9/2/2015. Brian Rogge RN, BSN, CEN, EMT-P. Child in Distress: Pediatric Medical Assessment September 08, The veterinarian story..

Transcription

1 Child in Distress: Pediatric Medical Assessment September 08, 2015 Brian Rogge RN, BSN, CEN, EMT-P Northwest MedStar Pediatric Flight Nurse Spokane County EMS The veterinarian story.. Quick review of Assessment S.A.M.P.L.E. History is a great start. Age and Weight are very important Use Broslow Tape for weight Signs and Symptoms Why was EMS called What is different Allergies Medications 1

2 Past Medical History If under 1-2 months get brief birth history ANY hospitalizations Immunizations, ask about seasonal flu (or H1N1) Last Meal or oral intake Include last medication and doses Tylenol, Ibuprofen and Cold Remedies Events leading up to the event How long have the symptoms been going on Any siblings sick School or Day Care? Capillary Refill! Central and distal Is temperature dependent especially distal How is the Child Responding to you Age appropriate? Too sick to care? Fontanels Bulging, full, flat, sunken Soft, firm Assessment Differences Know your equipment The haves The have nots Use a reference There is an app for that Pedi-wheel etc Protocol based reference Know your available resources Intrinsic Extrinsic Tools not just Skilz 2

3 Pediboard? Pedimate? Istat? Cap refill or warmth down arm Peds Patients: Meds: Allergies: Weight: (Broslow Stated EMS estimate ) Temperature Glucose Meds given (Tylenol/ibuprofen/nebs) ETT: Age/4 + 4 Depth+ diameter x3 Versed / Vecuronium 0.1mg/kg Fentanyl 1mcg/kg Epinephrine 0.01mg/kg Epi ETT 0.1mg/kg 1:1000 Atropine 0.02mg/kg (min0.1 max0.5) Sodium Bicarb 1meq/kg Ativan mg/kg (max4mg) Keppra 50mg/kg over 15min Fosphenytoin 15mg pe/kg Solumedrol 2mg/kg Succinylcholine 1 2mg/kg (atropine) Benadryl 1mg/kg Dextrose(dilute to D25) then 2ml/kg IV Maintenance 0 10kg 4x (wt) ml/hr D5 ½ unless 10 20kg x (wt 10) ml/hr Head inj or diabetic (wt 20) ml/hr Dispatched to 2 year old unresponsive CPR in progress per family Case # Game Plan (outbound leg) Vomit if needed Convert tachyarrhythmia Hint tools Resources Case #1 What you find on scene 2 year old child being carried by adult Patient is pink Unresponsive (tone?) Breathing Mom crying and states, she heard a crash and child was unresponsive in other room she immediately called EMS and started CPR 3

4 Case #1 What do you want to do? Assessment Vitals (HR 140, RR 8, Cap refill 2 secs, feels warm) Oxygen (maybe) Any other involved interventions? Resources Airway Management? Tu be.. or not Tu be. Further history Patient has had similar episode before Patient had rhythmic motion of arms and legs CPR started for stopped breathing Patient has had a fever lately No previous medications Patient normally healthy Case #1 The vitals 4

5 Dispatched to local elementary school for child choking at lunch Case #2 Case #2 What you find. Child is in office Can hear stridor from doorway Child was eating classmate s homemade cookie School has record of multiple food allergies What you do next is very dependent on scope of practice Apply diesel Stay and play Vitals (HR 140, RR 30, Cap refill delayed, BP 60/40) Patient states hard to breathe Rash noted on patient Case #2 Epi-pen? Other meds in your scope of practice IV? I/O? 5

6 Case #2 The anaphylaxis usual suspects Epinephrine 0.01 mg/kg (auto injector 0.15 and.3mg) Albuterol nebulizer Diphenhydramine 1-2mg/kg H2 blocker cimetidine or ranitidine Corticosteroids (hydrocortisone, prednisone, methylprednisolone Fluids Case #2 Food allergies and anaphylaxis in children Food allergies are the most common source of anaphylaxis in children, whereas adults are more likely to experience venom and drug-induced response (Kim & Fisher, 2011). Most common sources for food allergies in children are milk, eggs and peanuts In November 2013, President Barack Obama signed into law the School Access to Emergency Epinephrine Act (PL ) Dispatched for infant with difficulty breathing 6

7 Report and assessment. Pale child that is not reacting much to environment Deep retractions, nasal flaring and grunting Report has not been feeding well and been fussy for 2-3 days. Decreased diapers Low grade fever. Coarse wheezes in lung fields Vitals HR 170 RR Cap refill delayed to 3-4 secs SpO2 91% Weak brachial pulse Are you nervous yet? 7

8 You give oxygen per pediatric non-rebreather Start an IV? I/O? Apply Diesel? Reassess vitals HR 170 RR 35 SpO2 90% Does our respiratory rate suggest we are getting better? What this child needs: Fluids Oxygen Airway management Ventilatory management Albuterol, antibiotics Not to be pushed over the fence!!!! You are an important part of the assessment tool for the hospital (even if they don t know it) Do what you can and don t focus on what you cannot Treat your patient and not the numbers Reassess 8

9 Question #1 The time of last meal is only important if the child is old enough to feed themselves. True False Question #2 Above what age do we consider vital signs to be consistent with adults a. At weight of 125# b. At age 13 and above or puberty c. Double digit age (10 and above) d. At age 12 minus a year for each month premature they were 9

10 Question #3 The foods most commonly associate with food allergies in children are a. Fruits and vegetables b. Milk, eggs and peanuts c. Brussel sprouts and cabbage d. Strawberries, peanuts and fish Question #4 Factors that can influence capillary refill do not include: a. Ambient temperature b. Injury to site assessing from c. Patient temperature d. What you or the patient had for breakfast Question #5 A pediatric patient respiratory rate decreasing from 80 to 40 is always a good sign True False 10

11 Secret question Kids can grow out of allergies True False Questions: Brian Rogge Special thanks to Sheila Crow Stitchin Dreams Embroidery For providing our Secret Question prize 11

12 Questions? Contact: Samantha Roberts Fax: Updates Please EMS presentation, all certificates will be printed by participants or their agency. The certificate template will be available through the health training website at the same location as all presentation downloads. It will be posted the day after each monthly presentation. 12

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