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Special Considerations The pediatric and geriatric patients 2005 EMT-Intermediate Curriculum Bridge Course Nationwide over 30% of all patients transported are over age 65 2005 EMT-Intermediate Curriculum Bridge Course Leading Causes of Death or Disability: • Heart disease • Misuse of drugs • Cancer • Fall (leading cause of trauma related injuries) • Stroke • Fractures • Pneumonia • Mva's (2nd leading cause) 2005 EMT-Intermediate Curriculum Bridge Course Who Is Elderly ? • Society normally thinks of those who are over 65 • Patient considered elderly: – Patient physically appears elderly – Patient is middle aged with significant medical problems associated with elderly – Patient is 65 years or older 2005 EMT-Intermediate Curriculum Bridge Course Things To Consider • After age 35 the effects of aging start affecting the body's ability to function • Here are some of the things to consider when treating the elderly 2005 EMT-Intermediate Curriculum Bridge Course Things To Consider • The GEMS Diamond • Remember the following when caring for older people: – Geriatric patients – Environmental assessment – Medical assessment – Social assessment 2005 EMT-Intermediate Curriculum Bridge Course Aging Statistics • 13% of people in the US are over age 65. • “Baby Boomers” will increase this number. • Expect to see an increase in emergency calls involving older patients. 2005 EMT-Intermediate Curriculum Bridge Course Case Study • Dispatched to a residence for an 84-year-old woman who has fallen • Patient, Mrs. Reed, cannot get up. 2005 EMT-Intermediate Curriculum Bridge Course Mrs. Reed Case Study (continued) • Mrs. Reed is on the kitchen floor. • She is alert but weak. • States she fell last night • Has pain in left hip • Vital signs are normal. 2005 EMT-Intermediate Curriculum Bridge Course Mrs. Reed Living Arrangements • Most live at home. • Women are more likely to live alone. • Less than 5% are institutionalized. 2005 EMT-Intermediate Curriculum Bridge Course Case Study (continued) • You conduct a GEMS exam: – Small amounts of food, home is warm and clean – No significant medical history, no medications – Son reports that mother lives alone, no regular contact with friends 2005 EMT-Intermediate Curriculum Bridge Course Mrs. Reed Access to Essential Services • • • • Transportation Meal preparation Health care Social activities 2005 EMT-Intermediate Curriculum Bridge Course Case Study Conclusion • Mrs. Reed is transported to ED. • Report to Social Services for potential follow up. 2005 EMT-Intermediate Curriculum Bridge Course Mrs. Reed Aging • Number of people over age 65 is rising • Older people have many social and environmental concerns. • We must understand and accept aging. • Family remains the most common residence for the older population. 2005 EMT-Intermediate Curriculum Bridge Course Leading Causes of Death in Older People • • • • • Disease of the heart Cancer CVA/Stroke COPD Pneumonia 2005 EMT-Intermediate Curriculum Bridge Course Case Study • Dispatched for 79-year-old man with difficulty breathing • Says he always gets winded easily and cannot catch his breath today • Environment is clean and warm. 2005 EMT-Intermediate Curriculum Bridge Course Mr. Brophy Case Study (continued) • History of AMI, CHF, COPD, hypertension, diabetes • Pulse = 112 beats/min • Respirations = 28 breaths/min • Blood pressure = 160/96 mm Hg • ECG = A-fib • Pulse Ox = 92% on oxygen 2005 EMT-Intermediate Curriculum Bridge Course Mr. Brophy Case Study (continued) What factors influence how well Mr. Brophy can compensate for his illness? How will aging affect these factors? 2005 EMT-Intermediate Curriculum Bridge Course Mr. Brophy The Aging Body: Integumentary System • • • • Wrinkles Thinner skin Decreased fat Gray hair 2005 EMT-Intermediate Curriculum Bridge Course The Aging Body: Respiratory System • Changes in airway • Decreasing muscles of ventilation • Increased residual volume • Decreased sensitivity of chemoreceptors 2005 EMT-Intermediate Curriculum Bridge Course Respiratory • Dental prosthesis • Pulmonary function can be reduced as much as 50 % by age 75 • Reduction in gas exchange through the pulmonary capillaries • Increased respiratory rate • Overall decrease in effectiveness 2005 EMT-Intermediate Curriculum Bridge Course The Aging Body: Cardiovascular System • • • • Development of atherosclerosis Decreasing cardiac output Development of arrhythmias Changes in blood pressure 2005 EMT-Intermediate Curriculum Bridge Course Cardiovascular • Increase in PVR • Between 30 and 80, resting cardiac output decreases about 30% • Significant drop in organ perfusion • Reduction of cardiac output by as much as 50 % 2005 EMT-Intermediate Curriculum Bridge Course Cardiovascular • Diminished ability to raise the heart rate • Decrease in compliance of the ventricle • Decrease response to hormone stimulation 2005 EMT-Intermediate Curriculum Bridge Course Even without specific heart disease advanced aging produces varying degrees of congestive heart failure 2005 EMT-Intermediate Curriculum Bridge Course The Aging Body: Nervous System • • • • Brain shrinkage Slowing of peripheral nerves Slowed reflexes Decreasing pain sensation 2005 EMT-Intermediate Curriculum Bridge Course Neurological and Sensory • Brain requires a continuous supply of oxygen to function • As much as a 45% loss of brain cells • Also affected are the senses • Response to stimuli is diminished • Slowed reaction time • Decreased response to pain 2005 EMT-Intermediate Curriculum Bridge Course Renal System Changes • Renal blood flow falls an average of 50% between the ages of 30 and 80 • Decline of renal function places the older patient at greater risk of renal failure 2005 EMT-Intermediate Curriculum Bridge Course The Aging Body: Renal, Hepatic, and GI Systems • Kidneys become smaller. • Hepatic blood flow decreases. • Production of enzymes declines. • Salivation decreases. • Gastric motility slows. 2005 EMT-Intermediate Curriculum Bridge Course Case Study (continued) • Mr. Brophy appears to have a hard time hearing your questions. • Does not respond to all of your requests What are the sensory changes found in older patients? 2005 EMT-Intermediate Curriculum Bridge Course Mr. Brophy The Aging Body: Sensory Changes • Vision distorts and eye movement slows. • Hearing loss is more common. • Taste decreases. 2005 EMT-Intermediate Curriculum Bridge Course Case Study (continued) • Mr. Brophy reports feeling “down” lately. • Lives alone and has few friends still around Is this patient at risk for depression? 2005 EMT-Intermediate Curriculum Bridge Course Mr. Brophy The Aging Body: Psychological Changes • Depression • Anxiety • Adjustment disorders 2005 EMT-Intermediate Curriculum Bridge Course Case Study (continued) • When asked about medications, Mr. Brophy directs your attention to a shoebox. How does the body react to medications with aging? 2005 EMT-Intermediate Curriculum Bridge Course Mr. Brophy The Aging Body: Musculoskeletal System • • • • Decreased muscle mass Changes in posture Arthritic changes Decrease in bone mass 2005 EMT-Intermediate Curriculum Bridge Course The Aging Body: Immune System • Less effective immune response • Pneumonia and UTI are common. • Increase in abnormal immune system substances 2005 EMT-Intermediate Curriculum Bridge Course Immune System • Pre-existing nutritional problems • An increased susceptibility to infection 2005 EMT-Intermediate Curriculum Bridge Course Case Study Conclusion • Mr. Brophy is treated for exacerbation of COPD. • Admitted to hospital, found to be on interacting medications • On discharge, Mr. Brophy was given follow-up visits with a home care service. 2005 EMT-Intermediate Curriculum Bridge Course Mr. Brophy Thermoregulatory • Diminished ability to maintain normal body temperature • More susceptible to heat and cold related injuries 2005 EMT-Intermediate Curriculum Bridge Course Chronic Medical Problems • As the effects of illness and injury cumulate they result in a progressive reduction in the bodies ability to function • As this progresses the body’s ability to withstand the introduction of disease, serious or even minor trauma is reduced 2005 EMT-Intermediate Curriculum Bridge Course Assessing The Elderly Patient • Difficult to separate the effects of aging / consequences of disease or injury • The patient may fail to report significant symptoms • Pain may be diminished or absent • Chronic illness make assessment acute problems difficult 2005 EMT-Intermediate Curriculum Bridge Course Assessing The Elderly • Aging may change the individual's response to illness or injury • There may be minimal or absent fever even in the presence of severe infection • Decreased vision or hearing may diminish the patient's ability to hear or comprehend 2005 EMT-Intermediate Curriculum Bridge Course Assessing The Elderly • Vital signs may be altered by chronic medical problems, resulting in abnormal findings which are normal • Social and emotional factors may have greater impact then in other age groups 2005 EMT-Intermediate Curriculum Bridge Course Assessing The Elderly Orientation should be evaluated using factors that are relative to that patient. An elderly patient who does not work or keep a schedule may not have reason to keep up with the day of the week 2005 EMT-Intermediate Curriculum Bridge Course Assessing The Elderly Be careful not to assume that the patient who has fallen simply tripped. Take into consideration the possible underlying conditions that may be manifested 2005 EMT-Intermediate Curriculum Bridge Course Assessing The Elderly Knowledge of the medications the patient is taking will also aid in understanding the condition of the patient and possible underlying causes of the incident at hand 2005 EMT-Intermediate Curriculum Bridge Course Assessing The Elderly Elderly trauma victim’s die as a result of the same causes as trauma victims of any age, but often due to their preexisting physical condition, can die from less severe injuries and more rapidly than younger patients 2005 EMT-Intermediate Curriculum Bridge Course Physical Exam Considerations • General – Patient may fatigue easily – Patients commonly multi-layer clothing – Explain actions clearly – Patient may minimize or deny symptoms – Peripheral pulses may be difficult to evaluate 2005 EMT-Intermediate Curriculum Bridge Course Respiratory Distress: Causes • Pulmonary embolism • In silent MI dyspnea may be only initial symptom • Pulmonary edema • Asthma/copd • Respiratory infections • Cancer 2005 EMT-Intermediate Curriculum Bridge Course Cardiovascular Conditions 2005 EMT-Intermediate Curriculum Bridge Course Syncope • Carries a higher incidence of morbidity in-patients over 60 years of age • Is a primary symptom of a silent MI 2005 EMT-Intermediate Curriculum Bridge Course Myocardial Infarction • Elderly are less likely to present with classic S/S • Could present with syncope, dyspnea, abdominal or epigastric pain, and fatigue 2005 EMT-Intermediate Curriculum Bridge Course Stroke (CVA) • Strokes are more common in the elderly • TIAs are also common in the elderly – 1/3 of all patients who experience TIAs will have a major stroke • TIAs are a common cause of syncope in the elderly 2005 EMT-Intermediate Curriculum Bridge Course Called to an MVC Arrive to find a 78F sitting in passenger side of car that struck a truck broadside Pt is CAO X3, denies any pain/discomfort Vs bp 140/80 p 80 r 24 2005 EMT-Intermediate Curriculum Bridge Course Vehicular Trauma • Estimated that more then 15 million licensed drivers are over age 65 • In 1990, more then 7600 deaths were attributed to vehicular crashes • Risk of fatality from multiple trauma is estimated to be 3 times greater at age 70 then at age 20 2005 EMT-Intermediate Curriculum Bridge Course Head Trauma • Two thirds of the head-injured patients over age 65 who are unconscious on arrival at the ER do not survive • Older patients are at significantly higher risk of cervical injury 2005 EMT-Intermediate Curriculum Bridge Course Chest Injuries • Any mechanism of injury suggesting thoracic trauma must be considered potentially lethal • Injuries to the heart, aorta, and major blood vessels are a greater risk to the older patient 2005 EMT-Intermediate Curriculum Bridge Course Abdominal Injuries • Abdominal injuries are often less apparent in the elderly and require a greater index of suspicion • Elderly patients less likely to tolerate surgery / more likely to develop postoperative complications 2005 EMT-Intermediate Curriculum Bridge Course Musculoskeletal Injuries • Remember that the older patient may have decreased perception of pain • Pelvic fractures are highly lethal in the elderly • The mortality rate associated with skeletal injuries is largely due to complications secondary to the initial injury 2005 EMT-Intermediate Curriculum Bridge Course Falls • Estimated one third of the older population falls each year • 1 in 4 are hospitalized for injuries • Of hospitalized 50% die within 12 months • Fractures most common fall related injury 2005 EMT-Intermediate Curriculum Bridge Course Medications in the Elderly • Accidental drug overdose and medication noncompliance account for approximately 30% of all hospital admissions related to drug induced illness in older people 2005 EMT-Intermediate Curriculum Bridge Course Common Reasons for These Medication Mishaps Include: • Noncompliance • Forgetfulness • Confusion • Self selection • Excessive dosing or improper mixing of over the counter medications • Multiple prescriptions from multiple physicians • Changes in habits that affect drug metabolism • Vision impairment 2005 EMT-Intermediate Curriculum Bridge Course Geriatric Abuse/neglect It is estimated that between 1 and 4 percent of the geriatric population suffers from some form of abuse or neglect 2005 EMT-Intermediate Curriculum Bridge Course Some Things to Watch for Are: • Inconsistencies in history • Unexplained trauma • History inconsistent with complaint • Visible signs • Contusions, lacerations, abrasions 2005 EMT-Intermediate Curriculum Bridge Course • Fractures, sprains, dislocations • Burns • Over-sedation • Dehydration • Poor hygiene • Malnutrition 2005 EMT-Intermediate Curriculum Bridge Course SUMMARY of the Geriatric Patient • Take into consideration the changes caused by the normal aging process in assessing the ill or injured elderly patient • Carefully assess the patients’ mental status and compare with what is considered to be normal for the patient 2005 EMT-Intermediate Curriculum Bridge Course • Carefully assess the patient taking into consideration the affects of chronic conditions the patient has and any medications the patient is taking • Treat the elderly patient aggressively and support vital functions 2005 EMT-Intermediate Curriculum Bridge Course The Pediatric Patient Do you remember your first kiss? 2005 EMT-Intermediate Curriculum Bridge Course Who Is the Pediatric Patient??? • Newly-born to • 18 years old 2005 EMT-Intermediate Curriculum Bridge Course PAT: Respiratory Distress Work of Breathing Appearance Normal Increased Circulation to Skin Normal 2005 EMT-Intermediate Curriculum Bridge Course PAT: Respiratory Failure Work of Breathing Appearance Abnormal Increased or Decreased Circulation to Skin Normal or abnormal 2005 EMT-Intermediate Curriculum Bridge Course PAT: Shock Work of Breathing Appearance Abnormal Normal Circulation to Skin Abnormal 2005 EMT-Intermediate Curriculum Bridge Course PAT: Primary Central Nervous System (CNS) Dysfunction or Metabolic Abnormality Work of Breathing Appearance Abnormal Normal Circulation to Skin Normal 2005 EMT-Intermediate Curriculum Bridge Course Common Medical Emergencies • • • • • Respiratory Cardiovascular Metabolic abnormalities Neurological crises Life-threatening infections 2005 EMT-Intermediate Curriculum Bridge Course Peculiarities of the Pediatric Lung • High proportion of mucus glands • Incomplete development of airway cartilage • Small peripheral airways compared to adult lung 2005 EMT-Intermediate Curriculum Bridge Course Peculiarities of the Pediatric Lung • Less compliant than adult lung, while chest is more compliant • Airways smaller in boys than in girls • More capability of regenerating than adult lung • Tongue is relatively large, likely to obstruct airway 2005 EMT-Intermediate Curriculum Bridge Course Peculiarities of the Pediatric Lung • Larynx is high: – C2 in neonate – C3-4 in child – C5-6 in adult • Narrowest at the cricoid ring • Young infants are often obligate nose breathers 2005 EMT-Intermediate Curriculum Bridge Course Clinical Signs of Respiratory Distress • Tachypnea - rapid respirations – What’s normal? • Dyspnea - labored respirations – Retractions – Accessory muscles – Nasal flaring – Expiratory grunting 2005 EMT-Intermediate Curriculum Bridge Course Clinical Signs of Respiratory Distress • Abnormal sounds – Stridor – Wheezing – Cough – Rales, rhonchi, “crackles” – Absent breath sounds - silent chest is an ominous sign 2005 EMT-Intermediate Curriculum Bridge Course Clinical Signs of Respiratory Distress • Preferred position – Upright except in infants or the unconscious child • Initial tachycardia fast heart rate • Later bradycardia slow heart rate • Cardiac arrest 2005 EMT-Intermediate Curriculum Bridge Course Clinical Signs of Respiratory Distress • Initial anxiety and irritability • Later lethargy and coma 2005 EMT-Intermediate Curriculum Bridge Course Clinical Signs of Respiratory Distress • Cyanosis - blue skin tone – Indicates presence of hemoglobin which is not carrying oxygen – Can be masked by severe anemia – Peripheral cyanosis may result from shock – May not be obvious in newly born until oxygen level is very low 2005 EMT-Intermediate Curriculum Bridge Course Respiratory Failure • End state of any of the causes of respiratory distress • Failure of respiratory drive – Apnea due to drug overdose – Head trauma 2005 EMT-Intermediate Curriculum Bridge Course Causes of Respiratory Crisis • • • • • Asthma Bronchiolitis Croup Epiglottitis Foreign body aspiration • Laryngeal edema as part of anaphylaxis • Smoke inhalation • Fractured larynx due to trauma • Birth defects • Sids 2005 EMT-Intermediate Curriculum Bridge Course Treatment of Pediatric Respiratory Patients Assess the child’s breathing 2005 EMT-Intermediate Curriculum Bridge Course General Treatment for all Respiratory Distress • Conscious child: • Observe as much as possible without touching • Minimize handling the child How agitation affects breathing: A child with respiratory problems who is agitated or frightened by EMTs will begin breathing harder and faster. This leads to increased resistance in the air passages, which in turn worsens breathing problems. 2005 EMT-Intermediate Curriculum Bridge Course General Treatment • Keep close to parent in position of comfort • Oxygen • DO NOT attempt IV 2005 EMT-Intermediate Curriculum Bridge Course General Treatment • Obtain brief history • Perform limited physical exam - as tolerated • Do not examine or instrument the oral cavity • Administer any specific therapy indicated for child’s illness 2005 EMT-Intermediate Curriculum Bridge Course General Treatment • • • • • • Unconscious child: Open airway Suction Ventilate with oxygen immediately Coordinate with child’s effort Watch for chest movement with bagging 2005 EMT-Intermediate Curriculum Bridge Course General Treatment • Watch for improvement – The child who remains blue and bradycardic is inadequately ventilated until proven otherwise 2005 EMT-Intermediate Curriculum Bridge Course Watch the pupils: • Low blood oxygen can cause the child’s pupils to become enlarged. If the child is responding to oxygen, the pupils may get smaller. 2005 EMT-Intermediate Curriculum Bridge Course Summary • Airway problems are common and potentially lethal in children • Invasive techniques should be reserved primarily for children whose severe airway compromise has led to loss of consciousness. 2005 EMT-Intermediate Curriculum Bridge Course Cardiovascular Crisis • Cardiac arrest is almost always a complication of respiratory failure, not primary cardiac disease; mortality is high • Shock and bradycardia are most frequently encountered cardiovascular abnormalities 2005 EMT-Intermediate Curriculum Bridge Course Summary • Primary cardiac disease is uncommon in children; hypoxia, acidosis and other metabolic derangement's are much commoner causes of cardiac symptoms 2005 EMT-Intermediate Curriculum Bridge Course Metabolic Crisis - Dehydration • More frequently seen in children than in adults • Increased frequency of infections • Tendency to develop vomiting and diarrhea with viral illness • Tendency to develop higher fever than adults 2005 EMT-Intermediate Curriculum Bridge Course Signs and Symptoms • • • • • • Dry mucous membranes Absence of tears Reduced skin turgor Depressed anterior fontanel Sunken eyeballs Rapid respirations 2005 EMT-Intermediate Curriculum Bridge Course Signs and Symptoms • Hypotension (orthostatic) • Increased pulse rate 2005 EMT-Intermediate Curriculum Bridge Course Therapy of Dehydration • Definitive therapy varies with degree of dehydration – <10% can often be treated with oral fluids – >10% generally requires IV rehydration 2005 EMT-Intermediate Curriculum Bridge Course Treatment • • • • Abc's Oxygen Consider IV Notify hospital 2005 EMT-Intermediate Curriculum Bridge Course You are called to an unresponsive newly born. Upon arrival you find a 1 month old child with decreased LOC, signs of dehydration. 2005 EMT-Intermediate Curriculum Bridge Course Glucose Abnormalities • Hypoglycemia – More common in children than adults, especially in newly born and insulin dependent diabetics 2005 EMT-Intermediate Curriculum Bridge Course Signs and Symptoms • • • • • • Anxiety Sweating Tachycardia Tremors Headache Depressed level of consciousness • Seizures • Frequent urination • Excessive thirst • Vomiting, abdominal pain • Fruity odor to breath if child is ketotic (not all are) 2005 EMT-Intermediate Curriculum Bridge Course Signs and Symptoms • Signs of dehydration • Kussmaul respirations • Lethargy, coma, seizure 2005 EMT-Intermediate Curriculum Bridge Course Signs and Symptoms • • • • • In neonates Tachypnea or apnea Jitteriness Color changes NO visible signs at all 2005 EMT-Intermediate Curriculum Bridge Course Treatment • Check chemstrip <60% treat • Administer sugar-containing fluid by mouth if child is conscious and able to tolerate oral intake • 1 - 2 cc/kg D25 if IV access is available 2005 EMT-Intermediate Curriculum Bridge Course Treatment • Remember that prolonged significant hypoglycemia can result in permanent CNS injury or death • If in doubt give sugar • Repeat chemstrip q 10 - 15 minutes 2005 EMT-Intermediate Curriculum Bridge Course Neurological Crisis • Seizures – Abnormal electrical discharge from the brain; often results in motor activity but may be manifested as a period of unawareness or visual or auditory hallucinations 2005 EMT-Intermediate Curriculum Bridge Course Causes of Seizures • Febrile convulsions – Most common in children 6 months to 6 years • CNS infections – Meningitis – Encephalitis – Brain abscess 2005 EMT-Intermediate Curriculum Bridge Course Causes of Seizures • Toxic ingestion – Lead, cocaine, PCP, amphetamine, aspirin • Withdrawal from: – Narcotics, benzodiazepines, cocaine 2005 EMT-Intermediate Curriculum Bridge Course Causes of Seizure • • • • • Metabolic Trauma Epilepsy Brain tumor Stroke 2005 EMT-Intermediate Curriculum Bridge Course Treatment for Seizure • • • • • • ABC’s Oxygen Support ventilation Protect child from injury Check chemstrip Consider anticonvulsant therapy if seizure continues 2005 EMT-Intermediate Curriculum Bridge Course Neurological Crisis • Coma – A disturbance of consciousness in which patient becomes unaware and unresponsive to stimuli 2005 EMT-Intermediate Curriculum Bridge Course Common Causes of Coma • • • • • Hypoglycemia, diabetic ketoacidosis Meningitis, encephalitis Cerebral hypoxia/ischemia Cerebral edema Intoxication/drug overdose 2005 EMT-Intermediate Curriculum Bridge Course Common Causes of Coma • • • • • • Reye syndrome Epilepsy Severe hypothermia or hyperthermia Intracranial hemorrhage or contusion Brain tumor Increased ICP 2005 EMT-Intermediate Curriculum Bridge Course Reye Syndrome • Cause unknown – Associated with influenza, – Chicken pox, – Use of aspirin – Gastroenteritis • Occurs in children 5 - 15 years • Fall and winter 2005 EMT-Intermediate Curriculum Bridge Course Reye Syndrome • • • • Should be considered a serious disease Respiratory failure Cardiac arrhythmias Acute pancreatitis 2005 EMT-Intermediate Curriculum Bridge Course Treatment of Coma • Abc's • Oxygen • En route focused assessment – Check for signs of trauma, rash, bruises, patients breath, 2005 EMT-Intermediate Curriculum Bridge Course Treatment of Coma - History • Has child had recent symptoms of infection? • Has child sustained any trauma recently? • Has he access to medications, alcohol, or household toxins? 2005 EMT-Intermediate Curriculum Bridge Course Treatment of Coma - History • Does he have diabetes or any history of blood sugar abnormalities? • Has he has unexplained headaches or vomiting? • What medications does he normally take? 2005 EMT-Intermediate Curriculum Bridge Course Treatment of Coma - History • Did his diminished responsiveness develop gradually following a period of increasing lethargy or was it of sudden onset with no premonitory signs? • Has he had any periods where he stopped breathing or appeared cyanotic? 2005 EMT-Intermediate Curriculum Bridge Course You are called to an 18 month old child who is said to be unresponsive. The mother tells you that the child has had a cold for a few days, today developed a fever and rapid breathing, she is having difficulty waking the child. 2005 EMT-Intermediate Curriculum Bridge Course Your initial assessment reveals a pale child with poor muscle tone, who does not appear responsive to his surroundings. 2005 EMT-Intermediate Curriculum Bridge Course How will you care for this child? 2005 EMT-Intermediate Curriculum Bridge Course Life-threatening Infections • Young children are particularly prone to serious infections – Immune systems are not fully developed – No sense of hygiene and explore the world with their mouth – Day care settings greater exposure to a variety of pathogens 2005 EMT-Intermediate Curriculum Bridge Course Life-threatening Infections • Recognition - consider in any child that presents with – Altered mental status, – Cardiovascular compromise – Respiratory compromise – Normal, high or low body temperature 2005 EMT-Intermediate Curriculum Bridge Course Sepsis • Illness resulting from invasive infection, including spread of pathogens or toxins via the blood stream; usually due to bacteria but may result from overwhelming viral or fungal infection • Some endocrine diseases, e.G. Diabetes or disorders of metabolism can mimic sepsis syndromes 2005 EMT-Intermediate Curriculum Bridge Course Meningitis • Infection of the meninges and cerebrospinal fluid • Most serious forms result from bacterial infection • Highly contagious 2005 EMT-Intermediate Curriculum Bridge Course Signs and Symptoms of Meningitis • • • • • • • Fever Irritability, lethargy Headache Vomiting Seizures Stiff neck Recent ear infection 2005 EMT-Intermediate Curriculum Bridge Course Signs and Symptoms • • • • Dehydration Decreased LOC Mottling, color changes Bulging fontanel 2005 EMT-Intermediate Curriculum Bridge Course 2005 EMT-Intermediate Curriculum Bridge Course Serious bacterial infection (SBI) • Any invasive bacterial infection e.g. pneumonia, meningitis, sepsis. • Unsuspected trauma, as in nonaccidental trauma/child abuse can present as SBI. 2005 EMT-Intermediate Curriculum Bridge Course SBI Symptoms • • • • • • Listlessness Lethargy Decreased oral intake Floppiness Moaning Cry Decreased activity level • Labored or rapid breathing • High-pitched cry • Decreased urine output. • Grunting • Vomiting • Poor Color • Bilious vomiting • Elevated temperature • Hypothermia 2005 EMT-Intermediate Curriculum Bridge Course Treatment for life-Threatening Infections • • • • • ABC’s Oxygen Respiratory support If febrile cool History – Very important! – if the child was well 3 hours ago and is now very ill, SBI is likely • Transport 2005 EMT-Intermediate Curriculum Bridge Course One “Pill” Killers • Theophylline • Imipramine (tricyclics) • Clonidine • Camphor • Verapamil • Propanolol 2005 EMT-Intermediate Curriculum Bridge Course Trauma in Oregon 1997 1998 • • • • • • 3090 children infant to 18 years 444 children died 210 deaths related to MVCs 45 from suicide 60 occurred due to violence boys were injured twice as often as girls 2005 EMT-Intermediate Curriculum Bridge Course Oregon Trauma System • • • • • • • 8.4% of injuries were intentional 91.6% of injuries were unintentional. 1208 children were tested for blood alcohol. 270 tested positive. 163 were involved in a motor vehicle crash, 27 were injured by a cutting or piercing object 21 by firearms. 2005 EMT-Intermediate Curriculum Bridge Course Oregon Trauma System • 575 children were tested for drugs. • 172 tested positive for one or more drugs. 2005 EMT-Intermediate Curriculum Bridge Course Cannabis 60.5%, amphetamine 14.8%, Opiates 9.0%, Benzodiazepine 7.1%, Cocaine 4.8%, Barbiturate 2.9%, Other 1.0%. References • Cristofani, C. B., J. Fairchild, and W. B. Long. Pediatric Prehospital Care Courses. Oregon Emergency Medical Services for Children, 1990. • TRIPP Instructor course 2005 EMT-Intermediate Curriculum Bridge Course