NREMTP Review-Connor A. 🚑🚒 Peds
Strokes
Ischemic Stroke
TIA
Hemorrhagic Stroke
Ischemic Stroke
Due to a blood clot or a blockage in a vessel in the brain
Brain Stem
Medulla (Regulates HR, RR, Vomiting center)
Hypothalamus
Pulse Pressure
Difference between the SBP & DBP
Normal PP-30-50 120/80=40
Widened PP->50
Narrowed PP-,30
Hemorrhagic Stroke
Caused by a ruptured aneurysm
Most common cause of an aneurysm=Uncontrolled HTN
Leads to Increased ICP
Signs of Increased ICP
Cushing's Triad
Increased SBP
Bradycardia
Depressed & irregular respirations
Widened Pulse Pressure
Unequal pupils
Seizures
Rapid unconsciousness
Posturing
Brain Herniation=DEATH!!!!
Paramedic Treatment
No Hyperventilation
Secure an airway
Always give LIDOCAINE prior to intubation
Maintain ETCO2 at 30-40
HOB >30 degrees
Monitor for seizures
Check a BGL
No fluid boluses
May consider Mannitol
Beta-1-Heart
excitability
Increases the HR
Beta-2-Lungs
Beta Blockers
MOA-Block the Beta-1 response of the heart, causing a decrease in the HR, thus lowering the BP
Contraindications
HR less than 60
SBP less than 100
Sugar (Glucose) & Salt (Sodium) are DEHYDRATING AGENTS!!!!!!!!
Dehydration=Electrolyte imbalances
PEDS
Sphincter
A strong muscle that opens and closes
Pyloric Sphincter
The muscular opening that allows food to pass from the stomach to the small intestine
Stenosis
Narrowing and hardening
Pyloric Stenosis
Patho-Narrowing and hardening of the pyloric sphincter. Congenital condition in infants
Forceful projectile vomiting
Especially happens after feeding
Olive shaped mass in the abdomen
Leads to massive dehydration
Leads to Metabolic Alkalosis
Small Intestine (3 parts)
Duodenum
Jejunum
ileum
Volvulus
Twisting to the bowel (large intestine)
causes blood supply to the bowel to be cut off
Causes a large bowel obstruction
Constipation
Severe abdominal pain
Croup (Laryngotracheitis)
A Viral infection of the larynx & upper trachea
Ages 6 months-4 years
Insidious onset (Slow onset)
Symptoms
Seal bark cough
Hoarseness in the voice
Stridor
Low Grade fever
irritability
Tachycardia
Rhinorrhea (Runny nose)
Mild Croup (NO Stridor)
Humidified oxygen
Get them into a steamed-up bathroom
Get them outside into the night air
Passive cooling
Moderate/Severe Croup (+ Stridor)
Humidified oxygen
Racemic Epinephrine (nebulized epinephrine) *******
Passive cooling
Consider Steroids
Epiglottis (Peds)
Longer and floppier than an adult
Epiglottitis
DANGEROUS!!!!!!!
It can occur in both Peds & Adults
Peds-Ages-3-8 years
Bacterial Infection!!
FAST Onset
Often occurs after another infection
Symptoms
Drooling
Muffled voice
Hot potato voice
Unable to clear or swallow secretions
High grade fever
Stridor
NO COUGHING!!!!!!!
Irritable
Unable to tolerate lying flat!!!!
Paramedic Treatment
DO NOT attempt to open or even look at the airway
DO NOT attempt an IV
DO NOT separate the child from the parents
Do NOT administer nebulizers
Calm, cool, quiet environment
If that child is critical and in impending respiratory failure/complete airway obstruction....You get "1" chance to intubate!!!!!
Choose an ET Tube 1-2 sizes smaller than normal
Have a CRIC KIT readily available!!!!
Peds ET Tube
16 + Age/4
Drowning
Near Drowning
Wet Drowning-They aspirated water into the lungs/alveoli
Dry Drowning
Crackles=Rales=Pulmonary Edema
Think about the presence of Trauma
Hypothermia!!!!!!
Cardiac Arrest from prolonged hypoxia
Crackles
Accumulation of fluid in the alveoli
You MUST secure an airway!!!!=Intubation
Perform deep suctioning w/ a French Cath (Soft tipped Cath)
Use PEEP (Positive end expiratory pressure)
Consider CPAP/BiPap (If they are alert and not hypotensive)
Hypothermia
Poor circulation, poor perfusion, and drugs will have a hard time circulation
Passive warming & Active warming
Immediately remove from the water, dry them, remove wet clothing. Heat on in the ambulance
Cardiac Arrest (Peds)-V-fib/V-Tach
High-quality CPR
Immediate defibrillation
Epinephrine (0.01 mg/kg 1:10000)
Amiodarone (5 mg/kg)
OR
Lidocaine 1 mg/kg
PD on scene, especially for crowd control
Calling FD for extra resources
Our safety
Bring the cardiac monitor, backboard, Airway Bag/ACLS meds
Suspect
Drowning
Trauma
Hypothermia
respiratory arrest
Cardiac Arrest
Chest pain
ACS
Pneumonia
Pericarditis
18 y/o female who is unresponsive
Drug or alcohol OD
Sexual assault
Type 1 Diabetes
Ectopic pregnancy
Trauma=Diaphragmatic Rupture
Congenital Diaphragmatic Hernia
