Suspect child abuse if the child is
  ____________.
• (frightened of parents/clinging to
  parents/affectionate to parents)
• 5. If you suspect child abuse, you should
  _________.
• (confront the parents at the scene/report your
  suspicions to
• authorities/ask the child to confirm your
  suspicions)

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Differing Signs and Symptoms

• In myocardial infarction
• Pain is less common.
• Aching shoulders and indigestion are common.
• The most common symptoms are shortness of breath,
  fatigue, and anxiety.
• In congestive heart failure
• Little or no dyspnea is present.
• In pneumonia
• Fever is usually absent (it is a classic sign of
  pneumonia in other age groups).
• Chest pain is much less common.
• Cough is much less common.

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Special Assessment Considerations

• The elderly become debilitated much more rapidly
  a minor problem can become major within a few
  hours.
• The victim may be taking a number of medications.
• As many as one in four elderly have psychiatric
  disorders, which can be the cause of some
  symptoms (such as clouding of consciousness).
• It can be difficult to separate the effects of
  aging from the consequences of disease.
• The victims chief complaint may seem trivial.
• The victim may fail to report important symptoms.
• The geriatric victim is likely to suffer from
  more than one disease at a time.
• Aging may change the victims response to illness
  and injury, causing you to underestimate the
  severity of the victims condition.

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Special Examination Considerations

• The victim may be fatigued easily.
• The victim may be wearing several layers of
  clothing.
• You need to explain actions clearly before
  assessing the elderly victim.
• The victim may minimize or deny symptoms out of
  fear of being bedridden or institutionalized or
  of losing a sense of self-sufficiency.

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Special Trauma Considerations

• They may have slower reflexes, failing eyesight
  and hearing, arthritis, less elastic blood
  vessels, and fragile tissues and bones.
• They are at higher risk for trauma from criminal
  assault.
• They are prone to head injury, even from
  relatively minor trauma signs and symptoms of
  brain compression develop more slowly, sometimes
  over days or weeks.
• They often have a significant degree of
  degenerative disease of the cervical vertebrae,
  which can gradually compress the roots of nerves
  to the arms or possibly to the spinal cord
  itself. Sudden neck movement, with or without
  fracture, can cause spinal cord injury.

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PROGRESS CHECK

• 1. ____________ is less common in elderly victims
  of myocardial infarction. (Pain/Indigestion/Shortn
  ess of breath)
• 2. There is usually little or no ____________ in
  elderly victims of congestive heart failure.
  (edema/cyanosis/dyspnea)
• 3. ____________, a classic sign of pneumonia, is
  usually absent in the elderly. (Weakness/Pain/Feve
  r)
• 4. Signs or symptoms may be masked in elderly
  victims because they usually ____________. (take
  multiple medications/ are
  immobile/have failing eyesight)