Pediatric Assessment and Management
Information Covered:
- Pediatric Anatomical Variations and Assessment
- Head compared to an adult’s
- Compared to the body, the head is proportionally larger in size
- The head contributes a larger portion of the body’s surface area than in adults
- Anterior and posterior fontanelles open
- Implications for the health care provider
- Airway compared to an adult’s
- Chest and lungs compared to an adult’s
- Abdomen compared to an adult’s
- Extremities compared to adult’s
- Skin and body surface area compared to an adult’s
- Thinner with less subcutaneous fat
- Larger surface area to body mass
- Implications for the health care provider
- Respiratory system compared to an adult’s
- Tidal volume of breaths is smaller (10-15 mL/kg)
- Higher oxygen demand per kilogram of body weight (2 times that of an adult)
- Smaller lung oxygen reserves
- Implications for the health care provider
- Nervous system and spinal column compared to an adult’s
- Continually evolves throughout childhood allowing them to develop new abilities
- Brain tissue is more fragile and prone to bleeding from injury
- The subarachnoid space is relatively smaller offering less cushioning to the brain
- The brain requires nearly twice the cerebral blood flow as does an adult’s
- Brain and spinal cord are less well protected by a thinner skull and spinal column
- Spinal column
- Implications for the health care provider
- Head compared to an adult’s
- Metabolic differences compared to an adult
- Infants and children have limited glucose stores
- Infants and children are prone to hypothermia due to increased body surface area
- Newborns and infants less than 1 month are the most susceptible to hypothermia
- Implications for the health care provider
- Growth and Development
- Infancy
- birth-2 months
- Physical development
- Cognitive development
- Emotional development
- Implications for the health care provider
- 2-6 months
- Physical development
- Cognitive development
- Emotional development
- Implications for the health care provider
- 6-12 months
- Physical development
- Cognitive development
- Emotional development
- Implications for the health care provider
- birth-2 months
- Toddler years
- 12-18 months
- Physical development
- Cognitive development
- Emotional development
- Implications for the health care provider
- 18-24 months
- Physical development
- Cognitive development
- Emotional development
- Implications for the health care provider
- Preschool years (2-5 years)
- Physical development
- Cognitive development
- Emotional development
- Implications for the health care provider
- Middle Childhood years (6-12 years)
- Physical development
- Cognitive development
- Emotional development
- Implications for the health care provider
- Adolescence (12-20 years)
- Physical development -- Puberty begins
- Cognitive development
- Emotional development
- Implications for the health care provider
- 12-18 months
- Infancy
- Pediatrics: Specific Pathophysiology, Assessment, and Management
- Respiratory Compromise
- Pathophysiology
- Assessment
- Upper airway obstruction
- Lower airway disease
- Pneumonia
- Foreign body lower airway obstruction
- Pertussis
- Cystic fibrosis
- Bronchopulmonary dysplasia (BPD)
- Chronic lung disease that usually occurs in infants form born prematurely and treated with positive pressure ventilation and high oxygen concentrations
- Recurrent respiratory infections and exercise induced bronchospasm are complications
- Management
- Non Cardiogenic Shock
- Introduction
- Pathophysiology (compensated vs. decompensated)
- Assessment
- Management
- Cardiac
- Introduction
- Epidemiology
- Anatomic and physiologic differences in children
- Pathophysiology
- Shock in children (compensated vs. decompensated)
- Cardiogenic vs. noncardiogenic shock
- Assessment
- History (age, sweating while feeding, cyanotic episodes, difficulty breathing, syncope, prior cardiac surgery, poor weight gain)
- Physical findings (heart rate, blood pressure, capillary refill, color, mental status, cardiac murmurs/rubs/gallops, pulse oximetry, 4 extremity blood pressures)
- Bedside testing (rhythm strip)
- Congestive heart failure
- Myocarditis
- Cardiomyopathy
- Congenital heart disease as underlying cause
- Congenital heart disease
- Arrhythmias
- Management
- Pathophysiology
- Assessment
- Hyperglycemia
- Hypoglycemia
- Introduction
- Respiratory Compromise
- Hematologic/Oncologic/Immunoloic
- Introduction
- Epidemiology
- Anatomic and physiologic differences in children
- Pathophysiology
- Assessment
- Sickle cell disease
- Bleeding disorders
- Leukemia/Lymphoma
- Immunocompromised
- Management
- Introduction
- Gastrointestinal
- Introduction
- Pathophysiology
- Assessment
- History (blood or bile in emesis, diarrhea, age, gender, constipation, fever, medications, tolerance of gastrostomy tube feeds, prematurity, blood type incompatibility, epistaxis, liver disease)
- Physical findings (heart rate, blood pressure, mucous membranes, icterus, capillary refill, blood in nares, abdominal distention or mass, hepatomegaly, pallor, anal fissure)
- Inspection of gastrostomy tube
- Vomiting
- Gastroenteritis
- Malrotation
- Pyloric stenosis
- GI Bleeding
- Neonatal Jaundice
- Physiologic
- Pathologic
- Management
- Bowel rest (for vomiting and GI bleed)
- IV hydration
- Replacement of G-tube if dislodged or dysfunctional
- Toxicologic
- Introduction
- Epidemiology
- Nontoxic exposures
- Role of the Poison Control Center
- Assessment
- Ingestion
- Inhalation
- Management
- Introduction
- Abuse and Neglect
- Introduction
- Assessment
- Elements in the history or scene concerning for abuse or neglect
- Assessing the caregiver’s behavior
- Physical findings concerning for abuse or neglect
- Benign findings often confused for physical or sexual abuse
- Management
- 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)
- Role of Child Protective Services (CPS)
- Role of Medical Examiner and law enforcement
- Sudden Infant Death Syndrome
- Introduction
- Definition of SIDS
- Definition of ALTE
- Epidemiology and Risk Factors
- Assessment
- Cardiopulmonary status
- Clinical signs of death
- Evaluation for other signs of abuse
- Management
- Local EMS criteria for death in the field
- Notification of appropriate authorities
- Controversy over transport after failed advanced life support
- Introduction
Content Creator: Joyce Lockwood
CAPCE Course Number: 20-EMTP-F3-6201
Total CE Hours: 1.5
Level: Advanced
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.