Pediatric Training

[Spyro2500]

Don't forget to explain everything that you are doing - kids are a lot more intelligent than you think and will not take kindly to you doing something unexpected without some kind of warning! Also I second the idea of learning a couple of funny songs - and be prepared to sing them many many times! Also if time permits, ask the parent or caregiver if there is a favourite toy/stuffy the child will need - often this can really help to sooth the child.

 

[Lil Medic]

What made you pick those 2 things?

I chose those because I am close to his level with, what I think, is a slightly stronger grip on the subject. For me, those two points seem to repeat themselves often in my basic scope of thinking. faster metabolic rate with medication administration or accidental consumptions; the size things with burns, intubation, airway management, IV fluids, etc. We don't supply definitive care obviously. And again, those two ideas, seemed to re-occur throughout my reasons behind specific interventions. Or am I wrong?
But I wouldn't recommend myself as a teacher. What points would you say are 2 basic concepts for a beginner to start with? Or is the topic too broad for you to breakdown in that way? I don't claim to know much at all, but what I know I'll gladly share. Again I was only trying to help out. I guess some people get a jolly from putting others down though. Hope it gave you the boost you needed. :rofl:

 

[abckidsmom]

Indeed! You take a little human in physical pain, add some stranger danger, throw in bizarre equipment that you're planning on putting on their body, escalate the stress of their caregiver, and then try to invade their personal space.. They're going to go in lockdown/defense mode and view everyone as a threat..

There's three kinds of peds, an unresponsive one where you don't have to worry about your approach and how they view you. The screaming-out-of-control ped where you don't have to worry too much about your bedside manner because it's doubtful you can calm them down. And and the responsive terrified one who's watching every move you make and JUDGING you.

Starting out slow, being gentle, smiling while you check a babinski reflex (if time allows), counting their piggy toes, singing the "toe bone's connected to the foot bone" song... Taking the extra time to show you're not a threat can ultimately save time and make it easier as you get to more important parts of the exam where accuracy is vital.

Peds are like dogs and bees, they can smell your fear. They're so stinking receptive to body language and tone of voice.

And it totally is possible to talk them down off of the screaming cliff even after they've gotten started.

For the older than 4 set, firm words like: "I know you're scared/hurting/whatever, but I'm going to help you. You are not in trouble, I just need to talk to you right now. You can cry for another minute while I count to 10, and then I need you to stop crying. It's OK."

This really does work. You have to first establish your credibility with the mom, get the story from her and then get down and talk to the kid. Eye level to eye level, with a smiling, firm voice will work.

Even when they are really hurt, I use the same tactic with my own kids. Once my daughter (5 yo) was playing goalie against some bigger kids and took the full-on kick of the soccer ball from a 9 yo boy right to her eye. It laid her out, and she was screaming like crazy. I picked her up and brought her to the sideline, then did the, cry for a little bit more, but then you're done, and she stopped. The other moms thought that was like a magic trick, and I got to see if she was really hurt without dealing with wondering because I couldn't get a good assessment through her screaming.

Under 4, this is a bit more hit or miss, but a firm but friendly "Stop crying now, so I can check it out" (very hard to acheive that, be careful so you don't get a complaint, lol) will have good success a lot of times.

Just like they teach in EMD, giving an action with a reason is a very good way to manage people who you want to do something.

 

[Veneficus]

I guess some people get a jolly from putting others down though. Hope it gave you the boost you needed. :rofl:

Let me get this out of the way first.

There is nobody on this forum that gives me jollies or a boost.

A good day for me is being recognized by people who have easily 2 decades of education and another 3+ of experience in the highest levels of medicine and are often department heads or assistant department heads of university medical centers around the world.

I come here to try and give a little back to the EMS community because my time in it and the teachers/mentors that shared their knowledge with me has given me great benefit.

If you find that my knowledge and experience are of no value to you, you can always add me to your ignore list and you will not be burdened by my posts.

Now then, to business.

What points would you say are 2 basic concepts for a beginner to start with? Or is the topic too broad for you to breakdown in that way?

the 2 most important points I would offer to a beginner are:

1. Children are not small adults, they are almost a different organism, Their physiology is completely different and changes depending on the stage of development. You must learn these physiologic differences. All of them as well as you know adult physiology.

2. Children often do not show how truly sick they are until it is too late. Do not underestimate their condition based on how they look.

I chose those because I am close to his level with, what I think, is a slightly stronger grip on the subject. For me, those two points seem to repeat themselves often in my basic scope of thinking.

The reason I asked you why was to see your thinking, so I could help you out and show you where you are making your error.

faster metabolic rate

This is a good point, but I wouldn't say the most important to grasp and you obviously don't understand why it is important.

with medication administration or accidental consumptions;

This is inconsequential. Because children have a different physiology, medication or toxic metabolism is affected more by their various metabolic pathways than by the speed.

What is important to know is that they burn through energy stores because of higher metabolic consumption. In order to compensate in sickness, and why they crash suddenly and usually irreversibly, is because they are depleting their energy substrates like glucose, fat, and protein, in order to maintain their functions. They can and do basically "burn" themselves out. Reducing this instrinsic compensation by medical assistance as well as replacing substrates to reverse a catabolic state, will directly decide whether they live or die from whatever sickness they have.

That translates down to the need for early, aggressive, and sustained, medical intervention for children who don't look that bad. Children are not easily resuscitated once they decompensate, so allowing it to happen by not providing enough or stopping too soon basically seals their doom. I have seen it many times, I hope you do not. Especially when you are the one signing for responsibility.

the size things with burns, intubation, airway management, IV fluids, etc.

What you are referring to as "size" is more accurately described as body surface area. It does have implications in terms of injury surface area, fluid resuscitation, and medical devices.

But more importantly, it gives you an idea of the stage of development, which determines the physiological processes that are occuring or should be occuring but are not because of pathology. It also lets you know what physically is likely to be injured and the extent of the injuries. It tells you what pathological processes (aka disease states) may be present. By extension that should give you a clue as to what treatments you will need to perform and how sick the child could be or is. (the very basic EMS concept of "sick or not sick")

those two ideas, seemed to re-occur throughout my reasons behind specific interventions. Or am I wrong?

No doubt they re-occur, but it seems you misinterpreted why they are important. I would say it has less to do with specific interventions because EMS doesn't have many ped specific interventions that are not also used in adults. But it will change the way you approach treating pediatric patients compared to adults now that you understand the actual significance.

I don't claim to know much at all, but what I know I'll gladly share. Again I was only trying to help out

There is nothing wrong with that, but I would suggest that instead of looking at challenges and corrections as an affront to your knowledge, you see it as people trying to help you out by expanding and guiding your knowledge. There are quite a few very knowledgable, highly experienced, and capable providers on this forum. There are also some people directly in charge of hiring for their agencies here. There is much to be gained for free.