Pediatrics

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josh rousseau

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is there any different approach or any tips or tactics to be used when dealing with anything pediatric related?
 
Yes, lots. Do you have a specific situation in mind?
 
There's so much to it, Josh. The only quick answer I can give you is to start by asking yourself, Does this look like a sick kid? If so, transport the kid and the parent/guardian(s) asap, confirm with the adults what's different about the kid, then follow your training en route.
 
mgr22 said:
There's so much to it, Josh. The only quick answer I can give you is to start by asking yourself, Does this look like a sick kid? If so, transport the kid and the parent/guardian(s) asap, confirm with the adults what's different about the kid, then follow your training en route.
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No I understand what to do but kids donT always comply like adults so what do you do to get them to let u take vitals and stuff tips or tricks do you make animals out of gloves stuff like that do you speak in a softer voice
 
From a medical standpoint read your chapter on peds, and if you want a good general course on pediatrics you could either audit ENPC (Emergency Nursing Pediatrics Course) or purchase the book and read through it. I took ENPC before I was a nurse and it was still very applicable to my practice as a medic. Depending on who you end up working for they may have a affiliation with a children's hospital or university system that will heavily discount the course for EMS personnel (I took it for free when the local university system was pushing their education for EMS personnel).

Capillary refill is a great physical assessment sign that can be easily overlooked. Ask parents if their mentation is appropriate. Know your doses for meds, keep a cheat sheet with your meds and vitals available. If a kid is sick don't be afraid to be aggressive in your management, don't be too proud to place an IO or worse not place access and leave it to the receiving facility. Kids are great at compensating until they are out of energy, then it gets really hard to pull them back. Early oxygen/suctioning/fluids can make a huge difference.

From a less textbook standpoint I think most of it is being comfortable with kids before you get a peds call. When I was in fire I made our members who were less comfortable with kids come and teach forestry, first aid, fire safety, et cetera at the local elementary with me so that they could be comfortable with kids (specifically those they don't know) when they were healthy. Understand that you are there as a medical provider and not their friend, if a patient tells you to keep a secret about something unsafe you need to inform the receiving facility/PD/CPS.

Don't be afraid to get down to their height when you talk to them. Don't use medical jargon or overly complicated syntax, but also don't talk down to them. Be honest, the first time you lie is the last time they trust you; some of what we do hurts, even things like taking a blood pressure. Don't be afraid to engage them in whatever they enjoy, if they love paw patrol that is the new topic for the ride in. As long as it is appropriate I have pulled up you tube on my phone and we would watch cartoons on the ride in. You can hide pulse ox sensors on their toe and cover it with a sock, if it is out of sight they will often forget about it.

Personal pet peeve, if they have an appropriately sized car seat that is in good condition that is the best thing to transport in. The universal systems sold by various manufacturers are not as good despite what they want to market. Since kids are relatively megalocephalic, especially those in car seat ages, they need lateral neck support if there was an accident with any rotational or lateral forces; the universal systems do not provide this.

Pet peeve number two, don't blow up gloves. Kids will pop them and they gasp as part of their startle reflex, I have taken care of multiple kids who have aspirated gloves who either ended up with significant neurological deficits or ended up having a withdraw of care in the PICU.

See if you can get a clinical in the ED of your local children's hospital. I have EMT and Medic students all the time and a lot of the little tricks are easier to show than try to explain.
 
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Peak said:
From a medical standpoint read your chapter on peds, and if you want a good general course on pediatrics you could either audit ENPC (Emergency Nursing Pediatrics Course) or purchase the book and read through it. I took ENPC before I was a nurse and it was still very applicable to my practice as a medic. Depending on who you end up working for they may have a affiliation with a children's hospital or university system that will heavily discount the course for EMS personnel (I took it for free when the local university system was pushing their education for EMS personnel).

Capillary refill is a great physical assessment sign that can be easily overlooked. Ask parents if their mentation is appropriate. Know your doses for meds, keep a cheat sheet with your meds and vitals available. If a kid is sick don't be afraid to be aggressive in your management, don't be too proud to place an IO or worse not place access and leave it to the receiving facility. Kids are great at compensating until they are out of energy, then it gets really hard to pull them back. Early oxygen/suctioning/fluids can make a huge difference.

From a less textbook standpoint I think most of it is being comfortable with kids before you get a peds call. When I was in fire I made our members who were less comfortable with kids come and teach forestry, first aid, fire safety, et cetera at the local elementary with me so that they could be comfortable with kids (specifically those they don't know) when they were healthy. Understand that you are there as a medical provider and not their friend, if a patient tells you to keep a secret about something unsafe you need to inform the receiving facility/PD/CPS.

Don't be afraid to get down to their height when you talk to them. Don't use medical jargon or overly complicated syntax, but also don't talk down to them. Be honest, the first time you lie is the last time they trust you; some of what we do hurts, even things like taking a blood pressure. Don't be afraid to engage them in whatever they enjoy, if they love paw patrol that is the new topic for the ride in. As long as it is appropriate I have pulled up you tube on my phone and we would watch cartoons on the ride in. You can hide pulse ox sensors on their toe and cover it with a sock, if it is out of sight they will often forget about it.

Personal pet peeve, if they have an appropriately sized car seat that is in good condition that is the best thing to transport in. The universal systems sold by various manufacturers are not as good despite what they want to market. Since kids are relatively megalocephalic, especially those in car seat ages, they need lateral neck support if there was an accident with any rotational or lateral forces; the universal systems do not provide this.

Pet peeve number two, don't blow up gloves. Kids will pop them and they gasp as part of their startle reflex, I have taken care of multiple kids who have aspirated gloves who either ended up with significant neurological deficits or ended up having a withdraw of care in the PICU.

See if you can get a clinical in the ED of your local children's hospital. I have EMT and Medic students all the time and a lot of the little tricks are easier to show then try to explain.
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Thank you for the insight I really appreciate it how long does that pediatric class run
 
It is generally 2 days, typically the first day and a half are class and the second half day is simulations and testing.
 
Gonna sound strange but hear me out. An pediatric emergency doc suggested that for kids especially in the toddler range the show doc mcstuffins has reduced fear and anxiety while dealing with medical providers. It's a fun tv show that walks kids thur medical assessment and treatment. The take away it can give us as providers is if you have seen it doc mcstuffins talks thur every assessment and procedure at a kid level. Not saying show it to the kids while trying to treat them but it could be a good thing to see once to "get on their level"
There is also several card classes out there available to emts and paramedics that deal with pediatric assessment.
 
One tip I figured out the hard way -- when cleaning abrasions or shallow lacs on kids, have the parent help you do it. If you are the one irrigating and cleaning (even simple stuff), the kid often goes nuts and starts screaming. Having mom or dad do the gentle irrigation and cleaning works much better. :)
 
zacdav89 said:
Gonna sound strange but hear me out. An pediatric emergency doc suggested that for kids especially in the toddler range the show doc mcstuffins has reduced fear and anxiety while dealing with medical providers. It's a fun tv show that walks kids thur medical assessment and treatment. The take away it can give us as providers is if you have seen it doc mcstuffins talks thur every assessment and procedure at a kid level. Not saying show it to the kids while trying to treat them but it could be a good thing to see once to "get on their level"
There is also several card classes out there available to emts and paramedics that deal with pediatric assessment.
Click to expand...
No that’s a great idea I’ve seen the show it’s a good show to have on deck lmao
 
berkeman said:
One tip I figured out the hard way -- when cleaning abrasions or shallow lacs on kids, have the parent help you do it. If you are the one irrigating and cleaning (even simple stuff), the kid often goes nuts and starts screaming. Having mom or dad do the gentle irrigation and cleaning works much better. :)
Click to expand...
That’s is also a good idea thank you
 
Seeing some great tips and helpful information offered up. My advice would be to always utilize parents,caregivers and older siblings whenever possible,they are some of your most valuable on scene tools when it comes to pediatric emergency care. Family centered care even in the pre hospital setting can make an emergency go a lot smoother for all involved. But also remember the very same parents or caregivers could become your next patients so be aware. Pediatric emergency medicine is often the hardest thing there is to face in the field. Being educated and prepared by taking on extra education and asking questions will serve you well.
 
It just depends on what type of setting you work in. If you're on a critical care setting, you'll be able to do more interventions and see some really sick kids and maybe have longer transport times. As for a 911 system for a city, knowing weight based dosages for emergencies like anything cardiac/respiratory related (asthma,cardiac arrest), diabetic emergencies, and seizures are the top 3 that are the most common you'll see. The other "emergencies" are usually parents calling 911 because the child "can't breathe" (has the hiccups or coughing), "feeling hot and wants a temperature", "needs to get checked out", and countless other complaints. These typically require a child restraint and/or seatbelt on the bench along with positive emotional support to the parent(s) on the way to the hospital.
 
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