2. Pediatric Assessment Pediatric Definitions Assessment of pediatric patient must take into account the characteristics of a child’s anatomy and physiology at each stage of development. Medical For the purpose of this protocol a “pediatric patient” is defined as a child who fits on the Broselow tape (36 kg or 145cm). If longer than the Broselow tape, they are considered an adult. Use of the Broselow tape is recommended if performing invasive procedures on all pediatric patients. While this protocol does not address some emotional and developmental issues, for the most therapies, the use of length-based determination of equipment and medication is evidence based. Use of the Broselow tape is particularly helpful in a situation where there in no confirmed weight or age. Legal *In the case of behavioral of emotional problems, a pediatric patient is defined as any child less than 15 years of age. *The legal definition of a child is one who has not yet reached his/her eighteenth birthday and is not emancipated. *With the exception of life threatening emergencies, EMS personnel are to attempt to contact the child’s parent or legal guardian and or obtain the guardian’s informed consent to treat and transport the child. Interpreting a child’s vital signs and symptoms as though they were an adult may result in an inaccurate assessment and incorrect treatment. Pediatric Ventilation Guidelines Respiration Rate Ventilation Age Too Slow Too Fast Breaths/Minute Newborn < 30 >80 40-60 Infant < 20 > 70 30-40 1-6 Yrs < 16 > 40 20-30 6-12 Yrs < 12 > 30 16-20 12-16 Yrs < 10 > 24 12-16 Pediatric Vital Signs by Age Age Heart Rate Respiration Systolic BP Avg. Range Range Avg. Range Newborn 140 90-170 40-60 72 52-92 1 month 135 110-180 30-50 82 60-104 1 year 120 80-160 20-30 94 70-118 2 years 110 80-130 20-30 95 73-117 4 years 105 80-120 20-30 96 65-117 6 years 100 75-115 18-24 97 76-116 8 years 90 70-110 18-22 99 79-119 10 years 90 70-110 16-20 102 82-122 12 years 85 60-110 16-20 106 84-128 14 years 80 60-105 16-20 110 84-136
Obstruction of airway(secondary to secretions, blood, and/or any other substance) in a patient currently being assisted with an airway adjunct such as NPA , OPA tube, Combi-tube/King Airway, tracheostomy tube or a cricothyrotomy tube. Procedure: Ensure the suction device is operable. Preoxygenate the patient. Keep an aseptic technique, attach the suction catheter to the suction unit. If applicable, remove devices from airway. Insert sterile end of catheter into the tube without suction. Insert until resistance is met, pull back approximately 1-2 cm. Once the desired depth is met apply suction by occluding the port and slowly remove the catheter from the tube, using a twisting motion. Suction duration should not exceed 15 seconds. May use saline flush to loosen and facilitate suctioning. Reattach the ventilation device and oxygenate the patient. AIRWAY/BREATHING AIRWAY/BREATHING GUIDELINES GUIDELINES OF AIRWAY ASSESSMENT PARTIAL OBSTRUCTION May include coughing with some air movement. Give 100% Oxygen and encourage the patient to cough. Monitor for change. Transport immediately. FOREIGN BODY AIRWAY OBSTRUCTION(FBAO) Should be removed immediately if able, Using AHA guidelines for airway obstruction (Abdominal trusts, or on unconscious victim CPR. Visualize airway and either suction or sweep out liquids and other materials Solids must be with finger or instrument. GUILDLINES OFBREATHING ASSESSMENT STRIDOR High pitched crowing sound caused by obstruction of upper airway. (Epiglottis/Croup) WHEEZING A whistling or sighing sound, usually lower airway and found upon expiration (Asthma) RALES Fine to course crackle representing fluid in the lower airway (CHF) COPD Pulmonary disease (emphysema/chronic bronchitis) that is characterized by chronic typically irreversible airway obstruction resulting in slower rate of exhalation. EPIGLOTTITIS Inflammation of the epiglottis is usually caused by Hemophilus influenza type B bacteria 35 KEY POINTS Airway Assessment: