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Riverbend EMS

The Pediatric Patient

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This page consist of online training for EMS personnel.  The subject of training is "Pediatric Patient".  To see more training topics,  Click Here!



Perhaps one of the most challenging calls EMS professionals encounter is the Pediatric Patient.   It is important to remember, "pediatric patient's are not just little adults".   We therefore feel it very important to share the difference between the "Glasgow Coma Scale" for the adult patient and the "Pediatric Trauma Score" for the pediatric patient.   As you will see, they are quite different but work under the same principle.   We will attempt to break the "Pediatric Trauma Score" down into sections,  hopefully,  this will provide you with a simple means of understanding the system.   Any questions, please feel free to E-mail us at any time.

Pediatric Components and Scoring:

The Pediatric Trauma Score (PTS) consist of six parameters that are common determinants of the overall condition of the injuried child. During the initial assessment of the child, all parameters should be assessed and given a numeric score based on the applicable variables. See the following chart!

+2No Injury or Non-Life Threatening
+1Minor Injury or Potientially Life-Threatening
-1Life-Threatening
Totals can range from a +12 to a -6 with the range of 8 - 9 being the critical point for transport to a comprehensive trauma care facility

Size of the Child:

The size of the child is one of the most obvious parameters assessed.    The smaller the child,  the greater the risk for severe injury.   This is due to increased body surface-to-volume ratio and a potential for limited physiological reserve.   Since there is less volume in the pediatric patient,  energy is displaced over a greater portion of the body than that of the adult.   This in turn increases the potential for multi-organ or multi-system involvement.   Moreover,  children are more susceptible to thermal stresses than that of the adult.   This is due to lack of a fully developed hypothalamus,  the hypothalamus regulates the loss and gain of heat.  See the following chart for scoring methods:

+220 kg or (44lbs.)
+110-20 kg or (22-44 lbs.)
-110 kg or (22 lbs.)

Pediatric Airway:

As with any patient,  airway assessment and management is the number one priority.   However,  it can be more difficult in the pediatric patient.   To establish a patent airway in the pediatric patient can be difficult due to anatomical differences in their airway structures when compared to the adult patient.   Respiratory failure is the Primary cause of death in most pediatric patients,  aggressive management to control the pediatrics airway should be initiated without delay!!!

ALL PEDIATIRC PATIENT'S MUST RECEIVE SUPPLEMENTAL OXYGEN!!

To identify scoring of the airway parameters, see the following chart:

+2 Normal, no airway mangement necessary
+1 Constant observation of the airway needed. Use of basic airway mangement techniques necessary
-1Use of suction or airway adjuncts, both basic and advanced airway manuvers necessary

Systolic Blood Pressure:

The Hemodynamic state of the Pedatric Patient is extremely important.   The circulating volume of the pediatric patient is signficantly less than the adult.   The pedatric patient often will not show the classic signs and symptoms of shock until it is to late.   This is due to their healthy cardiovascular system and it's reserve capacity.   The healthy heart has a 300% reserve capacity as a pump to help maintain longer periods of cardiac output.   Up to 25% volume loss could occur before any change in blood pressure may be seen.   With the new EMT Curriculum,  blood pressure determination in the pediatric patient is correlated to other cardiovascular signs and symptoms,  i.e.  peripheral pulses,  and capillary refill times.   Which ever assessment is made,  it is extremely important to note any changes in the pediatric patient.   The PTS score must be noted as well.   See the Systolic Blood Pressure parameter below for scoring:

+2 Systolic B/P 90, radial or brachial pulses present or capillary refill times 2 seconds.
+1Systolic B/P 50 - 90, carotid pulses present or capillary refill times 2 and 4 seconds
-1Systolic B/P <50, no palpable pulses or capillary refill times >4 seconds.

Level of Consciousness:

Like the adult,  the assessment of the Pediatric Patient's Level of Consciousness  (LOC)  is an extremely important determiner of the potential of Central Nervous System (CNS) injury.    Any change in the LOC will cause the score to decrease,  no matter how brief the period of change.   The scoring of this paramameter can be found in the below chart:

+2Alert and Oriented X 3. No apparent loss of consciousness.
+1Any loss of consciousness, no matter how brief the period of time.
-1Unresponsive, comatose

Fractures:

Adult bones can easily break when force is applied to them.   In the Pediatric Patient however,  when force is applied,  the bones will flex and give allowing the forces to be transmitted to the underlying organs.   The childs framework does not cover the same organs as in the adult.   The costal arch would be a good example.   The lower portion of each lung and areas of the liver and spleen are more exposed in the child when compared to the adult.   Below is the parameter for the scores.

+2 No evidence of fractures.
+1Single isolated fracture.
-1Multiple closed or any open fractures

Wounds or Soft Tissue Injuries:

Injuries or soft tissue injuries to large areas of the trunk in the pediatric patient can be much more serious than in the adult patient.   This due largely to the fact children have far less muscle or body fat than the adult.   This means the pediatric patient is not able to disperse the energey of trauma as well as the adult patient.   The forces of trauma are more easily transmitted to the core of the body and to the vital organs of the child.   This applies to blunt as well as penetrating trauma however,  more emphasis should be placed to any type of penetrating trauma to the pediatric patient.   The scoring of this parameter as follows:

+2 No wounds or skin trauma
+1Minor wounds involving the cutaneous layer
-1Major open wounds or any penetrating trauma


PEDIATRIC TRAUMA SCORE

COMPONENTS+2+1-1SCORE
Weight 20 kg (44 lbs.)10 - 20 kg (22-44 lbs.) 10 kg (22lbs.)Score here
AirwayPatentMaintainableUnmaintainableScore here
Systolic B/P 90 mm Hg50 - 90 mm Hg 50 mm HgScore here
PulsesRadialCarotidNon-PalpableScore here
CNSAwake+ LOCUnresponsiveScore here
FracturesNoneClosed or SuspectedMultiple Closed or OpenScore here
WoundsNoneMinorMajor Penetrating or BurnsScore here
TotalScoreScore-6 to 12 decreases with severity of conditionTotal Score

9 - 12 Minor trauma

6 - 8 Potentially Life Threatening

0 - 5 Life Threatening 0 Usually Fatal

Comment:

The EMS professional must feel comfortable treating the pediatric patient.  Education is the best resource available to the EMS provider.  We would love to hear your comment about this topic.  Please drop us a line, your input is very important.



This Site Designed and Maintained by:Lee Sampson/Flight Paramedic
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