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Advanced Study | Pediatrics Part Two

Assessment: scene size-up: is the scene safe? In what position was the child found? Do the history and the injuries match?

  • Pediatric Assessment Triangle (first 30-60 secounds):
    • Appearance
    • work of breathing
    • circulation
  • Initial Triage decision: if immediate treatment is necessary, then rapid transport
    • LOC – AVPU
    • ABCs 90% of cardiopulmonary problems start as respiratory problems
  • Respiratory distress is hypoxia, where work of breathing is increased
  • Respiratory failure is the inability to maintain adequate O2 in the blood
  • Apnea is the absence of airflow (breathing) for more than 15 seconds
  • Signs and symptoms: nasal flaring, retractions, head bobbing, grunting, stridor, prolonged expiration, slow irregular resps. Dyspnea causes bradycardia
    • Vital signs: respiratory rate and quality, pulse rate and quality, BP (over 3), pupils, skin temp. color and condition
  • Broselow Tape: resuscitation tool referencing proper range of vital signs as well as resuscitation equipment
  • History: get info from the parent/guardian/caregiver. SAMPLE history
  • Detailed physical: Infants and young children go toes to head. Older children head to toes

Managing the ABCs:

  • Allow the parent to hold infant and young children
  • Unconscious children, towel under shoulders will hold head in a sniffing position. Hyperextension can occlude the airway
  • Blocked airway? Never blind sweep the back of the mouth – abdominal thrusts for older children, chest thrusts and back blows for infants
  • OPAs: must use the right size – corner of mouth the earlobe, use tongue depressor to hold the tongue up, NPA: proper size, tip of nose to tragus ET tube can double as an NPA
  • Suction:  use a flexible tip. Monitor heart rate so they don’t vagal out and brady down
  • Intubation equipment: ET tube should be the size of the pinkie finger or Age/4 + 4 = mm ET Tube, blade sizes go down to zero
  • Bag Valve Mask Ventilation: at least 20 breaths/minute, O2 set at 15 L/min with a 450 mL bag
  • Nasal Cannual @ 2-4 L/min O2
  • Blow by O2 from a cup and hold the mask close to face

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