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Pediatric Assessment and Management

Pediatric Assessment and Management

Information Covered:

1. Pediatric Anatomical Variations and Assessment
   1. Head compared to an adult’s
      1. Compared to the body, the head is proportionally larger in size
      2. The head contributes a larger portion of the body’s surface area than in adults
      3. Anterior and posterior fontanelles open
      4. Implications for the health care provider
   2. Airway compared to an adult’s
   3.          Chest and lungs compared to an adult’s
   4. Abdomen compared to an adult’s
   5.          Extremities compared to adult’s
   6.          Skin and body surface area compared to an adult’s
      1. Thinner with less subcutaneous fat
      2. Larger surface area to body mass
      3. Implications for the health care provider
   7. Respiratory system compared to an adult’s
      1. Tidal volume of breaths is smaller (10-15 mL/kg)
      2. Higher oxygen demand per kilogram of body weight (2 times that of an adult)
      3. Smaller lung oxygen reserves
      4. Implications for the health care provider
   8. Nervous system and spinal column compared to an adult’s
      1. Continually evolves throughout childhood allowing them to develop new abilities
      2. Brain tissue is more fragile and prone to bleeding from injury
      3. The subarachnoid space is relatively smaller offering less cushioning to the brain
      4. The brain requires nearly twice the cerebral blood flow as does an adult’s
      5. Brain and spinal cord are less well protected by a thinner skull and spinal column
      6. Spinal column
      7. Implications for the health care provider
2. Metabolic differences compared to an adult
   1. Infants and children have limited glucose stores
   2. Infants and children are prone to hypothermia due to increased body surface area
   3. Newborns and infants less than 1 month are the most susceptible to hypothermia
   4. Implications for the health care provider
3. Growth and Development
   1. Infancy
      1. birth-2 months
         1. Physical development
         2. Cognitive development
         3. Emotional development
         4. Implications for the health care provider
      2. 2-6 months
         1. Physical development
         2. Cognitive development
         3. Emotional development
         4. Implications for the health care provider
      3. 6-12 months
         1. Physical development
         2. Cognitive development
         3. Emotional development
         4. Implications for the health care provider
   2.           Toddler years
      1. 12-18 months
         1. Physical development
         2. Cognitive development
         3. Emotional development
         4. Implications for the health care provider
      2. 18-24 months
         1. Physical development
         2. Cognitive development
         3. Emotional development
         4. Implications for the health care provider
      3. Preschool years (2-5 years)
         1. Physical development
         2. Cognitive development
         3. Emotional development
         4. Implications for the health care provider
      4. Middle Childhood years (6-12 years)
         1. Physical development
         2. Cognitive development
         3. Emotional development
         4. Implications for the health care provider
      5. Adolescence (12-20 years)
         1. Physical development -- Puberty begins
         2. Cognitive development
         3. Emotional development
         4. Implications for the health care provider
4. Pediatrics: Specific Pathophysiology, Assessment, and Management
   1. Respiratory Compromise
      1. Pathophysiology
      2. Assessment
      3. Upper airway obstruction
      4. Lower airway disease
      5. Pneumonia
      6. Foreign body lower airway obstruction
      7. Pertussis
      8. Cystic fibrosis
      9. Bronchopulmonary dysplasia (BPD)
         1. Chronic lung disease that usually occurs in infants form born prematurely and treated with positive pressure ventilation and high oxygen concentrations
         2. Recurrent respiratory infections and exercise induced bronchospasm are complications
         3. Management
   2.     Non Cardiogenic Shock
      1. Introduction
      2. Pathophysiology (compensated vs. decompensated)
      3. Assessment
      4. Management
   3.     Cardiac
      1. Introduction
         1. Epidemiology
         2. Anatomic and physiologic differences in children
      2. Pathophysiology
         1. Shock in children (compensated vs. decompensated)
         2. Cardiogenic vs. noncardiogenic shock
      3. Assessment
         1. History (age, sweating while feeding, cyanotic episodes, difficulty breathing, syncope, prior cardiac surgery, poor weight gain)
         2. Physical findings (heart rate, blood pressure, capillary refill, color, mental status, cardiac murmurs/rubs/gallops, pulse oximetry, 4 extremity blood pressures)
         3. Bedside testing (rhythm strip)
      4. Congestive heart failure
         1. Myocarditis
         2. Cardiomyopathy
         3. Congenital heart disease as underlying cause
      5. Congenital heart disease
      6. Arrhythmias
      7. Management
      8. Pathophysiology
         • Assessment
         • Hyperglycemia
         • Hypoglycemia
5. Hematologic/Oncologic/Immunoloic
   1. Introduction
      1. Epidemiology
      2. Anatomic and physiologic differences in children
   2. Pathophysiology
   3. Assessment
   4. Sickle cell disease
   5. Bleeding disorders
   6. Leukemia/Lymphoma
   7. Immunocompromised
   8. Management
6.     Gastrointestinal
   1. Introduction
   2. Pathophysiology
   3. Assessment
      1. History (blood or bile in emesis, diarrhea, age, gender, constipation, fever, medications, tolerance of gastrostomy tube feeds, prematurity, blood type incompatibility, epistaxis, liver disease)
      2. Physical findings (heart rate, blood pressure, mucous membranes, icterus, capillary refill, blood in nares, abdominal distention or mass, hepatomegaly, pallor, anal fissure)
      3. Inspection of gastrostomy tube
   4. Vomiting
      1. Gastroenteritis
      2. Malrotation
      3. Pyloric stenosis
   5. GI Bleeding
   6. Neonatal Jaundice
      1. Physiologic
      2. Pathologic
   7. Management
      1. Bowel rest (for vomiting and GI bleed)
      2. IV hydration
      3. Replacement of G-tube if dislodged or dysfunctional
7. Toxicologic
   1. Introduction
      1. Epidemiology
      2. Nontoxic exposures
      3. Role of the Poison Control Center
   2. Assessment
   3. Ingestion
   4. Inhalation
   5. Management
8. Abuse and Neglect
   1. Introduction
   2. Assessment
      1. Elements in the history or scene concerning for abuse or neglect
      2. Assessing the caregiver’s behavior
      3. Physical findings concerning for abuse or neglect
      4. Benign findings often confused for physical or sexual abuse
   3. Management
      1. Role of the Prehospital Professional (scene assessment, assessment of the caregiver, communication with the caregiver, documentation, reporting suspected abuse/neglect, safely transporting one or more injured children)
      2. Role of Child Protective Services (CPS)
      3. Role of Medical Examiner and law enforcement
9. Sudden Infant Death Syndrome
   1. Introduction
      1. Definition of SIDS
      2. Definition of ALTE
      3. Epidemiology and Risk Factors
   2. Assessment
      1. Cardiopulmonary status
      2. Clinical signs of death
      3. Evaluation for other signs of abuse
   3. Management
      1. Local EMS criteria for death in the field
      2. Notification of appropriate authorities
      3. Controversy over transport after failed advanced life support

Content Creator: Joyce Lockwood

CAPCE Course Number: 17-EMTP-F3-6201

Total CE Hours: 1.25

Level: Advanced

EMT-CE uses the NEMSES guidelines as the foundation for every course outline.