Pediatrics: Scene Management - The Missing Piece.
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Pediatric Emergencies are difficult for everyone. Emotions run high for patients, parents, bystanders and yes, even emergency responders. In addition, trying to recall or look-up pediatric-specific vitals, values and medication doses can be tremendously stressful. Because of this, providers often miss the simple steps that can make an important difference in our care. With an approach of “first-things-first” this program will show how to manage the scene of a pediatric emergency with confidence, care and compassion. Find more at www.romduckworth.com
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Pediatrics: Scene Management - The Missing Piece.
- 2. www.romduck.com “It’s hardly ever good when the rescuer’s pulse or respiratory rate is greater than that of their pediatric patient.” -Lou E. Romig MD, FAAP, FACEP www.jumpstarttriage.com Romig’s Rule of Vital Sign Comparisons
- 3. www.romduck.com Pediatric Emergencies Scene Management: The Missing Piece Arrangement Prep and Plan ahead Assurance Communicate with family and bystanders Assessment Communicate with patient Action Lead, follow or get out of the way.
- 4. www.romduck.com Crapronyms AAAAAAAAAAAAAAAAAAAAAAAAAY! (Arrangement) Always assign an assistant ahead. (Assurance) Anticipate and answer adult anxiety, agitation and aggressive appearance. (Assessment) Arrive assuming an age appropriate assessment. (Action) Adapt and allow awesome action, You! Crappy Acronyms
- 5. www.romduck.com Arrangement (because you’re in EMS) References Broslow Tape Pedi-Wheel Reference Cards Reference Books Smart Phone Apps
- 6. www.romduck.com Arrangement (At the start of shift) Check your gear What Peds equipment? How do we carry it? Where do we carry it? Is it ready to go?
- 7. www.romduck.com Arrangement (before you step out) What is our game plan? Who is the Clinical Lead? With whom are we interfacing? What is our Good / Bad plan? Everybody take a deep breath.
- 8. www.romduck.com Assurance (they’ll meet you at the door) Family and Bystanders Expectations? “Who are you?” What to do Be Polite Be Caring Assign Assistance Balance Calm and Concern
- 9. www.romduck.com Assurance (they’ll meet you at the door) Family and Bystanders Differing Cultures “Who are you talking to?” Be Polite Be Caring Assign Assistance Balance Calm and Concern Know Your Response Area
- 10. www.romduck.com Assurance (Makes Parents Happy) Treat your children well. LISTEN to parent and child. Ask (and use) their name. Keep them comfortable. Pain Management Emotional Comfort Relieve fear and anxiety
- 11. www.romduck.com Assurance (Makes Parents Happy) Treat your children well. Each and every child is the most… Special Smart Beautiful Whatever you can think of …child in the world.
- 12. www.romduck.com Assessment: What do we need to know? Can you tell if the child is Critical or Not Critical just by looking at them?
- 13. www.romduck.com The Pediatric Assessment Triangle Adapted from the AAP’s Pediatric Education for Prehospital Professionals (PEPP) course. www.PEPPsite.com Critical= QUICK Not Critical= Not QUICK
- 14. www.romduck.com General Appearance Are they with it or out of it? T Tone I Interactiveness C Consolability L Look/gaze S Speech/cry
- 15. www.romduck.com Work Of Breathing Be W Work A Abnormal Sounds R Retractions E Extreme Nasal Flaring Are they fighting for air?
- 16. www.romduck.com Circulation to Skin T Temperature - Skin T Time - Capillary Refill P Pulse Are they compensating?
- 17. www.romduck.com Respiratory Distress Gen. Appearance With it or not? Critical or Not Critical Circulation to Skin? With it Normal Critical Work of Breathing Fighting for air? Fighting
- 18. www.romduck.com Seizure? Hypoperfusion? Gen. Appearance With it or not? Work of Breathing Fighting for air? Circulation to Skin? Not with it Normal Abnormal Critical or Not CriticalCritical
- 19. www.romduck.com Hypovolemic Shock? Gen. Appearance With it or not? Work of Breathing Fighting for air? Circulation to Skin? Normal Normal Abnormal Critical or Not CriticalCritical
- 20. www.romduck.com Not Critical. Cold? Gen. Appearance With it or not? Work of Breathing Fighting for air? Circulation to Skin? Normal Normal Normal Critical or Not CriticalNot Critical
- 21. www.romduck.com Assessment Any single RED FLAG = SICK Critical= QUICK Not Critical= Not QUICK
- 22. www.romduck.com Caring for Critical Kids Airway Obstruction Choking Croup Epiglottitis Trauma RespiratoryF ailure Cardiac Arrest Respiratory Depression Seizures Poisoning Overdose Head Injury
- 23. www.romduck.com Caring for Critical Kids Fluid Loss Bleeding Vomiting Dehydration Burns Circulatory Failure Cardiac Arrest Fluid Distribution Anaphylaxis Sepsis Sick Heart Hurt Heart
- 24. www.romduck.com Inconsolable Infants T – Trauma (bites?) I - Infection M – Maternal Stress S – Strangled Part (Hair Tourniquet?) C – Cardiorespiratory Disease R - Reflux I – Intolerant of Milk E - Eyes S – Surgical (testicular torsion)
- 25. www.romduck.com Action: Tips for Tots
- 26. www.romduck.com Infant 1 mo. – 1 yr. Try to keep the child with a caregiver or familiar face. Use reassuring facial expressions and tone. Little stranger anxiety at this age. Will accept undressing but will want to stay warm. Toe to Head Exam. Have parent / caregiver assist with exam. Just LOOK at those chubby cheeks!
- 27. www.romduck.com Toddler 1 yr. – 3 yr. Use family, friends, toys to reassure. May perceive illness as punishment. Learning independence and modesty. They’ll understand more than they can speak. Be selective in undressing. Avoid hog-tying them, but don’t wait around forever for cooperation.
- 28. www.romduck.com Pre-School 3 yr. – 6 yr. Greatly fear blood, pain and “disfigurement”. Independent and modest. Explain what’s happening in child’s terms. Curious and talkative. Like to have choices.
- 29. www.romduck.com School Age 6 yr. – 12 yr. Question the patient directly. Respect, do not “baby” them. Do not embarrass them. Talk directly to your patient. Explain what’s going to happen. Ask about common interests. Movies, School, Sports
- 30. www.romduck.com Adolescent >12y/o Identity and peer relationships are a priority. Body image &“disfigurement” are of great concern. Emotional response can be highly understated or exaggerated. Patient may regress to an earlier emotional stage. Variable development in this group can make contact difficult.
- 31. www.romduck.com Adolescent >12y/o Be careful not to be aggressive or condescending. Approach physical assessment as with an adult. Do not try to be “Cool”, “With it” or “Jiggy”. Be cautious when questioning about drugs, sexual history or other sensitive issues. Do NOT lie to the patient. Be reassuring and respectful.
- 32. www.romduck.com Action: Transport (Let’s go!) Child Stretcher Car Seat Their Own Built-In Inflatable Flexible
- 33. www.romduck.com Action: Transport (Let’s go!) Family & Bystanders Get A Ride Ride with us Front Back Drive Themselves
- 36. www.romduck.com Crapronyms! Arrangement Prep and Plan ahead Assurance Communicate with family and bystanders Assessment Communicate with patient Action Lead, follow or get out of the way. AAAAAAAAAAAAAAAAAAAAAAAAAY!