EMS World

JAN 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 33 of 51

EMSWORLD.com | JANUARY 2019 33 and then with one. It is of ten useful to show the child what you're going to do by demonstrating first on yourself or a par tner. Let them listen as well. It will build trust and calm fears. Keeping a pediatric patient in respirator y distress calm can be a significant hurdle, but it will make a ssessment and treatment significantly easier. Grunting and head bobbing are fre- quently ominous signs. Generally respi- rator y and cardiac arrest soon follow. If you notice these signs on your initial assessment, it might be time to pick up the pace and be prepared for more sig- nificant air way inter ventions. The Upper Airway Typically abnormal breath sounds can be broken down into three different catego- ries: upper air way, lower air way, and "lung tissue disease," as our friends at AHA like to call it. In this discussion we will con - centrate on the upper air way. Aberrant upper-air way lung sounds include stridor on inspiration, a barking or "seal" cough, and generalized hoarseness when speak - ing or cr ying. These sounds are vital indicators that tell us we have upper-air way obstruction. The t ypical dif ferential with upper-air- way obstruction in pediatrics will include foreign-body obstruction, croup, pertussis, and epiglottitis. From the time small children figure out how to get their hands to their mouths, they star t exploring their surroundings with their mouths. There are occasions when a plastic building block or doll shoe may find its way into the upper air way. If Barbie lost her shoe down this precious baby's right main stem, they'll need to spend some time with a local pulmon- ologist to fetch it. The best course of action here is to keep your patient calm, help them main- tain their air way on their own, and not inter vene unless necessar y. You might think you can do the hero maneuver and extract it with your magical Magill for- ceps skills, but odds are, in an uncon- trolled environment with a conscious, breathing child, you will do more harm than good. If instead you're looking at a "disease process" and not a foreign body, most frequently it will be either croup or per- tussis, commonly referred to as whooping cough. Although the terms are frequently used interchangeably, these disease pro- cesses are not the same. They are both infectious and most commonly occur in small children with smaller airways. Croup is a viral infection that typically strikes children from 6 months up to 6 years of age and af fects roughly 5% of that age group ever y year. According to the Mayo Clinic, most cases of croup are treated at home with symptomatic com- for t care. 3 Cool-mist humidifiers have been shown to be beneficial in reducing symptoms and irritation. In the back of the ambulance, we can of ten nebulize saline for the same ef fect. If the case persists longer than five days or so, a www.junkinsafety.com 3121 Millers Lane • Louisville, KY 40216 Tel: 502-775-8303 • Fax: 502-772-0548 Toll Free: 888-458-6546 S A F E T Y A P P L I A N C E C O M P A N Y Stretchers Stretcher Kits & Accessories Evacuation Chairs Backboards First Aid Fire Blankets The name in Safety, Rescue and Survival.

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