Pediatric Emergency Nursing | Common Pediatric Emergencies.

 

Pediatric Emergency Nursing

Pediatric emergencies are unique due to children's physiological and developmental differences compared to adults. Quick, age-appropriate responses are essential for managing life-threatening situations in pediatric patients. This chapter outlines common pediatric emergencies, first aid and stabilization techniques, managing shock and dehydration, and the pivotal role of nurses in pediatric trauma care.

Common Pediatric Emergencies

  1. Choking
    • Causes: Foreign body aspiration (e.g., food, toys), swelling from allergic reactions, or infections.
    • Signs and Symptoms: Stridor, inability to speak or cry, cyanosis, and visible panic.
    • Management:
      • Infants (<1 year): Back blows and chest thrusts.
      • Children (>1 year): Abdominal thrusts (Heimlich maneuver).
      • Monitor breathing post-intervention and prepare for advanced airway management if necessary.
  2. Burns
    • Causes: Thermal (hot liquids, fire), electrical, or chemical burns.
    • Assessment: Use the "Rule of Nines" or pediatric-specific charts to estimate burn area.
    • Management:
      • Stop the burning process (remove the source, cool the burn with lukewarm water).
      • Cover with a clean, non-adherent dressing.
      • Administer pain relief and fluids to prevent hypovolemic shock.
      • For severe burns, initiate fluid resuscitation using Parkland formula.
  3. Seizures
    • Types: Febrile seizures (most common), epilepsy, or seizures secondary to trauma or infection.
    • Signs and Symptoms: Uncontrolled jerking movements, altered consciousness, and postictal state (confusion or fatigue).
    • Management:
      • Protect the child from injury by clearing the surroundings.
      • Do not insert anything into the mouth.
      • Place the child in the recovery position post-seizure to prevent aspiration.
      • Administer antiepileptic medication if prescribed.

First Aid and Stabilization Techniques

  1. Airway, Breathing, Circulation (ABC):
    • Ensure a patent airway using age-appropriate techniques (head tilt-chin lift or jaw thrust for trauma).
    • Provide oxygen therapy and assist ventilation if necessary.
    • Establish IV or intraosseous access for fluid and medication administration.
  2. Cardiopulmonary Resuscitation (CPR):
    • Follow pediatric-specific CPR guidelines (e.g., 15:2 compression-to-breath ratio for two-rescuer CPR).
    • Use automated external defibrillators (AEDs) with pediatric pads when indicated.
  3. Bleeding Control:
    • Apply direct pressure to bleeding sites.
    • Elevate the limb (if appropriate) and use tourniquets as a last resort for severe bleeding.

Managing Shock and Dehydration

  1. Shock in Pediatrics:
    • Types: Hypovolemic, distributive (e.g., septic shock), or cardiogenic shock.
    • Signs and Symptoms: Tachycardia, hypotension, delayed capillary refill, and altered mental status.
    • Management:
      • Administer isotonic fluids (normal saline or lactated Ringer's).
      • Monitor for signs of fluid overload, especially in neonates and infants.
      • Address the underlying cause (e.g., treat sepsis with antibiotics).
  2. Dehydration:
    • Causes: Vomiting, diarrhea, or insufficient fluid intake.
    • Types: Mild, moderate, and severe dehydration.
    • Signs and Symptoms: Sunken eyes, dry mucous membranes, reduced urine output, and poor skin turgor.
    • Management:
      • Oral rehydration therapy (ORT) for mild to moderate cases.
      • IV fluids for severe dehydration (e.g., isotonic crystalloid solutions).

Role of the Nurse in Pediatric Trauma Care

  1. Assessment and Prioritization:
    • Perform a rapid head-to-toe assessment (Primary Survey: ABCDE—Airway, Breathing, Circulation, Disability, Exposure).
    • Identify and manage life-threatening conditions immediately.
  2. Communication and Emotional Support:
    • Use age-appropriate language to explain procedures to children.
    • Provide reassurance and support to parents and caregivers during emergencies.
  3. Documentation:
    • Accurately document the nature of the injury or illness, interventions performed, and the child’s response to treatment.
  4. Collaboration:
    • Work closely with multidisciplinary teams, including physicians, social workers, and emergency personnel, to ensure holistic care.
  5. Preparedness:
Maintain readiness to handle pediatric emergencies by participating in regular training, simulations, and certifications (e.g., PALS—Pediatric Advanced Life Support).

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