Presents information concerning the developmental and anatomical differences in infants and children, discuss common medical and trauma situations, and also covered are infants children dependent on special technology. Dealing with an ill or injured infant or child patient has always been a challenge for EMS providers. Presentation is over 100 slides in length. Meets or exceeds USDOT NHTSA 2009 Training Standards.

1. PREVIEW OF
EMT/EMR
PEDIATRIC EMERGENCIES
POWERPOINT TRAINING
PRESENTATION

2. GENERAL CONSIDERATIONS
Many components of the initial evaluation can be
done by careful observation without touching
the patient
When appropriate, utilize the parent/guardian to
help the infant or child be more comfortable
with your exam & treatment
Communicating with scared, concerned parents &
family is important when caring for an ill infant
or child
Continue assessment until care is transferred

3. Subarachnoid
space

4. AIRWAY COMPAIRED
TO AN ADULTS
Smaller in diameter & shorter in length
Jaw is smaller with infant’s tongue taking up
more room in the oropharynx
Infants are nasal breathers
Tracheal cartilage is softer & more collapsible
Epiglottis of infants & toddlers is long, floppy,
narrow & extends at a 450 angle into airway

5. ABDOMINAL DIFFERENCE
Less-developed abdominal muscles & organs
situated more anteriorly, therefore less
protection of rib cage
Liver & spleen are proportionally larger
Implications for the health care provider
Seemingly insignificant forces can cause serious
internal injury
Liver, spleen, and kidneys are more frequently
injured
Multiple organ injury common

6. EXTREMITIES AS COMPAIRED
TO AN ADULTS
Bones are softer
Open growth plates are weaker
than ligaments & tendons,
so injury to growth plate can
result in length discrepancies
Drawing by
Bruce Blaus

7. NERVOUS SYSTEM AND SPINAL
COLUMN COMPARED TO AN ADULT’S
Brain tissue & vascular system is more fragile &
prone to bleeding from injury
Subarachnoid space is relatively smaller, with
less cushioning effect for brain
Pediatric brain requires nearly twice the
cerebral blood flow as does an adult’s
Brain & spinal cord less well protected

8. IMPLICATIONS FOR THE
HEALTHCARE PROVIDER
The large cerebral blood flow requirement
increases risk of hypoxia; hypoxia and
hypotension in a child with a head injury can
cause ongoing damage
Head momentum may result in bruising and
damage to the brain
Spinal cord injuries less common
Cervical spine injuries more commonly
ligamentous injuries

9. GROWTH & DEVELOPMENT
IN INFANCY BIRTH TO TWO
MONTHS
Cognitive development
Crying form of communication
Infants cry for obvious reasons such as
hunger and needing to be changed
When obvious reasons for crying have been
addressed, persistent crying can be a sign
of significant illness

10. IMPLICATIONS FOR THE
HEALTH CARE PROVIDER
Persistent crying or irritability in a 0 to 2
month-old can be a symptom of serious
illness
Infants sleep a lot, however should arouse
easily; inability to arouse a baby should be
considered an emergency
Head control is limited

11. IMPLICATIONS FOR THE
HEALTHCARE PROVIDER
They not like to be separated from parents
They do not want an oxygen mask (do NOT
blow in face)
Need to be kept warm - make sure hands
and stethoscope are warmed before
touching child

12. GROWTH & DEVELOPMENT
EIGHTEEN TO
TWENTY-FOUR MONTHS
Physical development
Improved gait and balance
Begin to run and climb
Cognitive development
Begin to understand cause and effect
Begin to label objects
Ten to 15 words becomes 100 by 24 months
Emotional development
Clinginess with parents
Attachment to a special object, like a blanket

13. IMPLICATIONS FOR THE
HEALTH CARE PROVIDER
Persistent crying or irritability can be a symptom
of serious illness
Allow a child to hold objects of importance to
them (e.g., blanket)
Children no longer require shoulder rolls to limit
flexion of the neck when bag-valve-mask
ventilating or intubating
Painful procedures make lasting impressions

14. GENERAL CONSIDERATIONS
OF ASSESSMENT
Many components of the initial evaluation can
be done by careful observation without
touching the patient
When appropriate, utilize the parent/guardian
to help the infant or child be more
comfortable with your exam and therapies

15. PREPARING FOR ARRIVAL
Assembling age-appropriate equipment
Reviewing age-appropriate vital signs and
anticipated development

16. PATIENT ASSESSMENT
“Pediatric Assessment Triangle” consists of
General
Components
Possible physiologic state

17. GENERAL
Provides a 15- to 30-second assessment of the
severity of the patient’s illness or injury
Use prior to addressing “the ABCs”
Does not require touching the patient, just
looking and listening

18. FOCUSED HISTORY
Symptoms and duration
Fever
Activity level
Recent eating, drinking, and urine output history
History of vomiting, diarrhea, or abdominal pain
Note any rashes
Medications taking and medication allergies
Past medical problems or chronic illnesses
Key events leading to the injury or illness

19. ASSESSMENT
History
Physical findings
Are respirations within normal limits
Labored breathing
Abnormal chest rise & fall
Tripod positioning

20. SPECIFIC CONDITIONS
Meningitis
Altered mental status
Closed head injury
Bleeding inside skull
Fractures

21. ALTERED MENTAL STATUS
Primarily caused by
Hypoglycemia Poisoning
Seizure Infection
Head trauma Hypoxia
Shock Fatigue
Cause should be determined for appropriate
care
Have understanding of normal mental status

22. MANAGEMENT
Altered mental status
Assess for need to protect airway
Assess and intervene for increased
intracranial
Supplemental oxygen as necessary

23. MOTOR VEHICLE PASSENGERS
Unrestrained passengers have head and neck
injuries
Restrained passengers have abdominal and
lower spine injuries
Struck while riding bicycle - head injury, spinal
injury, abdominal injury
Pedestrian struck by vehicle - abdominal injury
with internal bleeding, possible painful,
swollen, deformed thigh, head injury

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