73 terms

EMT OB/Peds Exam | GFAC

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infancy
first year of life
-first month after birth is the neonatal period
0-2 months
-spend most of their time sleeping and eating
-responds mainly to physical stimuli
-cannot tell the difference between parents and strangers
-crying is the main mode of expression
-soothing necessary
-hearing is well developed
-have sucking reflex
-head control is limited
-predisposed to hypothermia
basic needs of a neonate
food, warmth, and comfort
soothing
holding, cuddling, and comforting
2-6 months
-more active
-spend more time awake, smile, and make eye contact
-strong sucking reflex, active extremity movement, vigorous cry
-follows objects with eyes
-increased awareness of surroundings
-most sleep through the night
-begin to roll over
6-12 months
-infants begin to babble
-say their first word by their first year
-learn to sit without support
-begin to crawl and walk
-begin teething and explore by putting objects in their mouth
-may cry if separated from parents
toddlers
from age 1 to 3
-experience rapid changes in growth and development
12-18 months
-begin to walk and explore
-not afraid so injuries increase
-begin to imitate behavior of older children and parents
-know the major body parts
-may speak 4-6 words
-may not be able to fully chew food
18-24 months
-mind develops rapidly at this stage (voice increases to 100 words)
-begin to understand cause and effect
-balance and gait improve
-may cling to parents or comforting toy
school aged
3-12 years
3-6 years
-able to use simple language effectively
-most rapid increase in language occurs
-can walk and run well and begin throwing, catching, and kicking during play
-toilet training is mastered
-rich imaginations
-fearful of pain
-learn which behaviors are appropriate and inappropriate
6-12 years
-begin to act more like adults
-school is important
-children begin to understand death
adolescents (13-18 years)
-able to think abstractly and can participate in decision making
-physically similar to adults
-puberty begins
-time of experimentation and risk taking
child respiratory system
-airway is smaller in diameter and shorter in length
-lungs are smaller
-glottal opening is higher and more anterior
-proportionally larger tongue
-long, floppy, U-shaped epiglottis
-less developed rings of cartilage in the trachea
-narrowed, funnel-shaped upper airway
-oxygen demand 2x that of an adult
-muscles of diaphragm dictate the amount of oxygen a child inspires
-gastric distention can interfere with diaphragm and cause hypoventilation
child circulatory system
-infants HR can be 160 beats/min or more
-able to compensate for decreased perfusion by constricting the vessels in the skin
child nervous system
-head to body ratio is larger
-occipital region of the head is larger
-subarachnoid space is smaller leaving less cushioning for the brain
-brain tissue and cerebral vasculature is fragile and prone to bleeding from shearing forces
-spinal cord injuries are less common
child GI system
-abdominal muscles are less developed --> less protected from trauma
-liver, spleen, and kidneys are proportionately larger and situated more anteriorly and close to one another --> higher risk of multiple organ injury
child musculoskeletal system
-open growth plates allow bones to grow
-bones are softer and more flexible
-thoracic cage is highly elastic and pliable
child integumentary system
-thinner skin with less subcutaneous fat
-skin burns more deeply and more easily
-higher ratio of body surface area to body mass leads to larger fluid and het losses
signs and symptoms of increased work of breathing
-nasal flaring
-abdominal breath sounds
-accessory muscle use
-tripod position
pediatric progression to respiratory failure
-efforts to breath decrease
-chest rises less with inspiration
-body has used all available energy stores and cannot continue to support extra work of breathing
-changes in behavior and eventually, altered LOC
-periods of apnea
-heart muscle becomes hypoxic --> leads to bradycardia
causes of airway obstruction
-any item they can fit into their mouth
-teeth
-blood, vomitus, secretions
signs and symptoms of partial upper airway obstruction
-decreased breath sounds
-stridor
signs and symptoms of lower airway obstruction
-wheezing
-crackles
signs of severe airway obstruction
-ineffective cough
-inability to speak or cry
-increasing respiratory difficulty, with stridor
-cyanosis
-changes in LOC
pneumonia
leading cause of death in children
-unusual breathing
-nasal flaring
-tachypnea
-hypothermia or fever
-unilateral diminished breath sounds or crackles over the infected lung segments
bronchiolitis
specific viral illness of newborns and toddlers, often caused by RSV
-cause of inflammation of the bronchioles
-virsu can survive on surfaces
-more common in premature infants and results in copious secretions
-look for signs of dehydration, SOB, and fever
OPA
-keeps tongue from blocking airway
-used for pediatric patients who are unconscious and in respiratory failure
NPA
-usually well tolerated
-used for responsive patients
-used in association with possible respiratory failure
-rarely used in infants younger than 1
-should not be used with nasal congestion or head trauma
blow-by method
-6 L/min with more than 21% O2 concentration
-less effective
-does not provide high flow
nasal cannula
1-6 L/min with 24-44% O2 concentration
nonrebreathing mask
10-15 L/min with 95% O2 concentration
BVM
10-15 L/min with 100% O2 concentration
cardiopulmonary arrest in children
-typically associated with respiratory failure
-become hypoxic and hearts slow down
signs of shock in kids
-tachycardia
-poor capillary refill
-mental status changes
-increased RR
-cyanosis
altered mental status AEIOU-TIPS
-alcohol
-epilepsy
-insulin
-opiates
-uremia
-trauma
-infection
-poisoning
-shock
individuals with greater risk for meningitis
-males
-newborns
-compromised immune systems
-history of brain, spinal cord, or back surgery
-head trauma
-shunts, pins, or other foreign bodies in brain or spinal cord
signs and symptoms of meningitis in infants younger than 3 months
-apnea
-cyanosis
-fever
-distinct high pitch cry
-hypothermia
-increasing irritability
-bulging fontanelles without crying
signs of bacterial meningitis
-small, pinpoint, cherry-red spots
-larger purple/black rash
mild dehydration
-dry lips and gums
-decreased saliva and wet diapers
moderate dehydration
-sunken eyes
-sleepiness
-irritability
-loose skin
-sunken fontanelles
severe dehydration
-mottled, cool, clammy skin
-delayed capillary refit
-increased respirations
febrile seizures
-caused by fever alone
-typically occurs on first day of febrile illness
-characterized by tonic-clonic activity
-last less than 15 minutes with little or no postictal state
number one killer of children in the US
trauma
signs of head injury
-nausea and vomiting
common ways kids are burned
-exposure to hot substances
-hot items on stove
-exposure to caustic substances
green
minor; not in need of immediate treatment
-able to walk
yellow
delayed treatment
-presence of spontaneous breathing with peripheral pulses
red
immediate response necessary
-apneic
-responsive to positioning or rescue breathing
-respiratory failure
-breathing without a pulse
-inappropriate painful response
black
deceased or expectant deceased
-apneic without a pulse
-apneic and unresponsive with rescue breathing
signs of child abuse
-you will be called to a home due to reported injury of child
-burns to penis, testicles, vagina, or buttocks
-burns that look like a glove
-fractures to humerus or femur without trauma
-child may appear withdrawn, fearful, or hostile
-parent reveals a history of accidents
SIDS
unexplained death after complete autopsy
-risk factors: mother younger than 20, smoked during pregnancy, low birth weight
interventions for death of child
-use child's name
-speak to family members at eye level
-use "died"
-acknowledge feelings
-offer to call other family members or clergy
-keep instructions short and simple
-wrap child in blanket and stay with family while they hold their child
-do not remove equipment that was used in an attempt to resuscitate
umbilical vein
carries oxygenated blood from the placenta to the fetus
umbilical arteries
carry deoxygenated blood from the fetus to the placenta
amniotic sac
-contains 500-1000 mL of fluid
-helps insulate and protect fetus
normal changes in pregnancy
-hormone levels increase
-rapid uterine growth in second trimester
-blood volume gradually increases
-number of RBCs increase
-speed of clotting increases
-patient HR increases by 20%
preeclampsia
pregnancy-induced hypertension
-develops after 20 weeks gestation
signs and symptoms of preeclampsia
-high BP
-severe or persistent HA
-visual abnormalities
-swelling in hands and feet
-anxiety
eclampsia
characterized by seizures that occur as a result of hypertension
ectopic pregnancy
-embryo develops outside the uterus (most often in fallopian tubes)
-leading cause of maternal death in the first trimester (internal hemorrhage following fallopian tube rupture)
-sudden severe pain in the lower abdomen
abortion
passage of fetus and placenta before 20 weeks
-may be spontaneous or induced
-most serious complications are bleeding and infection
pregnant women abuse
-increased risk fro domestic abuse
-increases the chance of spontaneous abortion, premature delivery, low birth weight
effects of addiction on the fetus
-prematurity
-low birth weight
-severe respiratory distress
-death
-fetal alcohol syndrome
first stage of labor
dilation of the cervix
-begins with onset of contractions
-usually the longest stage
-longer the first pregnancy
-head of fetus descends into the pelvis and positions for delivery (lightening)
second stage of labor
delivery of fetus
-begins when fetus enters the birth canal
-ends when the baby is born
-uterine contractions last longer and are closer together
-the perineum will bulge slightly
-top of fetus head will appear (crowning)
this stage of labor
delivery of the placenta
-begins with the birth of the newborn and ends with the delivery of the placenta
-may take up to 30 mins --> if it does not occur, rapid transport, there is a problem
emergency situations after delivery
-more than 30 minutes elapse prior to placenta delivery
-there is more than 500 mL of bleeding before delivery of placenta
-significant bleeding after the delivery of the placenta
CPR on newborn
-use hand encircling technique for two person
-perform BVM ventilations during pause after every third compression (3:1)
apgar score
assigns number values to
-appearance
-pulse
-grimace or irritability
-activity or muscle tone
-respirations
--> 1 minute and five minutes after
breach delivery
baby is born buttocks first
-labor takes longer
limb presentation
single arm or leg extends from birth canal
-fetus cannot be delivered in the field
-C-section needed
-cover limb with sterile towel
-never try to push or pull on it
-place patient on her back, with her head down and pelvis elevated
prolapse of the umbilical cord
umbilical cord comes out before crowning
-fetus' head compresses the umbilical cord
-do not push cord back into vagina
-place pregnant woman supine with foot of the cot raised higher with hips elevated
-insert gloved hand into the vagina, and push the fetus' head away from the umbilical cord
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