Lecture #14

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Lecture #14
2013-05-07 13:01:40

Thurston County EMT
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  1. What is the leading cause of death in children under 14?
  2. Define neonate.
    birth to 30 days old
  3. What are the airway differences in children?
    • tongue is larger
    • smaller nose and mouth
    • trachea is narrower
    • cricoid cartilage is less rigid
    • airway is in general more easily obstructed
  4. What are the anatomical differences in a child's head?
    • proportionally larger than adults
    • infants cannot support own head
    • fontanelles
  5. What are the anatomical differences in a child's chest and lungs?
    • ribs are more pliable
    • lung tissue more fragile
    • normal for abdominal movement with inhalation
    • chest muscles used as accessory muscles
  6. Infants and children less than 5 y/o breath at a rate of ___ to ___ times faster than adults.
    2 to 3
  7. _______ is a late sign of hypoxia for infants and children.
  8. For newborns, _______ is the initial response to hypoxia
  9. What are two organs that are more exposed and less protected in a child's abdomen?
    liver and spleen
  10. What are the three components of the pediatric assessment triangle?
    • general appearance
    • work of breathing
    • circulation to the skin
  11. What should the EMT do in the case of an unresponsive infant or child with a FBAO? (list the steps)
    • place infant on firm flat surface
    • provide 30 chest compressions, then look for obstruction and remove if visible
    • provide 2 ventilations
    • continue ventilations and compressions until object is removed
  12. What is considered cardiac arrest in a child?
    heart rate less than 60 bpm
  13. What will increased respiratory effort in children look like?
    • nasal flaring
    • use of intercostals
    • stridor
    • audible wheezes
    • grunting (exerting pressure to get air out)
    • breathing rate elevated
    • cyanotic
    • altered LOC
  14. What is considered respiratory arrest in children?
    breathing rates less than 10/minute
  15. What are the things that can cause seizures in children?
    • sudden onset of high fever (febrile)
    • infection
    • poisoning
    • trauma
    • hypoxia
    • hypoglycemia
  16. What are the s/s of meningitis?
    • high fever
    • lethargy
    • irritability
    • severe headache
    • stick neck
    • sensitivity to light
    • bulging fontanels
    • painful movement
  17. What is the care for poisoning?
    • responsive: contact poison control and administer activated charcoal if advised, provide O2, monitor, transport
    • unresponsive: ensure airway, be ready with suction, ALS upgrade, rule out trauma
  18. What are the common causes of shock in children?
    • diarrhea
    • vomiting
    • dehydration
    • trauma
    • blood loss
    • infection
    • abdominal injuries
  19. What are the s/s of shock in children?
    • rapid respiratory rate
    • pale, cool, clammy skin
    • weak or absent distal pulses
    • delayed cap refill
    • decreased urine output
    • altered LOC
    • dry mucous membrane
  20. All drowning/near drowning require this....
    ED evaluation
  21. Define abuse vs neglect
    • abuse: improper or excessive action causing injury or harm
    • neglect: giving insufficient attention to someone who has claim to that attention
  22. List the s/s of abuse in children in young children according to protocol
    • clinginess
    • bedwetting
    • inappropriate sexual knowledge
    • aggressive behavior
    • nightmares
  23. Responding to a sudden unexpected death or serious injury in a child, the EMT should...
    • insure safety and provide medical aid as needed to save/assist the child
    • if child is clearly dead, do not move the body
    • ensure law enforcement has been notified
    • document all adults and children present
    • document all statements and demeanor of speakers
    • document all observations of the environment
    • consider and record the child's developmental level
    • know signs of possible abuse and neglect
  24. List the signs of abuse in older children according to protocol
    • inability to concentrate in school
    • drop in grades
    • promiscuity
    • self-destructive behavior
    • comments about suicide
    • poor relations with peers
    • depression
    • eating disorders
  25. What are some of the complications with a tracheostomy tube?
    • bleeding around the hole
    • becomes dislodged/blocked by mucous
    • infection around tube
  26. According to appendix E - infant transfer, qualified persons can accept custody of a newborn, which is defined as less than _____ old.
    72 hours
  27. According to appendix E - infant transfer, the EMT should do these things upon the transfer of custody...
    • notify dispatch and request ALS response
    • medically assess infant and provide care as needed
    • determine whether the transferor is the parent while protecting annonymity
    • attempt to obtain date and time of birth
    • ensure the situation fits within RCW 13.34.360
    • attempt to obtain family medical hx
    • notify CPS (1-866-END-HARM) within 24 hrs
    • if child is not newborn, notify LE and CPS
    • if "qualified person" is not present when infant has been transferred, ask transferor to wait for qualified person
  28. What does neonatal resuscitation consist of?
    • chest compressions at 1/3 depth of the chest
    • 120 compression/minute
    • 3 compressions to 1 ventilation
    • rescue breathing rate of 40-60 breaths per minute
  29. What is epiglottitis and what are the hallmark symptoms?
    • inflammation of the eppiglotis
    • drooling is a hallmark symptom b/c of painful swallowing
    • will also present with fever, hoarse voice, and stridor
  30. Define and list the symptoms of laryngitis.
    • inflammation of the larynx
    • hoarse voice or inability to speak
    • dry, burning throat
    • difficulty swallowing and/or breathing
    • fever
  31. List the steps for relieving choking in a responsive victim 1 year of age or older.
    • stand/kneel behind victim and wraps arms around victim
    • make fist with one hand
    • place fist thumb side against abdomen, in midline, slightly above navel and below breastbone
    • grasp fist with other hand and give quick, forceful, upward thrusts
    • repeat thrusts until object is expelled or victim becomes unresponsive
    • each thrust should be a separate distinct movement
  32. If a choking victim is pregnant, what should the EMT do?
    perform chest thrusts instead of abdominal thrusts
  33. List the steps for relieving choking in a responsive infant.
    • kneel/sit with infant on lap
    • hold infant face-down with jaw in hand
    • give 5 back blows between shoulder blades
    • flip the infant over and give 5 downward chest thrusts with fingertips in the middle of the chest over the lower half of the breastbone at a rate of 1 per second
    • repeat until object is removed or infant becomes unresponsive
  34. List the developmental markers for newborns and infants (1yr).
    • minimal stranger anxiety
    • like to warm
    • dislikes being separated from parents
    • dislikes objects near face (use "blow by" for O2)
    • EMT should observe breathing rate from a distance
    • EMT should evaluate heart and lungs first with head last
  35. List the developmental markers for toddlers (age 1-3).
    • prefer remaining dressed (EMT should remove, examine, replace)
    • dislikes being touched
    • dislikes being separated from parent
    • dislikes objects near face
    • afraid of needles, fear of pain
    • EMT should reassure child was not "bad"
    • EMT should examine trunk to head
  36. List the developmental markers for preschool age (3-6 y/o)
    • dislikes being touched by strangers
    • dislikes being separated from parents
    • dislikes objects near face
    • afraid of blood, pain and permanent injury
    • modest and shy
    • EMT should reassure child was not bad and replace clothing after exam
  37. List the developmental markers for school age children (6-12 y/o)
    • afraid of pain, blood and permanent injury/ disfigurement
    • modest
  38. List the developmental markers for adolescents (12-18 y/o)
    • afraid of permanent injury/disfigurement
    • modest
    • EMT should treat them as adult
    • EMT should assess away from parents or guardians