Chapter_32.ppt

Chapter 32
Pediatric Emergencies

Communication With the
Patient and the Family
• You may have more than one patient.
– Caregiver may need help and support.
• A calm parent contributes to a calm child.
– An agitated parent means child will act same
way.
• Remain calm, efficient, professional, and
sensitive.

Growth and Development
• Between birth and adulthood, many
changes occur.
• Thoughts and behaviors:
– Infancy: first year of life
– Toddler: 1 to 3 years
– Preschool-age: 3 to 6 years
– School-age: 6 to 12 years
– Adolescence: 12 to 18 years

Infants (1 of 7)
• Infancy is defined as first year of life.
– First month after birth is neonatal or newborn
period.
• 0 to 2 months
– Spend most time sleeping and eating
• Sleep up to 16 hours per day
– Respond mainly to physical stimuli
– Head control is limited.

Infants (2 of 7)
• 0 to 2 months (cont’d)
– Have a sucking reflex for feeding
– Predisposed to hypothermia
– Crying is one of main modes of expression.
– Cannot tell difference between parents and
strangers
– Basic needs: being warm, dry, and fed
– Hearing is well developed at birth.

Infants (3 of 7)
• 2 to 6 months
– More active at this stage
• Easier to evaluate
– Spend more time awake and recognize
caregivers
– Have strong sucking reflex, active extremity
movement, and vigorous cry
– May follow objects with eyes

Infants (4 of 7)
– Increased awareness of surroundings
• Will use both hands to examine objects
– Begin to roll over at this stage
– Persistent crying, irritability, or lack of eye
contact can be an indicator of serious illness,
depressed mental status, or a delay in
development.

Infants (5 of 7)
• 6 to 12 months
– Infants begin to babble.
– Say their first word by their first year
– Learn to sit without support
– Begin to crawl and finally walk
• Predisposes age group to increased
exposure to physical danger

Infants (6 of 7)
– Begin teething and putting objects in mouth
• Higher risk of foreign body aspirations and
poisonings
– Persistent crying or irritability can be symptoms
of serious illness.
– May prefer to be with parents
• Called separation anxiety

Infants (7 of 7)
• Assessment
– Observe infant from a distance.
– Caregiver should hold baby during assessment.
– Provide sensory comfort.
• Warm hands and end of stethoscope.
– Do painful procedures at end of assessment.

Toddlers (1 of 4)
• After infancy until 3 years of age, a child is
called a toddler.
– Experience rapid changes in growth and
development
• 12 to 18 months
– Begin to walk and explore
• Able to open doors, drawers, boxes, and
bottles

Toddlers (2 of 4)
– Injuries increase because of exploratory nature
and fearlessness.
– Begin to imitate behaviors of older children and
parents
– Knows major body parts
– May speak 4 to 6 words
– May not be able to fully chew food

Toddlers (3 of 4)
• 18 to 24 months
– Mind developing rapidly at this stage
• Vocabulary increases to about 100 words.
• Able to name common objects
– Begin to understand cause and effect
– Balance and gait improve rapidly.
• Running and climbing improve.
– May cling to parents or comforting toy

Toddlers (4 of 4)
• Assessment
– May have stranger anxiety
– May resist separation from caregiver
– May have a hard time describing pain
– Can be distracted
– Persistent crying can be a symptom of serious
illness or injury.

Preschool-Age Children (1 of 4)
• Ages 3 to 6 years
– Able to use simple language effectively
• Most rapid increase in language occurs
– Begin to run, start throwing, catching, and
kicking during play
– Toilet training is mastered.

• Ages 3 to 6 years (cont’d)
– Learning which behaviors are appropriate and
inappropriate
– Foreign body aspirations still high risk
• Assessment
– Can understand directions and be specific in
describing painful areas

• Assessment (cont’d)
– Much history must still be obtained from
caregivers.
– Appeal to child’s imagination to facilitate
examination.
– Never lie to the patient.
– Patient may be easily distracted.

– Begin assessment at feet, moving to head.
– Use adhesive bandages to cover the site of an
injection or other small wound.
– Modesty is developing; keep child covered as
much as possible.

School-Age Children (1 of 4)
• 6 to 12 years
– Beginning to act more like adults
• Can think in concrete terms
• Can respond sensibly to questions
• Can help take care of themselves
– School is important.
– Children begin to understand death.

• Assessment
– Assessment begins to be more like adults’.
– Talk to the child, not just the caregiver.
– Start with head and move to the feet.
– Give the child choices.

– Ask only questions that let you control the
answer:
• Would you like me to take the blood pressure
on the right or left arm?
– Allow the child to listen to his or her heartbeat
through the stethoscope.

– Can understand difference between physical
and emotional pain
– Give them simple explanations about what is
causing pain and what will be done about it.
– Ask the parent’s or caregiver’s advice about
which distraction will work best.

Adolescents (1 of 5)
• 12 to 18 years
– Able to think abstractly and can participate in
decision making
• Personal morals begin to develop.
• Able to discriminate between right and wrong
• Able to incorporate values into decision-
making
– Physically similar to adults
• Shifting from family to friends for support

• 12 to 18 years (cont’d)
– Puberty begins.
• Very concerned about body image and
appearance
– Time of experimentation and risk-taking
• Often feel “indestructible”
• Struggle with independence, loss of control,
body image, sexuality, and peer pressure

• Assessment
– Respect the adolescent’s privacy.
• Can often understand complex concepts and
treatment options
– Allow them to be involved in their own care.
• Provide choices, while lending guidance.
– EMT of same gender should do assessment, if
possible.

– Allow them to speak openly and ask questions.
– Risk-taking behaviors are common.
• Can ultimately facilitate development and
judgment, and shape identity
• Can also result in trauma, dangerous sexual
practices, and teen pregnancy

– Female patients may be pregnant.
• Important to report this information to
receiving facility.
• Adolescent may not want parents to know
this information.
• Try to interview without the caregiver/parent
present.

Anatomy, Physiology, and
Pathophysiology
• Body is growing and changing very rapidly
during childhood.
– Can create difficulties during assessment if you
do not expect them

Respiratory System (1 of 10)
• Anatomy of airway
differs from adults.
– Pediatric airway is
smaller in diameter
and shorter in
length.
– Lungs are smaller.
– Heart is higher in
child’s chest.

• Anatomy of airway differs from adults
(cont’d).
– Vocal cords are higher and positioned more
anteriorly, and neck appears to be nonexistent.
– As child develops, the neck becomes
proportionally longer as the vocal cords and
epiglottis achieve anatomically correct adult
position.

• Anatomy of airway differs from adult
(cont’d).
– Larger, rounder occiput
– Proportionally larger tongue
– Long, floppy, U-shaped epiglottis
– Less well-developed rings of cartilage in the
trachea
– Narrowing, funnel-shaped upper airway

(cont’d).
– Diameter of trachea in infants is about the same
as a drinking straw.
• Airway is easily obstructed by secretions,
blood, or swelling.
• Infants are nose breathers and may require
suctioning and airway maintenance.
• Respiratory rate of 20 to 60 breaths/min is
normal for a newborn.

(cont’d).
– Children have an oxygen demand twice that of
an adult.
• Increases risk for hypoxia

• Anatomy of airway
differs from adult
(cont’d).
– Muscles of diaphragm
dictate the amount of
oxygen a child
inspires.
• Pressure on child’s
abdomen can
cause respiratory
compromise.

(cont’d).
– Breath sounds are more easily heard in children
because of their thinner chest walls.
– Gastric distention can interfere with movement
of the diaphragm and lead to hypoventilation.
– Muscle fatigue from breathing hard may lead to
respiratory failure.

• Pathophysiology
– Respiratory
problems are the
leading cause of
cardiopulmonary
arrest in the pediatric
population.
• Failure to
recognize and
treat declining
respiratory status
will lead to death.

• Pathophysiology (cont’d)
– During respiratory distress, the pediatric patient
is working harder to breathe and will eventually
go into respiratory failure.
– Respiratory failure occurs when the pediatric
patient has exhausted all compensatory
mechanisms.
– Waste products collect, leading to respiratory
arrest, a total shutdown.

Circulatory System (1 of 3)
• Pulse rates differ from adults.
– Infants heart can beat 160 beats/min or more.
• Primary method used to compensate for
decreased perfusion
– Ability of children to constrict blood vessels also
helps them compensate for decreased
perfusion.

Circulatory System (2 of 3)
• Pathophysiology
– Pediatrics are more dependent on actual
cardiac output.
• Blood being pumped out of heart in 1 minute
– May be in shock despite normal blood pressure
– A small amount of blood loss can lead to shock.

Nervous System (1 of 3)
• Pediatric nervous system is immature,
underdeveloped, and not well protected.
– Head-to-body ratio is larger.
– Occipital region of head is larger.
– Subarachnoid space is relatively smaller,
leaving less cushioning for brain.
– Brain tissue and cerebral vasculature are fragile
and prone to bleeding from shearing forces.

• Pediatric brain requires higher cerebral
blood flow, oxygen, and glucose.
– At risk for secondary brain damage from
hypotension and hypoxic events.
• Spinal cord injuries are less common.
– If injured, it is more likely to be an injury to the
ligaments because of rapid neck movements.

• Pathophysiology
– Altered mental status may result from
hypoglycemia, hypoxia, seizure, or ingestion of
drugs or alcohol.
– Parent of caregiver is important resource.
– Pediatric patient with AMS may appear sleepy,
lethargic, combative, unresponsive.

Gastrointestinal System (1 of 3)
• Abdominal muscles are less developed.
– Less protection from trauma.
– Liver, spleen, kidneys are proportionally larger
and situated more anteriorly and close to one
another.
• Prone to bleeding and injury
• There is a higher risk for multiple organ
injury.

• Pathophysiology
– Signs and symptoms may be vague.
– Abdominal walls are underdeveloped.
– May not be able to pinpoint origin of pain
– Take complaints of abdominal pain seriously.
• Large amount of bleeding may occur within
abdominal cavity, without signs of shock.

• Pathophysiology (cont’d)
– Liver and splenic injuries are common in this
age group.
– Needs to be monitored for shock; may include
AMS, tachypnea, tachycardia, and bradycardia

Musculoskeletal System (1 of 4)
• Open growth plates allow bones to grow.
– As a result of growth plates, children’s bones
are softer and more flexible, making them prone
to stress fracture.
• Bone length discrepancies can occur if
injury to growth plate occurs.
– Immobilize all strains and sprains.

• Bones of an infant’s head are flexible and
soft.
– Soft spots are located at front and back of head.
• Referred to as fontanelles
• Will close at particular stages of development
• Fontanelles of an infant can be a useful
assessment tool.

• Thoracic cage is highly elastic and pliable.
– Composed of cartilaginous connective tissue
– Ribs and vital organs are less protected.

• Pathophysiology
– Muscles and bones grow into adolescence.
– The younger the child, the more flexible the
bone structures.
• Sprains are uncommon and femur fractures
rare.
– Older children are prone to long bone fractures
due to more risks and activity.

Integumentary System (1 of 2)
• Pediatric system differs in a few ways:
– Thinner skin and less subcutaneous fat
– Higher ratio of body surface area to body mass
leads to larger fluid and heat losses.
– Composition of skin is thinner and tends to burn
more easily and deeply.

Integumentary System (2 of 2)
• Pathophysiology
– Thermoregulator system is immature.
• Makes pediatric population more prone to
hypothermic events
• Lack of ability to shiver to generate heat
• Children should be kept warm during
transport.
• Without treatment of hypothermic event,
patient may lapse into convulsive seizure
activity.

Patient Assessment
• Patient assessment steps
– Scene size-up
– Primary assessment
– History taking
– Secondary assessment
– Reassessment

Scene Size-up (1 of 4)
• Assessment begins at time of dispatch.
– Prepare mentally for approaching and treating
an infant or child.
– Plan for pediatric size-up, equipment, and age-
appropriate physical assessment.
– Collect age and gender of child, location of
scene, and NOI or MOI from dispatch.

• Scene safety
– Ensure proper safety precautions.
– Note position in which patient is found.
– Look for possible safety threats.
– Bring medications with you that could have
been ingested by the patient.

• Scene safety (cont’d)
– Patient may be safety threat if he or she has
infectious disease.
– Do an environmental assessment.
• Will provide important information
• Includes inspection of physical environment

• Mechanism of injury/nature of illness
– Imperative this information is gathered from
patient, parent/caregiver, or bystander
– Assume the injury was significant enough to
cause head or neck injuries.
– Full spinal protocol with cervical collar should be
performed if suspected MOI is severe.

Primary Assessment (1 of 19)
• Form a general
impression.
– Use pediatric
assessment
triangle (PAT).
• 15- to 30-
second
structured
assessment tool
Source: Used with permission of the American Academy of Pediatrics, Pediatric Education
for Prehospital Professionals, © American Academy of Pediatrics, 2000.

• PAT
– Does not require equipment
– Does not require you to touch the patient
– Three steps:
• Appearance
• Work of breathing
• Circulation

• Appearance
– Note LOC, muscle tone, interactiveness.
– TICLS mnemonic helps determine if patient is
sick or not sick.
• Tone
• Interactiveness
• Consolability
• Look or gaze
• Speech or cry

• Work of breathing
– Increases body temperature
– May manifest as tachypnea, abnormal airway
noise, retractions of intercostal muscles or
sternum

• Circulation to the skin
– Pallor of skin and mucous membranes may be
seen in compensated shock.
– Mottling is sign of poor perfusion.
– Cyanosis reflects decreased level of oxygen.

• Stay or go
– From PAT findings, you will decide if the patient
is stable or requires urgent care.
• If unstable, assess ABC’s, treat life threats,
and transport immediately.
• If stable, continue with the remainder of the
assessment process.

• Hands-on ABCs
– For pediatric patient you will now perform a
hands-on ABCs assessment.
• Airway
• Breathing
• Circulation
• Disability
• Exposure

• Airway
– If airway is open and will remain open, assess
respiratory adequacy
– If patient is unresponsive or has difficulty
keeping airway open, ensure it is properly
positioned and clear of mucus, vomitus, blood,
and foreign bodies.
• Use head tilt–chin lift or jaw-thrust maneuver
to open airway.

• Airway (cont’d)
– Always position airway in neutral sniffing
position.
• Keeps trachea from kinking
• Maintains proper alignment
– Establish whether patient can maintain his or
her own airway.

• Breathing
– Use the look, listen, feel technique.
– Place both hands on patient’s chest to feel for
rise and fall of chest wall.
– Belly breathing in infants is considered
adequate.

• Breathing (cont’d)
– Note signs of increased work of breathing:
• Accessory muscle use
• Retractions
• Head bobbing
• Nasal flaring
• Tachypnea
• Bradypnea (indicates impending cardiac
arrest)

• Circulation
– Determine if patient has a pulse, is bleeding, or
is in shock.
– In infant, palpate brachial or femoral pulse.
– In children older than 1 year, palpate carotid
pulse.
– Strong central pulses usually indicate that the
child is not hypotensive.

• Circulation (cont’d)
– Weak or absent peripheral pulses indicate
decreased perfusion.
– Tachycardia may be early sign of hypoxia.
– Feel skin for temperature and moisture.
– Estimate the capillary refill time.

• Disability
– Use AVUPU scale or pediatric Glasgow Coma
Scale.
• Check pupil response.
• Look for sympathetic movement of
extremities.
• Pain is present with most types of injuries.
• Assessment of pain must consider
developmental age of patient.

• Exposure
– PAT requires that the caregiver remove some of
patient’s clothing for observation.
• Avoid heat loss by covering the patient as
soon as possible.

• Transport decision
– Immediate transport indicated if:
• Significant MOI
• History compatible with serious illness
• Physiologic abnormality noted
• Potentially serious anatomic abnormality
• Significant pain
• Abnormal level of consciousness

• Transport decision (cont’d)
– Also consider:
• Type of clinical problem
• Benefits or ALS treatment in field
• Local EMS protocol
• Comfort level of EMT
• Transport time to hospital
– If nonurgent, obtain history and perform
secondary assessment on scene.

– Less than 40 lb, transport in car seat.
– To mount a car seat to a stretcher:
• Put head of stretcher upright.
• Put car sear against the back of stretcher.
• Secure upper and lower stretcher straps
through seatbelt holes on car seat.
• Push seat into stretcher tightly and retighten
straps.

– Follow manufacturer’s instructions to secure car
seat in captain’s chair.
– In cases of spinal immobilization or
cardiopulmonary arrest, it is not appropriate to
secure patient in a car seat.

History Taking (1 of 3)
• Investigate chief complaint.
– Approach to history depends on age of patient.
• Historic information will be obtained from
caregiver.
• Adolescent information is obtained from
patient.

• Investigate chief complaint (cont’d).
– Questions based on chief complaint:
• NOI or MOI
• Length of sickness or injury
• Key events leading up to injury or illness
• Presence of fever
• Effects of illness or injury on behavior
• Patient’s activity level
• Recent eating, drinking, and urine output

• Investigate chief complaint (cont’d)
– Questions to ask (cont’d)
• Changes in bowel or bladder habits
• Presence of vomiting, diarrhea, abdominal
pain
• Presence of rashes
• SAMPLE history
– Same as adult’s
– Questions based on age

Secondary Assessment (1 of 11)
• Physical examinations
– Full-body scan should be used when patient is
unresponsive or has significant MOI.
• Check for DCAP-BTLS.
– Focused assessments should be performed on
patients without life threats.
• Focus on areas of body affected by injury or
illness.

• Physical examinations (cont’d)
– Infants, toddlers, and preschool-aged children
should be assessed started at the feet and
ending at the head.
– School-aged children and adolescents should
be assessed using the head-to-toe approach.

– Head
• Look for bruising, swelling, and hematomas.
• Assess fontanelles in infants.
– Nose
• Nasal congestion and mucus can cause
respiratory distress.
• Gentle bulb or catheter suction may bring
relief.

– Ears
• Drainage from ears may indicate skull
fracture.
• Battle’s sign may indicate skull fracture.
• Presence of pus may indicate infection.
– Mouth
• Look for active bleeding and loose teeth.
• Note the smell of the breath.

– Neck
• Examine trachea for swelling or bruising.
• Note if patient cannot move neck and has
high fever.
– Chest
• Examine for penetrating trauma, lacerations,
bruises, or rashes.
• Feel clavicles and every rib for tenderness
and/or deformity.

– Back
• Inspect back for lacerations, penetrating
injuries, bruises, or rashes.
– Abdomen
• Inspect for distention.
• Gently palpate and watch for guarding or
tensing of muscles.
• Note tenderness or masses.
• Look for seatbelt abrasions.

– Extremities
• Assess for symmetry.
• Compare both sides for color, warmth, size of
joints, swelling, and tenderness.
• Put each joint through a full range of motion
while watching the patient’s eyes for signs of
pain.

• Vital signs
– Some guidelines/equipment used to assess
adult circulatory status have limitations in
pediatric patients.
• Normal heart rates vary with age in pediatric
patients.
• Blood pressure is usually not assessed in
patients younger than 3 years.

• Vital signs (cont’d)
– Assessment of skin is best indication of
pediatric patient’s circulatory status.
– When equipment is used, it is important to use
appropriately sized equipment.
• Use a cuff that covers two thirds of the
pediatric patient’s upper arm.

– Use this formula to determine blood pressure
for children ages 1–10:
• 70 + (2 × child’s age in years) = systolic
blood pressure
– Respiratory rates may be difficult to interpret.
• Count respirations for at least 30 seconds
and double that number.
• In infants and those younger than 3 years,
evaluate respirations by assessing the rise
and fall of the abdomen.

– Normal vital signs in pediatric patients vary with
age.
• Assess respirations, then pulse, then blood
pressure.
– Evaluate pupils using a small pen light.
• Compare size of the pupils against each
other.
– Use appropriate monitoring devices.
• Use pulse oximeter to measure oxygen
saturation.

Reassessment (1 of 2)
• Repeat the primary assessment.
– Obtain vitals every 15 minutes if stable.
– Obtain vitals every 5 minutes if unstable.
– Continually monitor respiratory effort, skin color
and condition, and level of consciousness.

Reassessment (2 of 2)
• Interventions
– Always consider getting help from a parent or
caregiver.
• Able to calm and reassure child
• Communication and documentation
– Communicate and document all relevant
information to staff at receiving hospital.

Respiratory Emergencies and
Management (1 of 5)
• Respiratory illnesses are among top 10
reasons for ER visits in children under 17 in
United States.
– Asthma is the most common cause of
respiratory emergencies in children.
– Foreign bodies and trauma can also cause
respiratory emergencies.

Management (2 of 5)
• Signs and symptoms of increased work of
breathing:
– Nasal flaring
– Grunting respirations
– Wheezing, stridor, other abnormal sounds
– Accessory muscle use
– Retractions/movements of child’s flexible rib
cage
– In older children, tripod position

Management (3 of 5)
• As the patient progresses to possible
respiratory failure.
– Efforts to breathe decrease.
– Chest rises less with inspiration.
– Body has used up all available energy stores
and cannot continue to support extra work of
breathing.

Management (4 of 5)
respiratory failure (cont’d):
– Patient reaches an altered level of
consciousness and may experience periods of
apnea.
– Heart muscle becomes hypoxic.
• Leads to bradycardia
• If heart rate is slow, you must begin CPR.

Management (5 of 5)
respiratory failure (cont’d):
– Condition can progress from respiratory distress
to failure at any time.
• Reassess frequently.
– A child or infant needs supplemental oxygen.
– Allow patient to remain comfortable.

Airway Obstruction (1 of 8)
• Children obstruct
airway with any
object they can fit
into their mouth.
• In cases of trauma,
teeth may have
been dislodged
into the airway.
Source: © Jones and Bartlett Learning. Photographed by Kimberly Potvin.

• Blood, vomitus, or other secretions can
cause severe airway obstruction.
• Infections can cause obstruction.
– Croup is an infection in the airway below the
level of the vocal cords.
• Usually caused by a virus
– Epiglottitis is an infection of the soft tissue
above the level of the vocal cords.

• Infection should be considered if child has
congestion, fever, drooling, and cold
symptoms.
• Obstruction by foreign object may involve
upper or lower airway.
– Signs and symptoms associated with upper
airway obstruction include decreased breath
sounds and stridor.

• Signs and symptoms of lower airway
obstruction include wheezing and/or
crackles.
• Best way to auscultate breath sounds in
pediatric patient is to listen to both sides of
the chest at armpit level.

• Treatment of airway obstruction must begin
immediately.
– Encourage coughing to clear airway when
patient is conscious and forcibly coughing.
• If this does not remove the object, do not
intervene except to provide oxygen.
• Allow patient to remain in whatever position is
most comfortable.

• Signs of severe airway obstruction:
– Ineffective cough (no sound)
– Inability to speak or cry
– Increasing respiratory difficulty, with stridor
– Cyanosis
– Loss of consciousness
• Clear the airway immediately if you see
these signs!

• Use head tilt–chin lift and finger sweep to
remove a visible foreign body in an
unconscious pediatric patient.
• Use chest compressions to relieve a severe
airway obstruction in an unconscious
pediatric patient.
– Increases pressure in chest, creating an
artificial cough

Asthma (1 of 4)
• Acute spasm of the bronchioles
• One of the most common illnesses seen
• Almost 5 million US children are affected.
– Common causes for asthma attack include
upper respiratory infection, exercise, exposure
to cold air, emotional stress, and passive
exposure to smoke.

Asthma (2 of 4)
• Asthma is a true emergency if not promptly
treated.
• Signs and symptoms:
– Wheezing as patient exhales
• In some cases, airway is completely blocked.
– Cyanosis and respiratory arrest may quickly
develop.
– Tripod position allows for easier breathing.

Asthma (3 of 4)
• Treatment
– Administer supplemental oxygen.
– Bronchodilator via metered-dose inhaler with a
spacer mask device (if protocol allows)
• Often caregivers have administered albuterol.
– If assisting ventilations, use slow, gentle
breaths.
• Resist temptation to squeeze bag hard and
fast.

Asthma (4 of 4)
• Treatment (cont’d)
– A prolonged asthma attack may progress into
status asthmaticus.
• A true emergency
• Give oxygen and transport immediately.
– Patient may become exhausted from trying to
breath.
• Manage airway aggressively, administer
oxygen, and transport promptly.

Pneumonia (1 of 3)
• Leading cause of death in children
• Pneumonia is a general term that refers to
an infection to the lungs.
– Often a secondary infection
– Can also occur from chemical ingestion
– Diseases causing immunodeficiency in children
also increase predisposal.

Pneumonia (2 of 3)
• Presentation in pediatric patient:
– Unusual rapid breathing
• Sometimes with grunting or wheezing sounds
– Nasal flaring
– Tachypnea
– Crackles
– Hypothermia or fever
– Unilateral diminished breath sounds

Pneumonia (3 of 3)
• Pediatric patient treatment:
– Primary treatment will be supportive.
– Monitor airway and breathing status.
– Administer supplemental oxygen if required.
• Diagnosis of pneumonia must be confirmed
in the hospital.

Bronchiolitis (1 of 3)
• Specific viral illness of newborns and
toddlers, often caused by RSV.
– Causes inflammation of the bronchioles
– RSV is highly contagious and spread through
coughing or sneezing.
– Virus can survive on surface.
– Virus tends to spread rapidly through schools
and in child care centers.

• More common in premature infants and
results in copious secretion
– Occurs during the first 2 years of life
– More common in males
– Most widespread in winter and early spring
• Look for signs of dehydration, shortness of
breath, and fever.

• Treatment
– Calm demeanor when approaching
– Allow patient to remain in position of comfort.
– Treat airway and breathing problems.
• Humidified oxygen is helpful.
– Consider ALS backup.

Airway Adjuncts (1 of 3)
• Devices that help to maintain the airway or
assist in providing artificial ventilation,
including:
– Oral and nasal airways
– Bite blocks
– Bag-mask devices

• Oropharyngeal airway
– Keeps tongue from blocking airway and makes
suctioning easier
– Should be used for pediatric patients who are
unconscious and in respiratory failure
• Should not be used in conscious patients or
those who have a gag reflex
– See Skill Drill 32-2.

• Nasopharyngeal airway
– Usually well tolerated
– Used for conscious patients or altered LOC
– Used in association with possible respiratory
failure
– Rarely used in infants younger than 1 year
– Should not be used if there is nasal obstruction
or head trauma

Oxygen Delivery Devices (1 of 9)
• Several options for pediatric patient
– Blow-by technique at 6 L/min provides more
than 21% oxygen concentration.
– Nasal cannula at 1 to 6 L/min provides 24% to
44% oxygen concentration.
– Nonrebreathing mask at 10 to 15 L/min provides
up to 90% oxygen concentration.
– Bag-mask device at 10 to 15 L/min provides
90% oxygen concentration.

• Nonrebreathing mask, nasal cannula, or
simple face mask is indicated for pediatrics
who have adequate respirations and/or tidal
volumes.
– Bag-mask device is used for those with
respirations less than 12 breaths/min, more
than 60 breaths/min, an altered LOC, or
inadequate tidal volume.

• Blow-by method
– Less effective than face mask or nasal cannula
for oxygen delivery
– Does not provide high oxygen concentration
– Administration:
• Place tubing through hole in bottom of cup.
• Connect tube to oxygen source at 6 L/min.
• Hold cup 1″ to 2″ away from nose and mouth.

• Nasal cannula
– Some patients prefer the nasal cannula; some
find it uncomfortable.
– Applying a nasal cannula:
• Choose appropriately sized nasal cannula.
• Connect tubing to an oxygen source at 1 to
6 L/min.

• Nonrebreathing mask
– Delivers up to 90% oxygen
– Allows patient to exhale all carbon dioxide
without rebreathing it
– Applying a nonrebreathing mask:
• Select appropriately sized mask.
• Connect tubing to oxygen source at 10 to
15 L/min.
• Adjust oxygen flow as needed.

• Bag-mask device
– Indicated in patients with too fast or too slow
respirations, who are unresponsive, or who do
not respond to painful stimuli
– Assisting ventilations with bag-mask device:
• Select appropriately sized equipment.
• Maintain a good seal with the mask on the
face.
• Ventilate at the appropriate rate and volume,
using a slow, gentle squeeze.

• Two-rescuer bag-mask ventilation
– Similar to one-rescuer ventilation except one
rescuer will hold the mask to the face and
maintain the head position
– Usually more effective in maintaining a tight
seal
– Use thumb and index finger to gently apply
pressure over area below Adam’s apple.

Cardiopulmonary Arrest
• Cardiac arrest in pediatric patients is
associated with respiratory failure and
arrest.
– Children are affected differently by decreasing
oxygen concentration.
• Adults become hypoxic, heart gets irritable,
and sudden cardiac death comes from
arrhythmia.
• Children become hypoxic and their hearts
slow down, becoming more bradycardic.

Shock (1 of 12)
• A condition that develops when the
circulatory system is unable to deliver a
sufficient amount of blood to the organs
– Results in organ failure and eventually
cardiopulmonary arrest
• Compensated shock is the early stage of
shock.
• Decompensated shock is the later stage of
shock.

Shock (2 of 12)
• Common causes include:
– Trauma injury with blood loss
• Especially abdominal
– Dehydrations from diarrhea or vomiting
– Severe infection
– Neurologic injury
• Such as severe head trauma

Shock (3 of 12)
• Common causes include (cont’d):
– Severe allergic reaction/anaphylaxis to an
allergen
• Insect bite or food allergy
– Diseases of the heart
– Collapsed lung
• Pneumothorax
– Blood or fluid around the heart
• Cardiac tamponade or pericarditis

Shock (4 of 12)
• Children have less blood circulating than
adults.
– Small amount of blood loss may lead to shock.
• Children react differently than adults to fluid
loss.
– May respond by increasing heart rate,
increasing respirations, and showing signs of
pale or blue skin

Shock (5 of 12)
• Signs of shock in children
– Tachycardia
– Poor capillary refill time (> 2 seconds)
– Mental status changes
• Treat shock by assessing ABCs, intervening
as required.

Shock (6 of 12)
• Treatment
– In assessing circulation:
• Assess rate and quality of pulses.
• Assess temperature and moisture of hands
and feet.
• A 2-second capillary refill time is normal.
• Assess skin color.
– Changes in pulse rate, color, skin signs, and
capillary refill time suggest shock.

Shock (7 of 12)
– Blood pressure difficult to measure in children
• Cuff must be proper size
• Blood pressure may be normal with
compensated shock.
• Low blood pressure may be sign of
decompensated shock.

Shock (8 of 12)
– Determine when signs and symptoms first
appeared and whether:
• Decrease in urine output
• Absence of tears
• Sunken or depressed fontanelle (infants)
• Changes in level of consciousness and
behavior

Shock (9 of 12)
– Ensure airway is open; prepare for artificial
ventilation.
– Control bleeding.
– Give supplemental oxygen by mask or blow-by.
– Continue to monitor airway and breathing.
– Position with head lower than feet.
– Keep warm with blankets and heat.

Shock (10 of 12)
– Provide immediate transport.
– Contact ALS backup as needed.
• Anaphylactic shock
– A major allergic reaction that involves
generalized, multisystem response
• Airway and cardiovascular system are
common.
• Common causes are insect sting or food
allergy.

Shock (11 of 12)
• Anaphylactic shock (cont’d)
– Signs and symptoms
• Hypoperfusion
• Stridor and/or wheezing
• Increased work of breathing
• Altered appearance
• Restlessness, agitation, and sometimes a
sense of impending doom
• Hives

Shock (12 of 12)
• Anaphylactic shock (cont’d)
– Treatment
• Maintain airway and administer oxygen.
• Allow caregiver to assist in positioning the
patient, oxygen delivery, maintaining calm.
• Assist with epinephrine auto-injector based
on protocol.
• Transport promptly.

Bleeding Disorders
• Hemophilia is a congenital condition in
which patients lack normal clotting factors.
– Most forms are hereditary and severe.
– Predominantly found in male population.
– Bleeding may occur spontaneously.
– All injuries become serious because blood does
not clot.

Altered Mental Status (1 of 2)
• Abnormal
neurologic state
– Understanding
developmental
changes and
listening to
caregiver’s opinion
are key.
– AEIOU-TIPPS
reflects major
causes of AMS.

Altered Mental Status (2 of 2)
• Signs and symptoms vary from simple
confusion to coma.
• Treatment focuses on ABCs and transport.
– If level of consciousness is low, patient may not
be able to protect airway.
• Ensure patent airway and adequate
breathing through nonrebreathing mask or
bag-mask device.

Seizures (1 of 5)
• Result of disorganized electrical activity in
the brain
– Manifests in a variety of ways
– Subtle in infants, with an abnormal gaze,
sucking, and/or bicycling motions
– Obvious in older children with repetitive muscle
contractions and unresponsiveness

Seizures (2 of 5)
• Common
causes of
seizures

Seizures (3 of 5)
• Once seizure stops and muscles relax, it is
referred to as postical state.
• The longer and more intense the seizures
are, the longer it will take for this imbalance
to correct itself.
– Postictal state is over once normal level of
consciousness is regained.

Seizures (4 of 5)
• Status epilepticus
– Seizures that continue every few minutes
without regaining consciousness or last longer
than 30 minutes
• Recurring or prolonged seizures should be
considered life threatening.
– If patient does not regain consciousness or
continues to seize, protect him or her from
harming self.

Seizures (5 of 5)
• Management
– Securing and protecting airway are priority.
• Position head to open airway.
• Clear mouth with suction.
• Use recovery position if patient is vomiting.
– Provide 100% oxygen by nonrebreathing mask
or blow-by method
• Begin bag-mask ventilation if no signs of
improvement.

Febrile Seizures
• Common in children between 6 months and
6 years
– Caused by fever alone
– Typically occur on first day of febrile illness
– Characterized by tonic-clonic activity
– Last less than 15 minutes with little or no
postictal state
– May be sign of more serious problem

Meningitis (1 of 8)
• Inflammation of tissue that covers the spinal
cord and brain
– Caused by infection by bacteria, viruses, fungi,
or parasites
– Left untreated can lead to brain damage or
death

Meningitis (2 of 8)
• Important to recognize in children
– At greater risk:
• Males
• Newborn infants
• Geriatric population
• Compromised immune system by AIDS or
cancer

Meningitis (3 of 8)
• At greater risk (cont’d):
– History of brain, spinal cord, back surgery
– Children who have had head trauma
– Children with shunts, pins, or other foreign
bodies in their brain or spinal cord
• Especially children with VP shunts

Meningitis (4 of 8)
• Signs and symptoms vary with age.
– Fever and altered level of consciousness
• Changes can range from mild headache to
inability to interact appropriately.
– Child may experience seizure.
– Infants younger than 2 to 3 months can have
apnea, cyanosis, fever, distinct high-pitched cry,
or hypothermia.

Meningitis (5 of 8)
• Signs and symptoms (cont’d)
– “Meningeal irritation” or “meningeal signs” are
terms to describe pain that accompanies
movement.
• Often results in characteristic stiff neck
– In an infant, increasing irritability and a bulging
fontanelle without crying

Meningitis (6 of 8)
• Neisseria meningitidis is a bacterium that
causes rapid onset of meningitis symptoms.
– Often leads to shock and death
– Children present with small, pinpoint, cherry-red
spots or a larger purple/black rash.
• Serious risk of sepsis, shock, and death

Meningitis (7 of 8)
Source: © Mediscan/Visuals Unlimited

Meningitis (8 of 8)
• Use standard precautions when dealing
with pediatric patients with possible
meningitis.
• Treatment
– Provide supplemental oxygen and assist with
ventilations if needed.
– Reassess vital signs frequently.

Gastrointestinal Emergencies
and Management (1 of 3)
• Complaints of gastrointestinal origin are
common in pediatric patients.
– Ingestion of certain foods or unknown
substance
– In most cases, patient will be experiencing
abdominal discomfort with nausea, vomiting,
and diarrhea.
• Can cause dehydration

• Appendicitis is a possibility.
– If untreated, can lead to peritonitis or shock
– Will typically present with fever and pain upon
palpation of right lower quadrant
– Rebound tenderness is a common sign.
• If you suspect appendicitis, transport to the
hospital for further care.

• Obtain a thorough history from the primary
caregiver.
– How many wet diapers today?
– Is the child tolerating liquids and keeping them
down?
– How many times has the child had diarrhea and
for how long?
– Are tears present during crying?

Poisoning Emergencies and
Management (1 of 5)
• Common among children
– Can occur by ingesting, inhaling, injecting, or
absorbing toxic substances
• Common sources:
– Alcohol
– Aspirin and acetaminophen
– Household cleaning products such as bleach
and furniture polish
– Houseplants

Management (2 of 5)
• Common sources (cont’d):
– Iron
– Prescription medications of family members
– Street drugs
– Vitamins
• Signs and symptoms vary, depending on
substance, age, and weight.

Management (3 of 5)
• Be alert for signs of abuse.
• After primary assessment, ask caregiver the
following:
– What is the substance involved?
– Approximately how much was ingested?
– What time did the incident occur?
– Any changes in behavior or level of
consciousness?
– Any choking or coughing after the exposure?

Management (4 of 5)
• Treatment
– Perform external decontamination.
• Remove tablets or fragments from mouth.
• Wash or brush poison from skin.
– Assess and maintain ABCs.
– Give activated charcoal, according to medical
control or local protocol.
– If shock is present, treat and transport.

Management (5 of 5)
• Activated charcoal
– Not recommended for those who have ingested
acid, an alkali, or a petroleum product
– Not recommended for patients who have
decreased level of consciousness
– Common trade names are Insta-Char, Actidose,
and Liqui-Char.
• Usual dose is 1 g per kilogram of body
weight.

Dehydration Emergencies and
Management (1 of 3)
• Occurs when fluid loss is greater than fluid
intake
– Vomiting and diarrhea are common causes.
• Can lead to shock and death if left untreated
– Infants and children are at greater risk.
• Life-threatening dehydration can overcome
an infant in a matter of hours.
– Can be mild, moderate, or severe

Management (2 of 3)
• Mild dehydration signs
– Dry lips and gums, decreased saliva and wet
diapers
• Moderate dehydration signs
– Sunken eyes, sleepiness, irritability, loose skin
• Severe dehydration signs
– Cool, clammy skin, delayed CRT, increased
respiration, sunken fontanelle

Management (3 of 3)
• Treatment
– Assess ABCs and
obtain baseline
vital signs.
• If severe, ALS
backup may be
necessary for IV
access.
• Transport to
emergency
department.
Source: Credit line>Courtesy of Ronald Dieckmann, M.D.

Fever Emergencies and
Management (1 of 4)
• An increase in body temperature
– 100.4°F (38°C) or higher are abnormal.
– Rarely life threatening
• Causes
– Infection
– Status epilepticus
– Neoplasm (cancer)
– Drug ingestion (aspirin)

Management (2 of 4)
• Causes (cont’d)
– Arthritis
– Systemic lupus erythematosus (rash on nose)
– High environmental temperature
• Result of internal body mechanism in which
heat generation is increased and heat loss
is decreased

Management (3 of 4)
• Accurate body temperature is important for
pediatric patients.
– Rectal temperature is most accurate for infants
and toddlers.
– Under tongue or arm will work for older children.

Management (4 of 4)
• Patient may present with signs of
respiratory distress, shock, a stiff neck, a
rash, hot skin, flushed cheeks, and, in
infants, bulging fontanelles.
– Assess for nausea, vomiting, diarrhea,
decreased feedings, and headache.
• Transport and manage ABCs.
– Follow standard precautions with communicable
diseases.

Drowning Emergencies and
Management (1 of 3)
• Take steps to ensure your own safety.
– Second most common cause of unintentional
death among children
• Children younger than 5 are particularly at
risk.
• Alcohol is usually a factor with adolescents.
– Principal condition is lack of oxygen.
• A few minutes without oxygen affects heart,
lungs, and brain.
• Hypothermia from submersion in icy water

Management (2 of 3)
• Signs and symptoms
• Coughing and choking
• Airway obstruction and difficulty breathing
• AMS and seizure activity
• Unresponsiveness
• Fast, slow, or no pulse
• Pale, cyanotic skin
• Abdominal distention

Management (3 of 3)
• Management
– Safety is critical.
– Assess and manage ABCs.
– Contact ALS crew to intervene if needed.
– Administer 100% oxygen.
– Apply cervical collar if trauma is suspected.
– Perform CPR in unresponsive patient in
cardiopulmonary arrest.

Pediatric Trauma Emergencies
and Management
• Number one killer of children in the US
– Quality of care can impact recovery.
– Infants and toddlers commonly hurt as a result
of falls or abuse
– Older children and adolescents commonly
injured in mishaps with automobiles
• Most significant threat to well-being of a child
• Gunshot wounds, blunt injuries, and sports
also causes

Physical Differences
• Children are smaller than adults.
– Locations of injuries may be different.
• Children’s bones and soft tissues are less
well developed than an adult’s.
– Force of injury affects structures differently.
• A child’s head is proportionally larger than an
adult’s and exerts greater stress on the neck
structures during a deceleration injury.

Psychological Differences
• Children are less mature psychologically
than adults.
– Often injured because of underdeveloped
judgment and lack of experience
• Forget to look both ways before crossing
street
• Forget to check depth of water before diving
– Always assume the child has serious head and
neck injuries.

Injury Patterns (1 of 2)
• Important for EMT to understand physical
and psychological characteristics of children
• Vehicle collisions
– Children can dart out in front of motor vehicles
without looking.
– Typically sustain high-energy injuries to the
head, spine, abdomen, pelvis, or legs.

Injury Patterns (2 of 2)
• Sport injuries
– Children are often injured in organized sports
activities.
– Head and neck injuries can occur in contact
sports such as football, wrestling, ice hockey,
field hockey, soccer, or lacrosse.
– Remember to stabilize cervical spine.
• Be familiar with protocols for helmet removal.

Injuries to Specific Body
Systems (1 of 14)
• Head injuries
– Common in children because the size of the
head in relation to the body
– Infant has softer, thinner skull.
• May result in brain injury
– Scalp and facial vessels may cause great deal
of blood loss if not controlled.

Systems (2 of 14)
• Head injuries (cont’d)
– Nausea and vomiting are common signs and
symptoms of a head injury in children.
• Easy to mistake for abdominal injury or
illness
• Should suspect a serious head injury in any
child who experiences nausea and vomiting
after a traumatic event

Systems (3 of 14)
• Immobilization
– Necessary for all children with possible head or
spinal injuries (see Skill Drill 32-5)
– May be necessary to immobilize child in a car
seat (see Skill Drill 32-6)

Systems (4 of 14)
• Immobilization (cont’d)
– May be difficult because of child’s body
proportions
• Infants and young children require padding
under the torso (See Skill Drill 32-7)
• Around 8 to 10 years of age, children no
longer require padding and can lie supine on
the board.

Systems (5 of 14)
• Chest injuries
– Usually the result of blunt trauma
– Chest wall flexibility in children can produce a
flail chest.
• May be injuries within the chest even though
there may be no sign of external injury
• Pediatric patients are managed in the same
way as adults

Systems (6 of 14)
• Abdominal injuries
– Very common in children
• Children can compensate for blood loss
better than adults.
• Children can have a serious injury without
early external evidence of a problem.
– Monitor all children for signs of shock.
– If signs of shock are evident, prevent
hypothermia with blankets.

Systems (7 of 14)

Systems (8 of 14)
• Burns
– Burns to children are considered more serious
than burns to adults.
• Have more surface area to relative total body
mass, which means greater fluid and heat
loss
• Do not tolerate burns as well as adults
• More likely to go into shock, develop
hypothermia, and experience airway
problems

Systems (9 of 14)
• Burns (cont’d)
– Common ways that children are burned:
• Exposure to hot substances
• Hot items on a stove
• Exposure to caustic substances
– Infection is a common problem.
• Burned skin cannot resist infection as
effectively.
• Sterile techniques should be used when
handling skin.

Systems (10 of 14)
– Should consider child abuse in any burn
situation
• Report any information about suspicions.
– Severity
• Minor
• Moderate
• Critical

Systems (11 of 14)
– Pediatric patients are managed in the same
manner as adults.
• Prevent hypothermia if shock is suspected.
• If patient shows bradycardia, ventilate.
• Monitor the patient during transport.

Systems (12 of 14)
• Injuries to the extremities
– Children have immature bones with active
growth centers.
– Growth of long bones occurs from the ends at
specialized growth plates.
• Potential weak spots
• Incomplete or greenstick fractures can occur.

Systems (13 of 14)
• Injuries to the extremities (cont’d)
– Generally, extremity injuries in children are
managed in the same manner as adults.
• Painful deformed limbs with evidence of
broken bones should be splinted.
– Should not attempt to use adult
immobilization devices on pediatric
patient

Systems (14 of 14)
• Pain management
– You are limited to these interventions:
• Positioning
• Ice packs
• Extremity elevation
– Will decrease pain and swelling to injury site
– Kindness and emotional support can go a long
way.

Disaster Management (1 of 4)
• JumpSTART triage system
– Intended for patients younger than 8 years and
weighing less than 100 lb
– Four triage categories
• Green
• Yellow
• Red
• Black

• JumpSTART triage system (cont’d)
– Green: minor not in need of immediate
treatment
• Able to walk (except in infants)
– Yellow: delayed treatment
• Presence of spontaneous breathing, with
peripheral pulse, responsive to painful stimuli

• JumpSTART triage system (cont’d)
– Red: immediate response
• Respirations less than 15 or greater than 45
breaths/min, apnea responsive to positioning
or rescue breathing, respiratory failure,
breathing without a pulse, inappropriate
painful response
– Black: deceased or expectant deceased
• Apneic without pulse, or apneic and
unresponsive to rescue breathing

Child Abuse and Neglect
• Any improper or excessive action that
injures or otherwise harms a child
– Includes physical abuse, sexual abuse, neglect,
and emotional abuse
– More than 2 million cases reported annually
• Many children suffer life-threatening injuries.
• If abuse is not reported, likely to happen
again.

Signs of Abuse (1 of 10)
• You will be called to homes because of
reported injury to a child.
• Child abuse occurs in every socioeconomic
status.
– Be aware of patient’s surroundings.
– Document findings objectively.

• Ask yourself the following:
– Injury typical for age of child?
– MOI reported consistent with the injury?
– Caregiver behaving appropriately?
– Evidence of drinking or drug use at scene?
– Delay in seeking care for the child?
– Good relationship between child and caregiver
or parent?

• Ask yourself the following (cont’d):
– Are there multiple injuries at different stages of
healing?
– Any unusual marks or bruises that may have
been caused by cigarettes, grids, or branding
injuries?
– Are there several types of injuries?
– Any burns on hands or feet that involve a glove
distribution?

• Ask yourself the following (cont’d):
– Is there unexplained decreased level of
consciousness?
– Is the child clean and an appropriate weight for
his or her age?
– Is there any rectal or vaginal bleeding?
– What does the home look like? Clean or dirty?
Warm or cold? Is there food?

• CHILD
ABUSE
mnemonic
may help.

• Bruises
– Observe color and location.
– New bruises are pink or red.
• Over time turn blue, then green, then yellow-
brown and faded
• Bruises to the back, buttocks, or face are
suspicious and are usually inflicted by a
person.

• Burns
– Burns to the penis, testicles, vagina, or buttocks
are usually inflicted by someone else.
– Burns that look like a glove are usually inflicted
by someone else.
• You should suspect child abuse if the child
has cigarettes burns or grid pattern burns.

• Fractures
– Fractures of the humerus or femur do not
normally occur without major trauma.
– Falls from bed are not usually associated with
fractures.
• Maintain an index of suspicion if an infant or
young child sustains a femur fracture.

• Shaken baby syndrome
– Infants may sustain life-threatening head
trauma by being shaken or struck.
• Life-threatening condition
• Bleeding within the head and damage to the
cervical spine
• Infant will be found unconscious often without
evidence of external trauma.

• Shaken baby syndrome (cont’d)
– Shaking tears blood vessels in the brain,
resulting in bleeding around the brain.
• Pressure from blood results in an increase in
cranial pressure leading to coma and/or
death.
• Neglect
– Refusal or failure to provide life necessities
• Examples are water, clothing, shelter,
personal hygiene, medicine, comfort,
personal safety.

Symptoms and Other
Indicators of Abuse (1 of 2)
• Abused children may appear withdrawn,
fearful, or hostile.
– Should be concerned if child does not want to
discuss how an injury occurred
• Parent may reveal a history of “accidents.”
– Be alert for conflicting stories or lack of concern.
– Abuser may be a parent, caregiver, relative, or
friend of the family.

Symptoms and Other
Indicators of Abuse (2 of 2)
• EMTs in all states must report suspected
abuse.
– Most states have special forms to do so.
– Supervisors are generally forbidden to interfere
with the reporting.
– Law enforcement and child protection services
will determine whether there is abuse.
• It is not your job.

Sexual Abuse (1 of 2)
• Children of any age and gender can be
victims of sexual abuse.
– Most victims of rape are older than 10 years.
• Younger children may be victims as well.
– Assessment
• Should be limited to determining type of
dressing required
• Treat bruises and fractures as well.
• Do not examine genitalia unless there is
evidence of bleeding or other injury.

Sexual Abuse (2 of 2)
– Do not allow child to wash, urinate, or defecate
until a physician completes exam.
• Difficult but important step
• If the victim is a girl, ensure a female EMT
or police officer remains with her.
– Maintain professional composure.
• Assume a caring, concerned approach.
• Shield the child from onlookers.

Sudden Infant Death Syndrome
(1 of 2)
• Unexplained death after complete autopsy
• Leading cause of death in infants younger
than 1 year
• Most cases occur in infants younger than 6
months.
• Impossible to predict

Sudden Infant Death Syndrome
(2 of 2)
• Risk factors
– Mother younger than 20 years old
– Mother smoked during pregnancy
– Low birth weight
• You are faced with three tasks
– Assessment of the scene
– Assessment and management of patient
– Communication and support of the family

Patient Assessment and
Management (1 of 4)
• Victim of SIDS will be pale or blue, not
breathing, and unresponsive.
• Other causes include:
– Overwhelming infection
– Child abuse
– Airway obstruction
– Meningitis

Management (2 of 4)
• Other causes include (cont’d)
– Accidental or intentional poisoning
– Hypoglycemia
– Congenital metabolic defects
• Begin with ABC assessment.
– Provide necessary interventions.

Management (3 of 4)
• Depending on how much time has passed,
patient may show postmortem changes.
– Rigor mortis
– Dependent lividity
• If you see these signs, call medical control.
• If no signs of postmortem changes, begin
CPR immediately.

Management (4 of 4)
• As you assess patient, pay special attention
to any marks or bruises on the child before
performing any procedures.
– Note any interventions that were done before
your arrival.

Communication and Support of
the Family
• Sudden death of an infant is very stressful
for a family.
– Tends to evoke strong emotional responses
among health care providers
– Allow the family to express their grief.
• Family may ask specific questions.
– Answers not immediately available
– Use infant’s name.
– Allow family to spend time with infant.

Scene Assessment
• Carefully inspect environment, noting
condition of scene and where infant was
found
• Assessment should concentrate on:
– Signs of illness
– General condition of the house
– Family interaction
– Site where the infant was discovered

Apparent Life-Threatening
Event (1 of 2)
• Infants who are not breathing, cyanotic, and
unresponsive sometimes resume breathing
and color with stimulation.
– Apparent life-threatening event (ALTE)
• Classic ALTE is characterized by:
– Cyanosis
– Apnea
– Distinct change in muscle tone
– Choking or gagging

Apparent Life-Threatening
Event (2 of 2)
• After ALTE, child may appear healthy and
show no signs of illness or distress.
– Must still complete careful assessment
• Pay strict attention to airway management.
• Assess infant’s history and environment.
• Allow caregivers to ride in the back of the
ambulance.
• Doctors will determine the cause.

Death of a Child (1 of 5)
• Poses special challenges for EMS
personnel
– In addition to medical care, you must provide
the family with support and understanding.
• Initiate CPR if family insists even though child
is deceased.
• Introduce yourself and ask about the child’s
date of birth and medical history.

• Do not speculate on the cause of the child’s
death.
• The following interventions are helpful:
– Use the child’s name.
– Speak to family members at eye level.
– Use “died” and “dead” instead of “passed away”
or “gone.”

• Helpful interventions (cont’d):
– Acknowledge family’s feelings, but never say, “I
know how you feel.”
– Offer to call other family members or clergy.
– Keep any instructions short, simple, and basic.
– Ask each family member if they want to hold the
child.
– Wrap the child in a blanket, and stay with the
family while they hold the child.

• Everyone expresses grief in a different way.
– Some will require intervention.
– Many caregivers feel directly responsible for the
death.
• Some EMS systems arrange for home visits
after a child’s death for closure.
• You need training for these visits.

• Child’s death can be difficult for health care
providers.
– Take time before going back to the job.
– Talk with other EMS colleagues.
– Be alert for signs of posttraumatic stress in
yourself and others.
• Consider the need for help if signs occur.

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