Pediatric Medical EmergenciesAndrea Abbas MS NRP FTO

Scenario

It’s 3 am, your unit responds lights and sirens to a residence for a 4 y.o. male

patient complaining of difficulty in breathing. You arrive to find the patient

on scene with his parents by his side. He is sitting in a tri-pod position and

lung sounds of stridor are noted with assessment. A barking cough is noted.

Nasal flaring and intercostal contractions are noted. His respiratory rate is

elevated and he is showing signs of respiratory distress. Enroute to the

emergency department his condition worsens and you note cyanosis and

irritability.

You begin to panic. The last time you cared for an unstable pediatric patient

was over a year ago. You’ve attended one pediatric webinar but chose to eat

a turkey sandwich and have a text conversation during the presentation.

You’ve had no required agency pediatric training and/or education. You

realize you’re underprepared for this medical emergency.

When Was Your Last Pediatric Focused Training Opportunity?

Internal vs. external

opportunities

What are some of the

challenges you face when it

comes to internal training?

How can you improve education

and training programs within

your

agency/department/division?

Kids Are Just Different

Anatomical differences:

Larger head

Less blood volume

Larger tongues and smaller airways

Smaller oxygen reserves

A child may be in shock and have a normal blood pressure

Bradycardia is often a response to hypoxia

The abdominal organs are closer together and less protected

Epiphyseal plates: bone growth

Kids Are Just Different

The Pediatric Assessment Triangle

Medical Emergency #1

You respond to a 5 y.o. male patient c/o difficulty breathing that began 30

minutes ago. His mother is on scene and explains that her son does not have

any significant medical history. Patient assessment reveals: a respiratory rate

of 36 breaths per minute, heart rate of 125 beats per minute, and an SPO2

showing 90% on room air. Nasal flaring is noted. Lung sounds show audible

expiratory wheezes. No fever. His skin is pale,warm,and dry.

What do you suspect?

What is the pathophysiology behind this respiratory disorder?

Pathophysiology

Treating Asthma With COVID in Mind

Weblink State of Michigan EMS Protocol:

Clinical Treatment for Patient with Suspected COVID-19 Crisis Standards of

Care [2]

Has treatment of the asthma patient changed since the COVID pandemic? How

so?

The Pediatric Assessment Triangle, ABC’s

Rapid transport decision

OPQRST

Advanced treatments to consider: Albuterol, Atrovent, Epinephrine,

Magnesium Sulfate, Prednisone, Methlyprednisone.

MI Medic Dosing Cards.pdf [3]

Medical Emergency #2

You respond to a 3 y.o. male having a witnessed seizure. His mother is on

scene and describes tonic clonic like movements lasting approximately one

minute. The child is awake and alert. He smiles. His skin is red, warm, and

dry. Patient assessment reveals: HR 140 bpm, RR 30 bpm, SpO2 95% on room

air. Axillary temperature shows 104 F. Lung sounds are clear.

What do you suspect?

What is the pathophysiology behind this neurological episode?

Pathophysiology

Treating Seizures

The Pediatric Assessment Triangle, ABC’s

Rapid transport decision, actively seizing?

OPQRST

Advanced treatments to consider: Midazolam (Versed), Lorazepam (Ativan),

blood glucose, antipyreitc

MI Medic Dosing Cards.pdf [3]

NAEMSP Study: Benzo Before Blood

Sugar [4]

The study investigated: Is routine blood glucose testing of all children in the

prehospital setting indicated?

The results:

67% of patients had a glucose recorded on chart review

14% were actively seizing on EMS arrival

0.5% of all patients were found to be hypoglycemic in the field.

The most common diagnosis was simple and complex seizures.

To view the full article click here

Publication: Mom Holding Onto Baby

Isn’t An Acceptable Transport Option [5]

This topic is becoming more widely discussed.

“Old School” mom holds the baby during transport. This is unsafe.

What about a newborn? How can you secure both mom and baby safely?

There are NHTSA guidelines outlining recommended practices (linked in the

publication below).

Many child restraints have been developed by vendors to secure young

children to the cot, to secure a child over a restrained parent, and even in

conjunction with the captain chair of the ambulance.

If children are not properly restrained in the back of the ambulance they

become projectiles.

View the full publication here. [5]

Agency Training

Does your education program

cover child restraint use?

Do new employees receive

training about these systems

during orientation?

Some child restraint systems

are complex and warrant hands

on training before use.

Bibliography

1. Sanders Paramedic Textbook 5th Edition. M. Sanders & K. McKenna 2019

2. Michigan Department of Health and Human Services EMS COVID-19

Resources.

3. Michigan MI-Medic Pediatric Dosing Cards, Michigan Department of Health

and Human Services

4. Article Bites: Benzo Before Blood Sugar: A proposed algorithm for

prehospital management of pediatric seizures. NAEMSP 2/20/2020.

5. Mom Holding Onto Baby is Unacceptable Transport Option. EMS1. T.

Nowak.3/2/2020.

CE Quiz and Evaluation

It is a requirement to complete the quiz/evaluation within two weeks of the

EMS webinar to receive your CE.

You must score at least 80% on the quiz to receive a CE award. If you score

below 80% you will be contacted.

The link to the CE quiz & evaluation can be found below and also in the email

communication containing all other course materials.

The slides have been sent to your email and are also posted on our EMS page

CE Quiz/Evaluation web-link:

https://msu.co1.qualtrics.com/jfe/form/SV_8c9ZL0KZYayO0JL

Special Guest Dr. Samantha Mishra

Contact information:

Dr. Samantha Mishra DO, MPH

EMS for Children Coordinator

Division of EMS and Trauma

Bureau of EMS, Trauma, and Preparedness

Michigan Department of Health and Human Services

Mishras@michigan.gov