Medical and Obstetrics/​Gynecology Study Guide for the EMT Test

Pediatric Emergencies

Pediatric patients can have many of the same emergencies as adult patients, but treating children requires special consideration. You need to understand the physical and emotional differences between adult and pediatric patients.

Patient and Family Communication

When you treat a pediatric patient, in many cases, you’re also dealing with caregivers or parents. It’s important to be respectful and inform parents of what you are doing and what is happening. Parents will likely feel helpless and scared and be in need of emotional support.

Developmental Stages

Each child is unique, but they may have some similarities in development based on age. When treating children, it is helpful to have an idea of the developmental stage. Infants easily cry as you examine them and may not remain still. Toddlers may also become anxious, so keep their parents near to avoid separation anxiety. Preschool children may have a limited vocabulary but may be able to answer simple questions, such as “Where does it hurt?” School age children and teens can usually respond to questions and provide information about their symptoms. If possible, allow children in this age group to make appropriate choices, such as in which arm they want their BP measured.

Pediatric Anatomy and Physiology

Children have smaller airways and a large tongue in proportion to mouth size, which may mean it is more difficult to intubate them. Also, children have higher heart rates than adults. A child’s abdominal muscles are less developed than an adult’s, which means they have less protection from trauma to the abdomen. A child’s bones are not as hard as an adult, which means they may suffer a fracture more easily.

Pediatric Patient Assessment

During a scene size-up with a pediatric patient, make sure you have the proper equipment to treat a child. It is also helpful to do a quick assessment of the environment to determine if the conditions may have contributed to the child’s injuries or ailment. During the primary assessment, focus on the ABCs as you would with an adult. The pediatric assessment triangle (PAT) can be a useful tool. The PAT involves a quick, 30-second assessment to determine work of breathing, muscle tone, and level of consciousness. Since an infant or young child will not be able to tell you what’s wrong or give a medical history, you’ll need to rely on signs and information from parents and caregivers. Children can take a turn for the worse quickly, so careful reassessment is vital to determine if there is a change in status.

Pediatric Respiratory Emergencies

Respiratory emergencies in children can involve chronic conditions (such as asthma), infections (such as RSV and pneumonia), or acute conditions, such as an airway obstruction due to choking. Children have smaller airways and can develop breathing problems more quickly than adults. When assessing a child’s work of breathing and level of distress, look for retractions, grunting, wheezing, and nasal flaring. A child in respiratory distress requires oxygen to avoid hypoxia.

Pediatric Circulatory Emergencies

Circulatory emergencies in children, such as cardiac arrest, most commonly occur due to respiratory arrest. When a child goes into respiratory failure and oxygen levels drop, it can lead to bradycardia and cardiac arrest. If cardiac arrest does occur in a child, it is treated the same way as it is in an adult. Medication doses are less, but ACLS protocols are similar.

Pediatric Neurologic Emergencies

Neurological emergencies in children are most commonly caused by hypoglycemia, seizures, and hypoxia. It’s important to determine if the child has an ALOC, which may cause the child to present as sleepy, irritable, or combative.

Pediatric Gastrointestinal Emergencies

Stomach pain is common in children and is not usually serious. But, in some cases, abdominal pain can indicate a medical problem, infection, or injury. Appendicitis is the most common gastrointestinal emergency you will encounter in pediatric patients. Symptoms of appendicitis include vomiting, abdominal pain, and fever. Children will also likely have abdominal tenderness.

Pediatric Poisoning and Fluid Loss Emergencies

Children may ingest various substances, which can lead to poisoning. Signs of poisoning can vary based on the substance, but may include sleepiness, vomiting, and ALOC. Common sources of poisoning in children include vitamins, cleaning products, and alcohol. It is important to determine how much of the substance was ingested, when that occurred, and if there was any choking after ingesting the substance. Treatment may start with a call to the poison control hotline for information regarding a specific poison. In some cases, treatment may also include administration of activated charcoal.

Fever Emergencies

Children, especially infants, can develop high fevers when they have an infection. Common causes of fevers in children include infections, such as pneumonia and gastroenteritis. Febrile seizures (seizures due to a high fever) can also occur in children, especially infants and toddlers. If you’re called for a child who had a febrile seizure, provide monitoring of the airway during transport.

Pediatric Drowning Emergencies

Drowning is the second leading cause of accidental death in children from ages 1 to 4. Young children can even drown in bathtubs and toilets. The severity of symptoms will likely depend on how long the child was submerged in the water. Signs may include coughing, choking, or, in the most serious cases, apnea and cardiac arrest. Treatment involves BLS and ALS support and management of the ABCs, as well as rapid transport.

Pediatric Trauma

Pediatric trauma can occur in a variety of incidents, including motor vehicle accidents, falls, and sports injuries. In some cases, a child may be too young to tell you where it hurts, so you’ll have to determine injuries from an exam and witness reports. The treatment for pediatric trauma patients varies greatly depending on the injury. Keep in mind that children have less blood volume than adults and may develop shock more easily due to internal bleeding.

Disasters

When treating children who are victims of a disaster, it can be helpful to use the JumpSTART triage system. The system is intended for children less than 8 years of age. Children are triaged according to their ability to walk, breathe, and respond appropriately to painful stimuli. Children are assigned a tag color: green for minor problems, yellow for second priority patients, and red for the most serious. This system allows children with the highest priority to be transported first.

Child Abuse and Neglect

As an EMT, you may encounter a child who is a victim of abuse. Signs of child abuse include multiple injuries at different stages of healing, unusual marks that could be caused by cigarettes, and unexplained decreased levels of consciousness. Signs of neglect may include a child who appears malnourished or dirty and uncared for. EMTs are required to report incidents of suspected child abuse and neglect. Keep in mind, you do not have to prove that there is abuse. Your job is just to report suspected abuse.

SIDS and ALTE

Sudden Infant Death Syndrome (SIDS) is the unexplained death of an infant. Risk factors for SIDS include having a mother who smoked during pregnancy and having a low birth weight. Since the campaign to put babies to sleep on their back started, the incidence of SIDS has decreased, but about 3,500 babies still die every year in the U.S. from SIDS. Infants may also suffer from an apparent life-threatening event (ALTE), which involves a period of apnea and unresponsiveness, but the child resumes breathing. When treating a child with SIDS or ALTE, it’s helpful to note the environment and look for signs of abuse and objects in the child’s crib.

Terms/Concepts to Know: croup, epiglottitis, pertussis, grunting, shaken baby syndrome