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Compiled from “Brady Emergency Care – Ninth Edition”
2001Chapter 31 – Infants and Children
AssessmentPediatric Vital signs differ slightly from
adults with typically higher pulse and respiration rates, and lower blood presssures.
Younger patients may not be able to convey symptoms well making assessment more critical.
Respiratory failure and shock can occur more easily in children and should be top of mind.
Assess children with the assistance of parent or caregiver when possible.
Vital Signs – Respiration ratesNewborn 30-50Infant (1-5 mos) 25-40 6 mos – 5 yrs 20-306-10 yrs 15-30Adolescent 12-20
Note these are normal rates – conditions/stress may elevate these. Lower rates should prompt consideration of assisted ventilations.
Vital Signs – Pulse RatesNewborn 120-160Infant (1-5 mos) 90-1406-12 mos 80-140Toddler (1-3 yrs) 80-130Preschool (3-5 yrs) 80-120School age (6-10yrs) 70-110Adolescent (11-14) 60-105
Vital Signs – Blood Pressure3-5yrs 78-1166-10yrs 80-12211-14yrs 88-140
Notes – BP rarely measured on children under 3
Above numbers are systolic. Diastolic is typically 2/3 systolic.
Respiratory Difficulty - Symptoms Stridor / crowing / grunting Muscle retractions in ribs/shoulders Flared nostrils Cyanosis Decreased or increased rate
Respiratory Difficulty - TreatmentTreat with O2, maintain airway, consider
blocked airway for young children.Ventilate at 20 breaths/minUse pediatric BVM – watch rise/fall –
appropriate volumePosition head neutral / sniffing positionSmall trachea / large tongue
ShockCauses
dehydration infection trauma blood lossallergypoisoning
Signsrapid respirationscoldweak peripheral
pulsedecreased urine
outputaltered mental
statusno tears when
crying
Ventilate an infant and child mannequin.
Shock - TreatmentMaintain AirwayHigh flow O2Keep warmImmediate transportSuction carefully – vegas nerve
FeverVarious causesCool cautiously
SeizuresVarious causes – History?Maintain airway Treat for shockTransport – Epilepsy patients or other history
may defer transport.
Altered Mental StatusCauses
Poisoning Injury Illness
TreatmentAirwayTreat for shockTransport (Immediate) – Diabetic deferral
PoisoningDetermine substance if possibleCall Medical Control (ER Doc on duty) or
AMR
TreatmentMaintain airwayTreat for shockTransport
Near DrowningRule out causes
InjuriesIllness
TreatmentCPRMaintain airwayTreat for hypothermiaTreat for shockTreat any trauma
Trauma - Injury Patterns / anatomyHead – larger in proportion / lead with their
headChest – elastic ribs allow internal injuries
with no outer signsAbdomen – belly breathers, watch abdomen
for respirations
BurnsConsider percentages of burned area – rule
of nines.Sterile dry dressingsAvoid hypothermia
Abuse and NeglectPsychologicalNeglectPhysicalSexual
Physical Abuse Injury Patternsshaped weltsswellingpoorly/partially healed bruiseshigh instance of broken bones or injuriesbitesburns
Determining Signs of AbuseMultiple visits for the same patient or siblingsPast injuries – note back and buttocksPoorly healed wounds/fractures (i.e. no treatment
received)Cigarette burns, bilateral burns, glove/stocking
pattern.Caregiver responses:
Different stories for the same injuryUnconcernedDifficulty controlling angerDepressionRefusal of transport / reluctant to give history
Physical Abuse – Treatments and ProceduresTreat injuries as per protocolsDocument wellGather information in a passive mannerDO NOT accuse or pass judgmentDO report your suspicions to AMR staff and
ICVerify documentation
Special Needs ChildrenTracheostomy tubes –obstruction, dislodged,
bleeding. Suction tube, maintain airway
Ventilators – maintain airway and manually ventilate as needed.
Central IV line – infection, bleeding, clooted, cracked. Apply pressure and dress as needed.
Gastric tubes – Assure airway, asses mental status – hypoglycemic
Shunts – Maintain airway as necessary