Pediatric Emergencies

Managing a pediatric emergency can be one of the most stressful situations as a first responder and the parent(s) of the child can face.

The child is frightened, anxious, and usually unable to communicate. Even if the child could communicate it isn't clear enough to understand what he problem is or what happened to them. The parents are also very anxious, frightened, and unsure of what to do. In this particular atmosphere, where everyone else is tense, as a first responder, this is when it is necessary to remain calm, controlled, and professional in your mannerisms.

EMS personnel often have mixed feelings when it comes to treating children. In some cases, the child reminds them of someone they know, or even their own child. Even the most experienced personnel respond emotionally to a seriously ill or injured child. Unless you're prepared, your anxiety and fear may interfere with your ability to deliver proper care.

The Parents

The child's parents or caregivers can be either allies or another problem all together. You must respond to them as much as to the child, although in a different way. Talk to both parents and to the child as much as possible. Parents are understandably concerned about their child's condition especially if they don't clearly understand the situation or id they think the situation is more serious than they think it is.

For instance, imagine a parent's reaction to a bleeding laceration of a child's forehead. You know that scalp wounds can bleed profusely, but that such bleeding can be easily controlled with direct pressure. However, most parents don't know that and may become a little more emotional.

Children get many of their behavioral cues from their parents. Calm the parents by talking with them, and then ask their assistance in calming the child. It is a good idea to allow a parent to hold the child if the illness or injury permits. If it doesn't permit the parent to hold the child on a lap, let the parent hold the child's hand, or at least keep a parent so the child can see them.

Quickly try to develop a good rapport with the child. Tell them your name and ask for theirs. Use the child's name as you explain what you're doing and what they should expect. You shouldn't stand over the child, instead kneel, squat, or sit next to the child. Establish eye contact with the child and ask them simple questions about the pain, where it is or ask them to point to the area that hurts.

Always be honest with the child. For instance, if you must move an arm or leg in order to splint it, be sure to tell the child what you're going to do and that moving it may cause it to hurt. Ask the child to help by being calm, lying still, or to hold the bandage for you. The level of understanding and cooperation you can receive from an ill or injured child is often remarkable and may even surprise you. Some emergency service agencies provide the child with a trauma teddy bear to hold in order to take their minds off being examined.

Swallowed Objects

Children often swallow small, round objects like marbles, beads, buttons, and coins. If they do not become airway obstructions, they usually pass uneventfully through the child and are eliminated in a bowel movement. However, sharp or straight objects such as safety pins, bobby pins, and bones are very dangerous if swallowed. Arrange for transport to an appropriate medical facility because special instruments and techniques are required to locate and remove the object from the stomach and intestinal tract.

Sudden Illness and Medical Emergencies

Not many illnesses occur suddenly in young children, but most of the medical calls for children will involve these sudden illnesses. It is important that you be able to recognize and treat these key pediatric illnesses. Key pediatric illnesses are: altered mental status, respiratory emergencies, asthma, croup, epiglottitis, near drowning, heat illness, high fever, seizures, vomiting and diarrhea, abdominal pain, poisoning, and sudden infant death syndrome (sids).

Treating Altered Mental Status

Altered mental status in children can be caused by a variety of conditions, including low blood sugar, poisoning, postseizure state, infection, head trauma, and decreased levels of oxygen. Sometimes you will be able to determine the cause of the altered state and take the appropriate steps to correct the problem.

For example, if the parent tells you that the child is a diabetic and suffering from insulin shock, you can give sugar to increase the patient's blood sugar. However in many cases, you will not be able to determine the cause and will have to have to treat the patient's symptoms. At this point it is very important to complete the patient's assessment, paying particular attention to any clues at the scene. Question bystanders or family about the situation and try to get as much medical history as possible. Pay absolute attention to the patient's initial vital signs, rechecking them frequently for change. Place unconscious patients in the recovery position to help keep an open airway and aid them in handling their secretions.

Treating respiratory Emergencies

A respiratory problem in an infant or child can range from a minor cold to complete blockage of the airway. Infants breathe primarily through their noses so even a minor cold can cause breathing difficulties. The excessive mucus in the nose resulting from a cold makes it harder for an infant to breathe than an older child who can breathe through their nose and mouth.

A child with asthma is usually already being treated for the condition by a physician and is taking a prescribed medicine. The parents call for assistance or transport only if the child experiences unusual breathing difficulty. During a severe asthma attack your primary treatment consists of calming and reassuring both the parents and the child. Tell them everything possible is being done and encourage them to relax.

Croup is an infection of the upper airway that usually occurs in children from six months to four years of age. The lower throat swells and compresses (narrows) the airway, resulting in a characteristic hoarse, whooping noise during inhalation and a seal-like barking cough. The last two signs, lack of fright or anxiety and a willingness to lie down, are important because they help to distinguish between croups from epiglottitis.

If the EMS unit gets delayed tell a parent to turn on the hot water in the shower and close the door. When the bathroom steams up, ask the parent to wait there with the child until the EMS unit arrives. The moist, warm air relaxes the vocal cords and lessens the croupy noise.

The third, and most severe, major respiratory problem is epiglottitis which is a sever inflammation of the epiglottis, the small flap that covers the trachea during swallowing. In this condition, the flap is so inflamed and swollen that air movement into the trachea is completely blocked. This usually occurs in children ages three to six years. This condition poses a serious threat to the child's life therefore you must be able to recognize the difference between croup and epiglottitis. Immediately arrange for transport and administer oxygen.

Near Drowning

Drowning is the second most common cause of accidental death among children five years of age or younger. Near drowning are people who survive the experience of suffocation under water. If you are the first responder to a near drowning begin assessment and treating. Signs and symptoms of near drowning may include lack of breathing and no pulse.

Begin by assessing the airway, breathing and circulation. Also known as the ABC's. Make sure the airway is clear of water. Turn the child to one side to allow the water to drain out. Start rescue breathing if necessary; administer supplemental oxygen if available, and if there isn't a pulse start chest compressions. You should maintain C-Spine at all times just in case of neck or spinal cord injury.

Heat Illnesses

Heat illnesses may range from relatively minor muscle cramps to vomiting, heat exhaustion, and heatstroke. The most dangerous in children is heatstroke. Any child who is in a closed, parked car on a hot day or in a poorly ventilated room and was hot, dry skin may be suffering from heatstroke. You should immediately undress and sponge or immerse the child with water and fan him or her to help lower body temperature quickly. If wet sheets are available you may use those, just do not let the child become chilled.

Treating High Fevers

Your first step in treating a child with a high fever is to uncover the child so that body heat can escape. Layers of clothing or blankets retain body heat and can increase body temperature high enough to cause convulsions. Fan the child to cool him or her down. Protect the child during any seizure (do not restrain the child's motion) and make certain that normal breathing resumes after each seizure.

Treating Seizures

If a seizure occurs, place the child on a soft surface (sofa, bed, or rug) to protect the child from injury. Maintain an adequate airway after the seizing has stopped. Arrange for transportation, monitor vitals, and support the ABC's if needed.

Vomiting and Diarrhea

Children are very susceptible to vomiting and diarrhea which are caused by gastrointestinal infections. Prolonged vomiting and diarrhea may produce severe dehydration. The dehydrated child may become lethargic and have dry skin, if this is suspected arrange for immediate transport so the hospital may replace lost fluids.

Abdominal Pain

One of the most serious causes of abdominal pain in children is appendicitis. A cramping pain usually starts in the belly button area of the stomach. Within a matter of hours, the pain moves to the lower quadrant of the abdomen becoming steady and more severe. Usually the child becomes nauseated, has no appetite, and will occasionally vomit. A field diagnosis is too difficult, arrange for the child to be transported to the nearest hospital.

Poisoning

The two most common types of poisonings in children are caused by ingestion and absorption. A child that has ingested poison may have chemical burns, odors, or stains around the mouth and be suffering from nausea, vomiting, abdominal pain, or diarrhea. Later symptoms may include abnormal or decreased respirations, unconsciousness, or seizures.

A child who has absorbed a poisonous substance may have localized symptoms, such as skin irritation or burning, or may have systemic signs and symptoms of the poisoning, such as nausea, vomiting, dizziness, and shock. Do not give liquids or induce vomiting in an unconscious or partially conscious child because of the danger of aspiration of the vomitus.

Sudden Infant Death Syndrome (SIDS)

SIDS is commonly mistaken for child abuse because it is unexplainable. It usually occurs between the ages of three weeks and seven months. These deaths are not the result of smothering, choking, or strangulation. If the infant is still warm immediately begin CPR and continue until help arrives.