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pediatrics.json
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Causes of Shock in Children
In addition to trauma, shock may also be caused by infection. Infections can send the body into shock because of the body’s reaction to the infection. The risk of shock increases with the severity and centrality of the infection. Among children, the most common cause of shock is vomiting or diarrhea. As they lose fluid...
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Assessing Shock
When assessing shock, watch the child’s mental status, including any changes that have occurred since you arrived on the scene. Some children may experience a change in mental status so pronounced that it makes them unable to recognize their parent or caregiver. This altered mental status is a strong indicator that sho...
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Providing Care for Shock
Lay the child flat if possible, but do not force it if the child is too agitated or upset. Constantly monitor the child’s respiratory and circulatory status. Have equipment available should the child go into cardiac arrest.
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Altered Mental Status
Altered mental status in children and infants is another medical condition you may encounter. This can be caused by low blood sugar, poisonings or overdoses, seizures, infections, trauma, decreased level of oxygen and the onset of shock. When assessing altered mental status, use the AVPU scale, which is covered more th...
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Trauma
Injury is the number-one cause of death for children in the United States. Many of these deaths are the result of motor-vehicle collisions. The greatest dangers to a child involved in a motor-vehicle crash are airway obstruction and bleeding. Ensure an open airway and control severe bleeding as quickly as possible. A r...
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Child Abuse and Neglect
You may at some point encounter a situation involving an injured child in which you believe or have reason to suspect child abuse or neglect is involved.
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Types of Abuse
Child abuse , or non-accidental trauma, is the physical, psychological or sexual assault of a child resulting in injury and emotional trauma. Child abuse involves an injury or pattern of injuries that do not result from a mishap. You might suspect child abuse if the child’s injuries cannot be logically explained or a c...
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Epidemiology of Child Abuse and Neglect
Epidemiology studies show that child abuse is not limited to a certain sector of society but may occur in any part. Every year in the United States, almost 700,000 children are victims of child abuse and neglect, and more than 1,600 children die from the abuse and neglect at a rate of 2.25 per 100,000 children. Of tho...
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Assessing Child Abuse and Neglect
Upon arriving on the scene, note anything in the child’s history or at the scene that causes concern or suspicion of abuse or neglect. Watch the caregiver’s behavior, which may be evasive; the caregiver (usually a parent) may not volunteer much information or may contradict information already given. Also observe for p...
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Managing Child Abuse and Neglect
When caring for a child who may have been abused, your first priority is to care for the child’s injuries or illness. An abused child may be frightened, hysterical or withdrawn. Abused children may also be unwilling to talk about the incident in an attempt to protect the abuser or for self-protection. If you suspect ab...
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Legal Aspects of Child Abuse and Neglect
If you have reasonable cause to believe that abuse has occurred, you can report your suspicions to a community or state agency, such as the Department of Social Services, the Department of Children and Family Services, or Child Protective Services. You may be afraid to report suspected child abuse because you do not wi...
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Documenting Child Abuse and Neglect
As with all emergency calls, you must document your observations and actions and the patient’s response objectively. When dealing with suspected child abuse or child neglect, remain objective in your documentation. Do not write any supposition or theories. If there is later legal action, your notes may be used in court...
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Sudden Infant Death Syndrome
Sudden infant death syndrome (SIDS), which used to be called crib death, is the unexplained sudden death of an infant younger than 1, but it occurs most often between the ages of 4 weeks and 7 months. SIDS almost always occurs while the infant is sleeping. This condition does not seem to be linked to any disease. Becau...
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Epidemiology and Risk Factors
The rate of SIDS occurrence is significantly lower now than prior to 1992, when parents and caregivers were first told to put infants to sleep on their back or side. Even so, unfortunately, SIDS still causes a significant number of deaths in infants younger than 1, and thousands of babies die of SIDS in the United Stat...
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Assessing and Managing SIDS
When called for a SIDS death, unless the infant is very obviously dead (rigor mortis has set in), attempt resuscitation with CPR as per infant protocols. Follow local EMS protocols for death in the field, and notify the appropriate authorities. If possible, try to obtain the following information:  When was the infant...
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Support for SIDS
Because of the circumstances of the death, the parents, caregivers and possibly siblings may be your patients as much as the infant. Shock can result from a severe emotional trauma, so observe the parent or caregiver closely for signs and symptoms of shock. When more advanced emergency personnel take over the infant’s ...
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Lowering the Risk for SIDS
Because it cannot be predicted or prevented, SIDS makes many new parents feel anxious. However, there are several things they can do to lower the risk for SIDS. The American Academy of Pediatrics has guidelines for safe sleep, which include the following for the first year of an infant’s life: • Always place an infant ...
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Apparent Life-Threatening Events
An apparent life-threatening event (ALTE) is a sudden event in infants younger than 1, characterized by apnea, change in Lowering the Risk for SIDS color, change in muscle tone, and coughing or gagging. About half the time, ALTE is linked to an underlying digestive, neurologic or respiratory health problem, but it rema...
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Considerations for Children with Special Healthcare or Functional Needs
In addition to the more common problems any child may have, a child with special healthcare or functional needs may have additional health concerns. When called to a scene with a child with special healthcare or functional needs, the parent or caregiver can generally provide you with the most information, because they ...
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THE EMERGENCY MEDICAL RESPONDER’S NEEDS
Dealing with emergency situations can be difficult for many emergency medical responders (EMRs). The difficulty can be compounded when the emergencies include children, particularly if they involve suspected child abuse or SIDS. The death of a child, especially if declared on the scene of an incident, can be very diffi...
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PUTTING IT ALL TOGETHER
Caring for children is similar in many ways to caring for adults, but differences exist, both physical and emotional. Caring for a child often also means providing support and care to the parent or caregiver, who are often stressed and anxious. Assessing breathing and pulse in children is, for the most part, the same a...
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Introduction
Sudden illnesses and medical emergencies are common in children and infants. This chapter covers the special knowledge and skills you will need to assess and treat children and infants. This chapter also covers the differences between the anatomy of an adult and a child and highlights the special considerations for exa...
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General Considerations
Managing a pediatric emergency can be one of the most stressful situations you face as an emergency medical responder (EMR). The child is frightened, anxious, and usually unable to communicate the problem to you clearly. The parents are anxious and frightened. In an atmosphere where everyone involved is tense, you must...
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The Parents
The child’s parents or caregivers can be either allies or a potential problem. You must respond to them as much as to the child, although in a different way. Talk to both the parents and the child as much as possible. Parents are understandably concerned about their child’s condition, especially if they do not clearly ...
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Pediatric Anatomy and Function
Children and adults have the same body systems that perform the same functions. However, there are certain differences, particularly in the airway, that you need to understand. A child’s airway is smaller in relation to the rest of the body. Therefore, secretions or swelling from illnesses or trauma can more easily blo...
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Examining a Child
It is important for you to perform a thorough and systematic assessment of a child to determine the extent of his or her illness or injury. The examination of a child should consist of the same five steps used in the patient assessment sequence that you learned for adult patients. First, perform a scene size-up to ensu...
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The Pediatric Assessment Triangle
It is important for you to be able to quickly determine when a child is seriously ill or injured. The pediatric assessment triangle (PAT) was developed to help you quickly form a general impression of a pediatric patient’s condition as part of your primary assessment. It does not change the steps of the patient assessm...
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The three components of the PAT
include appearance, work of breathing, and circulation to the skin.
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Appearance
The first element of the PAT is appearance. Does the child appear to be ill or injured? The child’s general appearance is important when you are trying to determine the severity of the child’s illness or injury. The general appearance is an indicator of how well the heart and lungs are working. Appearance is also a goo...
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Characteristics of Appearance
**Table 17-1: Characteristics of Appearance** outlines differences between healthy and unhealthy reactions in children. In terms of **movement**, a healthy child moves vigorously, whereas an unhealthy child may appear limp, listless, or flaccid. Regarding **interaction**, a healthy child reaches for a toy or reacts to ...
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Work of Breathing
The second element of the PAT is the work of breathing. In children, assessing the work of breathing is a more accurate indicator of a child’s condition than merely determining the rate of respirations. You can determine the child’s work of breathing by measuring four factors: (1) abnormal breath sounds, (2) abnormal p...
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Characteristics of Work of Breathing
**Table 17-2: Characteristics of Work of Breathing** lists observable signs that may indicate respiratory distress. **Abnormal breath sounds** include noisy breathing such as snoring, crowing, grunting, or wheezing. **Abnormal positioning** is seen when a patient leans forward while using their arms for support, often ...
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Circulation to the Skin
The third element of the PAT is circulation to the skin. The three characteristics for determining circulation to the skin are paleness, mottling, and cyanosis. Check the child’s skin for paleness or pallor. White or pale skin indicates an inadequate blood flow to the skin. The second characteristic of circulation to t...
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Characteristics of Circulation to the Skin
Pallor is characterized by white or pale skin or mucous membranes. Mottling appears as patchy skin discoloration caused by too much or too little blood flow to the skin. Cyanosis is identified by blue discoloration of the skin and mucous membranes.
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Respirations
To calculate the respiratory rate of a child, count respirations for 30 seconds and multiply by two. Counting for less than 30 seconds can cause inaccurate results because children often have irregular breathing patterns. As you examine children, look to see how much work they are doing to breathe. This work of breathi...
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Special Populations
From birth to about 6 months of age, children are 'nose breathers.' They have not yet learned to breathe through their mouths.
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Pulse Rate
The normal pulse rate of a child is faster than an adult's normal rate. For a child younger than 1 year, palpate a brachial pulse, which is located halfway between the shoulder and the elbow on the inside of the upper arm or directly over the heart.
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Table 17-4 normal vital signs for children at various ages.
Newborns (0 to 1 month) have a heart rate of 90–180 beats per minute and respirations of 30–60 breaths per minute. Infants (1 month to 1 year) have a heart rate of 100–160 beats per minute and respirations of 25–50 breaths per minute. Toddlers (1 to 3 years) have a heart rate of 90–150 beats per minute and respirations...
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High Body Temperature
Flushed, red skin, sweating, and restlessness often accompany high temperatures in children. You can often feel a high temperature just by touching the child’s chest and head. A child’s heart rate increases with each degree of temperature rise.
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Respiratory Care
Neither adults nor children can tolerate a lack of oxygen for more than a few minutes before permanent brain damage occurs. It is important for you to open and maintain the airway and to ventilate adequately any child with a respiratory condition. Otherwise, the child may go into respiratory arrest, followed by cardia...
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Treating Respiratory Emergencies in Infants and Children
You need four types of skills to treat respiratory emergencies in children: opening the airway, basic life support, suctioning, and the use of airway adjuncts. Each of these skills is described below.
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Treatment
Essential skills in treating pediatric respiratory emergencies include the following: 1. Opening the airway 2.Basic life support 3.Suctioning 4.Using airway adjuncts
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Opening the Airway
When opening the airway of a child or an infant, use the same general techniques that you use for an adult patient. The head tilt–chin lift maneuver can be used for children who have not sustained an injury to the neck or head. When using the head tilt–chin lift maneuver on a child, be sure that you do not hyperextend ...
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Basic Life Support
Because children are smaller than adults, you must use specific techniques when you perform cardiopulmonary resuscitation (CPR) on children. There are special procedures for hand placement, compression pressure, and airway positioning. CPR for children (1 year of age to the onset of puberty) is different from adult CPR...
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Treatment_0
To review techniques for CPR for infants and children, see Chapter 7, Airway Management, and Chapter 8, Professional Rescuer CPR. These chapters describe the techniques in detail.
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Suctioning
To clear secretions, vomitus, or blood from a patient’s airway, turn the patient on his or her side and use your gloved fingers to scoop out as much of the substance as possible. You can use suctioning (aspirating or sucking out fluid by mechanical means) to remove the foreign substances that cannot be removed with you...
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Airway Adjuncts
An oral airway can maintain an open airway after you have opened the patient’s airway by manual means. Use the steps in Skill Drill 17-1 to insert an oral airway in a child or an infant. 1. Select the proper size oral airway by measuring from the patient’s ear lobe to the corner of the mouth Step 1. 2. Position the pa...
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Treatment_1
In pediatric patients, you must be careful not to overextend the neck. In infants and some small children, the overextension may actually obstruct the airway because of the flexibility of the child’s neck. Smaller children may breathe easier if the neck is held in a neutral position rather than overextended. To maintai...
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Skill Drill 17-1: Inserting an Oral Airway in a Child
Step 1: Select the proper size oral airway by measuring from the patient’s ear lobe to the corner of the mouth. Step 2: Position the pediatric patient’s airway with the appropriate method. Step 3: Depress the patient’s tongue and press the tongue forward and away from the roof of the mouth. Follow the anatomic curve o...
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Mild (Partial) Airway Obstruction
You can usually relieve a mild (partial) airway obstruction by placing the child on his or her back (supine), tilting the head, and lifting the chin in the head tilt–chin lift maneuver. An airway blocked by an aspirated foreign object (eg, small toy, piece of candy, balloon) is a common occurrence in young children, p...
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Severe (Complete) Airway Obstruction in Children
A severe (complete) airway obstruction is a serious emergency. A severe airway obstruction exists when the child has poor air exchange, increased breathing difficulty, a silent cough, the inability to speak, or no air movement because of an obstruction. You have only a few minutes to act before permanent brain damage o...
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A skill performance sheet titled Child: Foreign Body Airway Obstruction
**Figure 17-8: Skill Performance Sheet – Child: Foreign Body Airway Obstruction** 1. Ask, “Are you choking?” 2. Give abdominal thrusts. 3. Repeat thrusts until the foreign body is dislodged or until the patient becomes unresponsive. **If the patient becomes unresponsive:** 4. If a second rescuer is available, ...
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Complete or Severe Airway Obstruction in Infants
An infant (younger than 1 year) is very fragile. Infants’ airway structures are very small and they are more easily injured than those of an adult. If you suspect an airway obstruction, first assess the infant to determine whether there is any air exchange. If the infant is crying, the airway is not completely obstruct...
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**Infant: Foreign Body Airway Obstruction – Skill Performance Sheet**
1. Confirm severe airway obstruction. Check for sudden onset of serious breathing difficulty, ineffective cough, silent cough, or silent cry. 2. Give up to five back slaps and up to five chest thrusts. 3. Repeat Step 2 until the foreign body is dislodged or until the infant becomes unresponsive. **If the infant ...
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Swallowed Objects
Children often swallow small, round objects like marbles, beads, buttons, and coins. If these objects 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 open safety pins, bobby pins, and bones are dangero...
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Respiratory Distress
Respiratory distress indicates that a child has a serious condition that requires immediate medical attention. Often respiratory distress quickly leads to respiratory failure. You must be able to recognize the following signs of respiratory distress: 1. A breathing rate of more than 60 breaths per minute in infants 2. ...
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Respiratory Failure/Arrest
Respiratory failure often results as respiratory distress proceeds. Many of the same factors that cause respiratory distress can cause respiratory failure. Characteristics of respiratory failure include the following conditions: 1. A breathing rate of fewer than 20 breaths per minute in an infant 2. A breathing rate of...
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Circulatory Failure
The most common cause of circulatory failure in children is respiratory failure. Uncorrected respiratory failure in children can lead to circulatory failure, and uncorrected circulatory failure can lead to cardiac arrest. That is why it is so important for you to correct respiratory failure before it progresses to circ...
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Sudden Illness and Medical Emergencies
Not many illnesses occur suddenly in young children, but most of the medical calls for children will involve sudden illnesses. It is important that you be able to recognize and treat these key pediatric illnesses.
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Altered Mental Status
Altered mental status in children can be caused by a variety of conditions, including low blood glucose level, poisoning, postseizure state, infection, head trauma, and decreased oxygen levels. Sometimes you will be able to determine the cause of the altered mental status and take steps to correct the condition. For ex...
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Special Populations_2
Key pediatric medical concerns include altered mental status and respiratory emergencies such as asthma, croup, and epiglottitis. Other serious conditions are drowning, heat-related illness, high fever, seizures, vomiting and diarrhea, abdominal pain, poisoning, and sudden infant death syndrome (SIDS).
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Respiratory Illnesses
A respiratory condition in an infant or child can range from a minor cold to complete blockage of the airway. Because infants breathe primarily through their noses, even a minor cold can cause breathing difficulties. The excessive mucus in the nose resulting from a cold makes it more difficult for an infant to breathe ...
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Asthma
A child who has asthma is usually already being treated for the condition by a physician and is taking a prescribed medication. In most situations, the child’s parents call for assistance or transport only if the child is experiencing unusual breathing difficulties. Asthma can occur in children older than 1 year; it r...
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Signs and Symptoms of croup
Signs and symptoms of croup include the following: Noisy, whooping inhalations Seal-like, barking cough History of a recent or current cold Lack of fright or anxiety Willingness to lie down
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Croup
Croup is an infection of the upper airway that occurs mainly in children who are between 6 months to 6 years. The lower throat swells and Croup occurs often in colder climates (during fall and winter) and is frequently accompanied by a cold. The child usually has a moderate fever and a croupy noise that has developed o...
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Epiglottitis
The third and most severe major respiratory condition is epiglottitis. Epiglottitis is a severe 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. Epiglottitis usually ...
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Safety
Do not examine a child’s throat if you suspect epiglottitis! An examination can cause more swelling of the epiglottis, resulting in a complete airway blockage.
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Signs and Symptoms of epiglottitis
The signs and symptoms of epiglottitis include the following: The child is usually sitting upright (he or she does not want to lie down). The child cannot swallow. The child is not coughing. The child is drooling. The child is anxious and frightened (he or she knows that something is seriously wrong). The child’s...
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Treatment_7
The child with epiglottitis must have medical attention to ensure an open airway.
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Drowning
Drowning is caused by submersion in water and initially causes respiratory arrest. It is the second most common cause of accidental death among children 5 years of age or younger in the United States. Although swimming pools, lakes, streams, and oceans present significant risks of drowning, ordinary water sources aroun...
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Heat-Related Illnesses
Heat-related illnesses may range from relatively minor muscle cramps to vomiting, heat exhaustion, and heatstroke. The most dangerous heat-related illness in children is heatstroke. Any child who is in a closed, parked car on a hot day or in a poorly ventilated room and who has hot, dry skin may be experiencing heatstr...
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High Fever
Fevers occur quite commonly in children and can be caused by many different infections, especially ear and gastrointestinal infections. Because the temperature-regulating mechanism in young children has not fully developed, a very high temperature (104°F to 106°F [40°C to 41°C]) can occur quickly even with a relatively...
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Seizures
Seizures (convulsions) can result from a high fever or from disorders such as epilepsy. Seizures can vary in intensity from simple, momentary staring spells (without body movements) to generalized seizures in which the entire body stiffens and shakes severely. Although seizures can be frightening to parents, bystanders...
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Voices of Experience
Suddenly, he made a loud noise, spit out his pacifier, and began full-body convulsions. During my EMS training, my instructor always told me I needed to learn my skills until I could do them without thinking. When we moved to the pediatrics section of the curriculum, my instructors increased their prompting to engrain ...
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Vomiting and Diarrhea
Children are very susceptible to vomiting and diarrhea, which are usually caused by gastrointestinal infections. Prolonged vomiting and diarrhea may produce severe dehydration. The dehydrated child is lethargic and has very dry skin, which can be especially noticeable around the mouth and nose. Hospitalization may be r...
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Abdominal Pain
One of the most serious causes of abdominal pain in children is appendicitis. Although it can occur at any age, appendicitis is often seen in people who are between 10 and 25 years. A cramping pain usually starts in the belly button area of the abdomen. Within a few hours, the pain moves to the right lower quadrant of ...
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Poisoning
Young children are curious and often like to sample the contents of brightly colored bottles or cans looking for something good to eat or drink. However, many common household items contain poisonous substances. The two most common types of poisonings in children are caused by ingestion and absorption.
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Ingestion
An ingested poison is taken by mouth. A child who has ingested a poison may have chemical burns, odors, or stains around the mouth and be experiencing nausea, vomiting, abdominal pain, or diarrhea. Later symptoms may include abnormal or decreased respirations, unconsciousness, or seizures. If you believe a child has in...
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Treatment_11
Do not attempt to give liquids or induce vomiting in an unconscious or partially conscious child because of the danger of aspiration of the vomitus.
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Safety_12
Be careful not to get any chemical on your skin.
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Absorption
Poisoning by absorption occurs when a poisonous substance enters the body through the skin. A child who has absorbed a poison 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. If you believe a child...
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Treatment_12
Chemical burns to the eyes cause extreme pain and injury. Gently flush the affected eye or eyes with water for at least 20 minutes. Hold the eye open to allow water to flow over its entire surface. Direct the water from the inner corner of the eye to the outward edge of the eye to avoid contaminating the other eye. Aft...
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Sudden Infant Death Syndrome
A condition that is frequently mistaken for child abuse is sudden infant death syndrome (SIDS), also called crib death or sudden unexpected infant death (SUID). It is the sudden and unexpected death of an apparently healthy infant. SIDS usually occurs in infants between the ages of 3 weeks and 7 months. The infants are...
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Pediatric Trauma
Trauma remains the number one killer of children. Each year, many young lives are lost because of accidental injury, particularly motor vehicle crashes. Treat an injured child as you would treat an injured adult, but remember the following differences: 1. A child cannot communicate symptoms as well as an adult. 2.A c...
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Patterns of Injury
The type of trauma a child experiences, the type of activity causing the injury, and the child’s anatomy affect the pattern of injuries sustained by the child. Motor vehicle crashes produce different patterns of injuries depending on whether the patient was using a seat belt, whether the patient was strapped into a car...
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Traumatic Shock in Children
Children show shock symptoms much more slowly than adults, but they progress through the stages of shock quickly. An injured child displaying obvious shock symptoms such as cool, clammy skin; a rapid, weak pulse; or rapid or shallow respirations is already experiencing severe shock. It is vital that you learn to recogn...
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Car Seats and Children
The impact of mandatory child restraint laws means that EMRs are finding more children still strapped into car seats after motor vehicle crashes. You should become familiar with child restraint seats and understand how to gain access to children restrained in them. If you find a child properly restrained in a car seat,...
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Treatment_13
Children younger than 9 years who are not in a booster seat but are wearing a seat belt are at risk for sliding out of the lap belt during a crash. Rapid, jackknife bending of the child’s body increases the chances of intra-abdominal, spinal cord, and brain injuries.
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Child Abuse
Child abuse is not limited to any ethnic, social, or economic group or to families with any particular level of education. Suspect child abuse if the child’s injuries do not match the story you are told about how the injuries occurred. Child abuse is often masked as an accident. The abused or battered child may have ma...
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Signs and Symptoms of neglect
Signs and symptoms of neglect include the following: Lack of adult supervision Malnourished-appearing child Unsafe living environment Untreated chronic illness
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Sexual Assault of Children
Sexual abuse occurs in children as well as adults. It may occur in both male and female infants, young children, and adolescents. In addition to sexual assault, the child may have been beaten and may have other serious injuries. If you suspect sexual assault has occurred, obtain as much information as possible from the...
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Signs and Symptoms_15
Signs and symptoms of child abuse include the following: Multiple fractures Bruises in various stages of healing (especially those clustered on the torso and buttocks) Human bites Burns (particularly cigarette burns and scalds from hot water) Reports of bizarre accidents that do not seem to have a logical explanation
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Emergency Medical Responder Debriefing
As an EMR, you will respond to many calls that involve children. These calls tend to produce strong emotional reactions. At times, you may experience a feeling of helplessness when an innocent child is seriously injured or gravely ill. An ill or injured child may remind you of your own children. You may feel especially...
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Prep Kit-Ready for Review
Sudden illnesses and medical emergencies are common in children and infants. Because the anatomy of children and infants differs from that of adults, emergency medical responders need special knowledge and skills to assess and treat pediatric patients. Managing a pediatric emergency can be a stressful situation for eme...
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Vital Vocabulary
asthma: A disease in which the airway becomes narrowed and inflamed, resulting in episodes of shortness of breath because of air being trapped in the small air sacs of the lungs., chest-thrust maneuver: A series of manual thrusts to the chest to relieve upper airway obstruction; used in the treatment of infants, pregna...
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Special Patient Populations
Applies a fundamental knowledge of the growth, development, and aging and assessment findings to provide basic emergency care and transportation for a patient with special needs.
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Patients With Special Challenges
Recognizing and reporting abuse and neglect
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pediatrics
Health care implications of
Abuse Neglect
pediatrics.json
knowledge
pediatrics
Pediatrics
Age-related assessment findings, and age-related assessment and treatment modifications for pediatric-specific major diseases and/or emergencies Upper airway obstruction Lower airway reactive disease Respiratory distress/failure/arrest
pediatrics.json
knowledge
pediatrics
Age-related assessment findings, and age-related assessment and treatment modifications for pediatric-specific major diseases and/or emergencies (cont’d)
Shock Seizures Sudden infant death syndrome