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UNIVERSIDAD NACIONAL PEDRO RUÍZ GALLO
FACULTAD DE MEDICINA HUMANA
INGLÉS MÉDICO
ROSA GONZALES LLONTOP
ARBOLEDA DÍAZ OSCARBECERRA SILVA FRANKCARRASCO HERRERA DENISMENDOZA HERNÁNDEZ ALEXPISCOYA TENORIO JORGETINEO TINEO DENNY
8
COMMON PEDIATRIC
EMERGENCIES
Children are not small adults!
Recognize the acuity and implement appropriate emergency management
Discuss the etiology and natural history of common pediatric emergencies
Communicate effectively with patients, families, nursing staff, EMS personnel, ancillary service personnel, referring physicians and consultants.
GOALS AND OBJECTIVES
Asthma
Bronchiolitis
Pneumonia
Croup
Foreign Body
5 MOST COMMON RESPIRATORY EMERGENCIES
Pathophysiology Chronic recurrent lower airway disease with
episodic attacks of bronchial constriction
Precipitating factors include exercise, psychological stress, respiratory infections, and changes in weather & temperature
Occurs commonly during preschool years, but also presents as young as 1 year of age
Decrease size of child’s airway due to edema & mucus leads to further compromise
Asthma
Assessment History
When was last attack & how severe was it Fever Medications, treatments administered
Physical Exam
SOB, shallow, irregular respirations, increased or decreased respiratory rate
Pale, mottled, cyanotic, cherry red lips Restless & scared Inspiratory & expiratory wheezing, rhonchi Tripod position
Management
Assess & monitor ABC’sBig O’s (Humidified if possible)IV of LR or NS at a TKO rateAssist with prescribed medicationsPrepare for vomitingPulse oximeter Intubate if airway management
becomes difficult or fails
Basics
Respiratory infection of the bronchioles Occurs in early childhood (younger than 1 yr) Caused by viral infection
Assessment/History
Length of illness or fever has infant been seen by a doctor Taking any medications Any previous asthma attacks or other allergy
problems How much fluid has the child been drinking
Bronchiolitis
Signs & Symptoms
Acute respiratory distressTachypneaMay have intercostal and suprasternal
retractionsCyanosisFever & dry coughMay have wheezes - inspiratory &
expiratoryConfused & anxious mental statusPossible dehydration
Management
Assess & maintain airwayWhen appropriate let child pick POCClear nasal passages if necessaryPrepare to assist with ventilationsIV LR or NS TKO rateIntubate if airway management becomes
difficult or fails
Basics
Upper respiratory viral infectionOccurs mostly among ages 6 months to 3
yearsMore prevalent in fall and springEdema develops, narrowing the airway
lumenSevere cases may result in complete
obstruction
Croup
Assessment/History
What treatment or meds have been given?
How effective?Any difficulty swallowing?Drooling present?Has the child been ill?What symptoms are present & how have
they changed?
Physical Exam
Tachycardia, tachypneaSkin color - pale, cyanotic, mottledDecrease in activity or LOCFeverBreath sounds - wheezing,
diminished breath soundsStridor, barking cough, hoarse cry
or voice
Management
Assess & monitor ABC’sHigh flow humidified O2; blow by if child
won’t tolerate maskLimit exam/handling to avoid agitationBe prepared for respiratory arrest, assist
ventilations and perform CPR as neededDo not place instruments in mouth or
throatRapid transport
Basics
Common among the 1-3 age group who like to put everything in their mouths
Running or falling with objects in mouthInadequate chewing capabilitiesCommon items - gum, hot dogs, grapes
and peanuts
Aspirated Foreign Body
Assessment
Complete obstruction will present as apnea
Partial obstruction may present as labored breathing, retractions, and cyanosis
Objects can lodge in the lower or upper airways depending on size
Object may act as one-way valve allowing air in, but not out
Management – Complete Obstruction
Attempt to clear using BLS techniques
Attempt removal with direct laryngoscopy and Magill forceps
Cricothyrotomy may be indicated
Management - Partial Obstruction
Make child comfortableAdminister humidified oxygenEncourage child to coughHave intubation equipment
availableTransport to hospital for removal
with bronchoscope
Physical Assessment/Signs & symptoms
Onset very abrupt Sudden jerking of entire body, tenseness, then
relaxation LOC or confusion Sudden jerking of one body part Lip smacking, eye blinking, staring Sleeping following seizure
MILD, MODERATE, & SEVERE DEHYDRATION
Management
If mild or moderate
Give fluids orally if there is no abdominal pain, vomiting or diarrhea and is alert
Severe
High flow O2 IV/IO with NS or LR Fluid bolus of 20 ml/kg IV/IO push Repeat fluid bolus if no improvement
PEDIATRIC ATTENTION
The care of the normal newborn child, he understands a special evaluation in four moments.
NEWBORN CHILD
IMMEDIATE ATTENTION• Evaluation of the breathing,
cardiac frequency and color,Test de Apgar.
• Anthropometry and the first evaluation of age gestational.
CARE OF TRANSITION• The first hours of life of the
newborn child need of a special supervision of his temperature, vital signs and clinical general condition.
ATTENTION OF THE NCH IN PUERPERIO• Spent the immediate period of
transition the NCH remains together with his mother in puerperal.
• This period has a great importance from the educational and preventive point of view.
PREVIOUS TO BE HIGH OF WITH HIS MOTHER OF THE HOSPITAL• It is necessary to give a last general
review• The mother needs to interest and to
catch knowledge that will facilitate to him the care of his son.
CONTROL OF THE HEALTHY CHILD
PAEDIATRIC CONTROLS• There will be realized pediatrics controls of
healthy children by major frequency when the child is developing
CONTROL OF THE HEALTHY CHILD• In this examination, the doctor checks the
growth and development of the baby or of the small child and tries to find problems in time.
CONSULTATIONS OR CONTROLS• They serve to receive information about
the normal development, nutrition, dream, safety, infectious diseases " and other important topics.
CALENDAR OF ATTENTION IN PREVENTIVE HEALTH
After the birth of the baby, the following consultation
must be between 2 and 3 days after.
Of there in forward, the consultations must
happen to the following ages
1 MONTH. 2 YEAR
2 MONTH. 3 YEAR
4 MONTH. 4 YEAR
6 MONTH. 5 YEAR
9 MONTH. 6 YEAR
1 YEAR. 8 YEAR
15 MONTH. 10 YEAR
18 MONTH. 10-21 EVERY YEAR
PHYSICAL EXAMINATION
AUSCULTATION
RESPIRATORY NOISES
INFANTILE REFLECTIONS
JAUNDICE NEWBORN
CHILD
THAN
KS
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