INTRODUCTION
Eleven percent of the EMS runs in Long Beach involve patients who are 14 years or younger. Optimal patient care requires that the EMT-I and EMT-P understand the differences within the various pediatric age groups and be able to confidently identify and manage the critically ill child in the field. The following topics will be discussed during this lesson:
• Anatomical Differences
• Physiological Differences
• Initial Assessment and Focused History and Physical Examination
• Pediatric Assessment Triangle
• Field Management
LESSON OBJECTIVES
At the end of this lesson the participants will be able to:
1. State at least 4 important factors to consider when dealing with the pediatric patient.
2. List the anatomical differences that can be found in the pediatric patient in regards to body proportions, airway, and musculoskeletal system.
3. List the physiological differences that can be found in the pediatric patient.
4. Describe how these anatomical and physiological differences can affect the management of these patients in the field.
5. Discuss why it may be necessary to vary your approach to a pediatric patient based on their age.
6. Perform an initial assessment and focused history and physical examination on any pediatric age group.
7. Explain how the Pediatric Assessment Triangle can help determine the severity of a child’s illness or injury and identify the potential physiologic problem.
8. Identify normal ranges for pediatric vital signs.
9. Identify the appropriate BLS field management that may be performed by EMS personnel
PATIENT DEALING WITH THE PEDIATRIC
• May feel like you are taking care of two patients when parent or guardian is present
• Common responses of caregivers to a child’s acute illness or injury: disbelief, guilt, and anger
• Children usually behave in a way consistent with how they truly feel
• The child’s appearance is generally more important than the chief complaint; always look at the child and listen to the parent
• Aggressive handling of the child can traumatize them psychologically
PEDIATRIC ASSESSMENT TRIANGLE (PAT)
• Allows the EMT-I or EMT-P to develop a general impression of the child from across the room.
• Assists in determining the level of severity, urgency for life support, and the key physiologic problems.
• PAT can be completed in 30 to 60 seconds; the three components can be assessed in any order.
6). Assess neurological status: (assess level of consciousness and neuro deficits)
Complete Glasgow Coma Score: For the child
Best Eye Opening Response:
4 Spontaneous
3 To voice
2 To pain
1 None
Best Motor Response:
6 Obedient
5 Localizes
4 Withdrawal
3 Flexion
2 Extension
1 None
Best Verbal response:
5 Oriented
4 Confused
3 Inappropriate
2 Incomprehensible
1 None
Note: Child is considered to be age 12 months to 14 years; GCS has been found to be unreliable in infants but can be used as an estimation as appropriate.
GOLDEN RULE:
The physiologic status of the child can change very quickly, so repeated
assessments are necessary.
