First Responder EMS Curriculum for Training Centers in Eurasia

c. Psychomotor ObjectivesAt the completion of this lesson, the First Responder student will be able to:1. Demonstrate the assessment of an infant and child.2. IntroductionThe First Responder will be called upon to provide emergency medical care to infants andchildren, as well as to adults. These younger patients often cause increased anxiety for theFirst Responder. Fear of failure and, more importantly, lack of experience in dealing withthis special population of patients, contribute greatly to this anxiety. There are manyspecial considerations when taking care of infant and child patients. We will learn whatmakes an infant or child unique, both in the assessment and treatment phases of emergencycare. This knowledge will significantly reduce the anxiety of the First Responder and willimprove the quality of care you deliver to infant and child patients.3. Anatomic and Physiologic ConcernsTo say that an infant or child is just a small adult may be generally accepted as true. Someimportant anatomic and physiologic differences, however, require identification. In infantsand children, the airway is notably different from that of an adult. Remembering thesedifferences will enable the First Responder to adequately manage the pediatric airway.The diameter of the airway is reduced in infants and children. Secretions and airwayswelling easily block small airways. The tongue also is large relative to the small mandible,and can cause airway obstruction in an unresponsive infant or child. Positioning the airwayis different in infants and children. The neck is not hyperextended to open the airway, as itis in adults. Hyperextension of the neck can actually further obstruct the airway in infantsand children. Also remember that infants are nose breathers. Suctioning secretions from thenasopharynx will often improve breathing problems in an infant.Children can compensate well for short periods of time when experiencing respiratoryproblems and shock. They compensate with an increased breathing rate and respiratoryeffort. Compensation, however, is followed rapidly by decompensation when therespiratory muscles become fatigued. Cardiac arrest resulting from heart problems is rarein infants and children. Cardiac arrest is most often the result of respiratory compromiseand failure. Finally, infants and children tend to lose heat more rapidly than do adultsbecause of a relative increase in body surface area to volume ratio. Keeping infants andchildren warm reduces the risk of hypothermia.4. Pediatric AirwayAirway management is reviewed in the lecture entitled Airway. This section willemphasize the essentials of pediatric airway management.Open the airway in an unconscious patient by positioning the infant or child’s airway usingthe head –tilt-chin lift maneuver. As a general guideline, extend the head and neck onlyuntil the bottom of the nose points straight up. This produces the “sniffing position” ininfants and children. This maneuver will limit potential airway obstruction caused by thetongue or other oropharyngeal muscles. Do not hyperextend the neck. Instead, placing afolded towel under the shoulders may assist in adequate positioning. In pediatric traumapatients, use the jaw-thrust maneuver with spine immobilization.206 First Responder EMS Curriculum/AIHA, July 2002