1. Pediatrics Assessment and Management of the Critically Ill Child

2. Kids are Tattle-Tales

11. Humboldt Siskiyou Modoc Lassen Shasta Trinity Tehama Plumas Sierra Butte Glenn Nevada Placer Colusa Mendocino Lake Sonoma Napa Yolo Sutter Yuba El Dorado Amador Alpine Mono Tuolumne Sacramento San Joaquin Solano Contra Costa Marin San Francisco San Mateo Santa Cruz Alameda Santa Clara Stanislaus Merced Mariposa Madera San Benito Monterey Fresno Inyo Kings Tulare Kern San Luis Obispo Santa Barbara Ventura Los Angeles San Bernardino Riverside Orange San Diego Imperial EMSC Systems in Place and not Funded by EMSA (3 Single County Agencies) EMSC Projects Funded by EMSA (18 Agencies Representing 40 Counties) No EMSC System in Place (9 Agencies Representing 11 Counties) Calaveras Del Norte EMSC SYSTEMS Note: Patterned areas indicate EMS regions 4/16/02 EMSC Projects in Early Stage Implementation (funded by EMSA) (2 Agencies Representing 4 Counties)

14. Infants and young children should be allowed to remain in their parent’s arms.

15. The approach to the pediatric patient should be gentle and slow.

16. A small toy may calm a child.

19. Head and Airway

47. PAT: Respiratory Distress Circulation to Skin Normal Work of Breathing Increased Appearance Normal

48. PAT: Respiratory Failure Circulation to Skin Normal or abnormal Work of Breathing Increased or decreased Appearance Abnormal

49. PAT: Shock Circulation to Skin Abnormal Work of Breathing Normal Appearance Abnorm al

50. PAT: (CNS) Dysfunction or Metabolic Abnormality Circulation to Skin Normal Work of Breathing Normal Appearance Abnormal

52. 2-week-old infant Circulation to Skin Face and trunk normal, hands and feet blue Work of Breathing Abdomen rises and falls with each breath Appearance Eyes open, moves arms and legs, strong cry

57. 9-month-old infant Circulation to Skin Pale skin color Work of Breathing No retractions or abnormal airway sounds Appearance Agitated, makes eye contact

63. Summary of BLS Maneuvers

64. Clearing an Infant’s Airway

66. Pediatric-size suction catheters. • Top: soft suction catheter. • Bottom: rigid or hard suction catheter.

67. Suction Catheter Sizes for Infants and Children

69. Inserting an oropharyngeal airway in a child with the use of a tongue blade.

70. a. In an adult, the airway is inserted with the tip pointing to the roof of the mouth, then rotated into position. b. In an infant or small child, the airway is inserted with the tip pointing toward the tongue and pharynx, in the same position it will be in after insertion.

72. In placing a mask on a child, it should fit on the bridge of the nose and cleft of the chin.

73. Sellick’s maneuver

74. Advanced Airway and Ventilatory Management

75. Infant/Child Endotracheal Tubes

80. Placement of the laryngoscope.

81. Endotracheal Intubation in the Child

82. Hyperventilate the child.

83. Position the head.

84. Insert the laryngoscope and visualize the airway.

85. Insert the tube and ventilate the child.

86. Confirm tube placement.

87. Nasogastric Intubation

89. Oxygenate and continue to ventilate, if possible.

90. Measure the NG tube from the tip of the nose, over the ear, to the tip of the xiphoid process.

91. Lubricate the end of the tube. Then pass it gently downward along the nasal floor to the stomach.

92. Auscultate over the epigastrium to confirm correct placement. Listen for bubbling while injecting 10–20 cc of air into the tube.

93. Use suction to aspirate stomach contents.

94. Secure the tube in place.

100. Intraosseous administration.

102. Correct needle placement for intraosseous administration.

103. Fluid Administration Accurate fluid dosing in children is crucial!

107. Immobilizing a Patient in a Child Safety Seat

108. One paramedic stabilizes the car seat in an upright position and applies and maintains manual inline stabilization throughout the immobilization process.

109. A second paramedic applies an appropriately sized cervical collar. If one is not available, improvise using a rolled hand towel.

110. The second paramedic places a small blanket or towel on the child’s lap, then uses straps or wide tape to secure the chest and pelvic area to the seat.

111. The second paramedic places towel rolls on both sides of the child’s head to fill voids between the head and seat. He then tapes the head into place, taping over the chin, which would put pressure on the neck. The patient and seat can be carried to the ambulance and strapped to the stretcher, with the stretcher head raised.

112. Applying a Pediatric Immobilization System

113. Position the patient on the immobilization system.

114. Adjust the color-coded straps to fit the child.

115. Attach the four-point safety system.

116. Fasten the adjustable head-support system.

117. The patient fully immobilized to the system.

118. Move the immobilized patient onto the stretcher and fasten the loops at both ends to connect to the stretcher straps.

119. Emotional support of the infant or child continues during transport.

120. Never delay transport to perform a procedure that can be done en route to the hospital!

121. Case Studies