6-1.4 Indicate various causes of respiratory emergencies.
6-1.5 Differentiate between respiratory distress and respiratory failure.
6-1.6 List steps in the management of foreign body airway obstruction.
Cognitive Objectives (1 of 3)
6-1.7 Summarize EMS care strategies for respiratory distress and respiratory failure.
6-1.8 Identify the signs and symptoms of shock (hypoperfusion) in the infant and child patient.
6-1.9 Describe the methods of determining end organ perfusion in the infant and child patient.
6-1.10 State the usual cause of cardiac arrest in infants and children versus adults.
Cognitive Objectives (2 of 3)
Cognitive Objectives (3 of 3)
6-1.12 Describe the management of seizures in the infant and child patient.
6-1.14 Discuss the field management of the infant and child trauma patient.
• There are no affective objectives for this chapter.
Psychomotor Objectives (1 of 2)
6-1.21 Demonstrate the techniques of foreign body airway obstruction removal in the infant.
6-1.22 Demonstrate the techniques of foreign body airway obstruction removal in the child.
6-1.23 Demonstrate the assessment of the infant and child.
Psychomotor Objectives (2 of 2)
6-1.24 Demonstrate bag-valve-mask artificial ventilations for the infant.
6-1.25 Demonstrate bag-valve-mask artificial ventilations for the child.
6-1.26 Demonstrate oxygen delivery for the infant and child.
Additional Objectives*Cognitive
1. Describe the steps in positioning an infant and/or child to maintain an open airway.
2. Summarize neonatal resuscitation procedures.
Affective
None
Psychomotor
3. Demonstrate the techniques necessary in neonatal resuscitation.
*These are noncurriculum objectives.
Pediatric Assessmentand Management
• Caring for sick and injured children presents special challenges.
• EMT-Bs may find themselves anxious when dealing with critically ill or injured children.
• Treatment is the same as that for adults in most emergency situations.
Scene Size-up
• Take note of your surroundings. • Scene assessment will supplement additional
findings.• Observe:
– Position of the patient– Condition of the home– Clues to child abuse
Initial Assessment
• Begins before you touch the patient
• Form a general impression.• Determine a chief complaint. • The Pediatric Assessment
Triangle can help.
Pediatric Assessment Triangle
• Appearance– Awake– Aware– Upright
• Work of breathing– Retractions– Noises
• Skin circulation
Assessing the ABCs
• Ensure airway is open and position patient.
• Breathing assessment– Effort– Obstructions– Rate
• Circulation assessment– Rate– Skin color, temperature,
and capillary refill
Transport Decision
• Children under 40 lb should be transported in a child safety seat, if the situation allows.
• Seat should be secured to the cot or captain’s chair.
• Cannot be secured to bench seat• Child may have to be transported without a seat,
depending on condition.
Focused History and Physical Exam
• Should be completed on scene unless severity requires rapid transport
• Young children should be examined toe to head.• Focused exam on noncritical patients• Rapid exam on potentially critical patients
Vital Signs by Age
Age Respirations (breaths/min)
Pulse (beats/min)
Systolic Blood Pressure
(mm Hg)
Newborn: 0 to 1 mo 30 to 60 90 to 180 50 to 70
Infant: 1 mo to 1 yr 25 to 50 100 to 160 70 to 95
Toddler: 1 to 3 yr 20 to 30 90 to 150 80 to 100
Preschool age: 3 to 6 yr 20 to 25 80 to 140 80 to 100
School age: 6 to 12 yr 15 to 20 70 to 120 80 to 110
Adolescent: 12 to 18 yr 12 to 16 60 to 100 90 to 110
Older than 18 yr 12 to 20 60 to 100 90 to 140
Respirations
• Abnormal respirations are a common sign of illness or injury.
• Count respirations for 30 seconds.
• In children less than 3 years, count the rise and fall of the abdomen.
• Note effort of breathing.• Listen for noises.
Pulse
• In infants, feel over the brachial or femoral area.• In older children, use the carotid artery.• Count for at least 1 minute.• Note strength of the pulse.
Blood Pressure
• Use a cuff that covers two thirds of the upper arm.
• If scene conditions make it difficult to measure blood pressure accurately, do not waste time trying.
Detailed Physical Examand Ongoing Assessment
• Status changes frequently in children.• The PAT can help with reassessment.• Repeat vital signs frequently.• If child deteriorates, repeat the initial assessment.
Care of the Pediatric Airway (1 of 2)
• Position the airway.
• Position the airway in a neutral sniffing position.
• If spinal injury is suspected, use jaw-thrust maneuver to open the airway.
Care of the Pediatric Airway (2 of 2)
• Positioning the airway:
– Place the patient on a firm surface.
– Fold a small towel under the patient’s shoulders and back.
– Place tape across patient’s forehead to limit head rolling.
Oropharyngeal Airways
• Determine the appropriately sized airway.
• Place the airway next to the face to confirm correct size.
• Position the airway.• Open the mouth.• Insert the airway until flange
rests against lips.• Reassess airway.
Nasopharyngeal Airways (1 of 2)
• Determine the appropriately sized airway.
• Place the airway next to the face to make certain length is correct.
• Position the airway.• Lubricate the airway.
Nasopharyngeal Airways (2 of 2)
• Insert the tip into the right naris.
• Carefully move the tip forward until the flange rests against the outside of the nostril.
• Reassess the airway.
Assessing Ventilation
• Observe chest rise in older children.• Observe abdominal rise and fall in younger
children or infants.• Skin color indicates amount of oxygen getting
to organs.
Oxygen Delivery Devices
• Nonrebreathing mask at 10 to 15 L/min provides 90% oxygen concentration.
• 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.
BVM Devices
• Equipment must be the right size.
• BVM device at 10 to 15 L/min provides 90% oxygen concentration.
• Ventilate at the proper rate and volume.
• May be used by one or two rescuers
Airway Obstruction
• Croup
– A viral infection of the airway below the level of the vocal cords
• Epiglottitis
– Infection of the soft tissue in the area above the vocal cords
• Foreign body airway obstructions
Signs and Symptoms
• Decreased or absent breath sounds
• Stridor
• Retractions
• Difficulty speaking
Signs of SevereAirway Obstruction
• Signs and symptoms– Ineffective cough (no sound)– Inability to cry– Increasing respiratory difficulty, with stridor– Cyanosis– Loss of consciousness
Removing a Foreign Body Airway Obstruction (1 of 5)
• In an unconscious child:– Place the child on a firm, flat surface.
• Open airway using head tilt-chin lift maneuver.– Inspect the upper airway and remove any
visible object.– Attempt rescue breathing.
• If unsuccessful, reposition head and try again.– If ventilation is still unsuccessful begin CPR.
Removing a Foreign Body Airway Obstruction (2 of 5)
• Place heel of one hand on lower half of sternum between the nipples.
• Administer 30 chest compressions at a depth of 1/3 to 1/2 the depth of the chest.
Removing a Foreign Body Airway Obstruction (3 of 5)
• Open airway using head tilt-chin lift maneuver. If you see the object, remove it.
• Repeat process.
Removing a Foreign Body Airway Obstruction (4 of 5)
• In a conscious child:– Kneel behind the
child.– Give the child five
abdominal thrusts.– Repeat the technique
until object comes out.
Removing a Foreign Body Airway Obstruction (5 of 5)
• If the child becomes unconscious, inspect the airway.
• Attempt rescue breathing.
• If airway remains obstructed, begin CPR.
Management of AirwayObstruction in Infants
• Hold the infant facedown.• Deliver five back slaps.• Bring infant upright on the thigh.• Give five quick chest thrusts.• Check airway.• Repeat cycle as often as
necessary.
Neonatal Resuscitation
• Resuscitation measures include:– Positioning airway– Drying– Warming– Suctioning– Tactile stimulation
Additional Efforts
• Deliver chest compressions at 120 per minute.
• Coordinate chest compressions with ventilations at a ratio of 3:1.
• If meconium is present, suction infant vigorously.
BLS Review
• Cardiac arrest in children is commonly due to respiratory arrest.
• Many causes of respiratory arrest• For purposes of pediatric BLS:
– Infancy ends at 1 year of age.– Childhood extends from 1 year of age to
onset of puberty (12 to 14 years of age).
Determine Responsiveness
• Gently tap on shoulder and speak loudly.• If responsive, place in position of comfort.• If you find an unresponsive child when you are not
on duty:– Provide BLS for about 2 minutes.– Then call EMS system.
Airway
• Airway may be obstructed by tongue.• Use head tilt-chin lift technique or jaw-thrust
maneuver to open the airway.• Jaw-thrust maneuver is safer if possibility of
neck injury exists.
Breathing
• Look, listen, and feel.
• Provide rescue breathing if needed.
• Perform Sellick maneuver to prevent gastric distention.
Circulation
• Assess circulation after airway is open and two rescue breaths have been given.
• Check for pulses.• Evaluate for other signs of circulation.• Take at least 5 seconds but not more than 10
seconds trying to find a pulse.• If infant or child is not breathing, the pulse is often
too slow or absent. CPR will be required.
Infant CPR (1 of 2)
• Place infant on firm surface and maintain airway.
• Place two fingers in the middle of the sternum.
• Use two fingers to compress the chest 1/3 to 1/2 the depth of the chest at a rate of 100/min.
Infant CPR (2 of 2)
• Allow sternum to return briefly to its normal position between compressions.
• Coordinate rapid compressions and ventilations in a 30:2 ratio.
• Reassess the infant for return of breathing and pulse after every 2 minutes of CPR.
Child CPR (1 of 2)
• Place child on firm surface and maintain airway with one hand.
• Place heel of other hand over lower half of the sternum.– Avoid the xiphoid
process.• Compress chest 1/3 to 1/2
the depth of the chest at a rate of 100/min.