First Responder EMS Curriculum for Training Centers in Eurasia

6. Common Problems in Infants and Childrena. Airway ObstructionsAs discussed earlier, airway obstructions are common in infants and children.Management of these patients requires a systematic approach. The First Respondershould differentiate between partial and complete airway obstruction. An infant or childwith a partial airway obstruction is alert (not unresponsive), pink, with possible chestwall retractions and stridor. The First Responder should allow the patient to be in aposition of comfort. Do not place the patient in a supine position. An infant or childwith a complete airway obstruction generally has an altered mental status, ineffectivecough, inability to speak or cry, stridor, and ultimately unresponsiveness. The child willbecome cyanotic (blue). In complete airway obstruction, the First Responder shouldattempt to clear the airway using back blow, chest thrust, and abdominal thrustprocedures as previously discussed. Attempt artificial ventilation with the mouth-tomasktechnique.b. Respiratory EmergenciesMore than 80% of cardiac arrests in infants and children are the result of a primaryrespiratory arrest. Respiratory distress is a condition of increased work of breathing,ultimately leading to respiratory failure if untreated. Several signs and symptomsindicate respiratory distress: a respiratory rate greater than 60 in infants or 30/40 inchildren, nasal flaring, intercostal muscle retractions (between the ribs), supraclavicularmuscle retractions (neck), subcostal muscle retractions (below the margin of the rib),stridor on inspiration, cyanosis (blue skin color), an altered mental status (combative,unresponsive), and grunting.Respiratory failure/arrest follows respiratory distress if the underlying cause is nottreated. Signs and symptoms of respiratory failure include a breathing rate of less than20 in an infant and a respiratory rate less than 10 in a child, unresponsiveness, limpmuscle tone, slow or absent heart rate, weak or absent distal pulses, as well as cyanosis.The role of the First Responder is to complete the First Responder assessment.Complete a scene size-up before initiating emergency medical care. Complete an initialassessment on all patients. Complete a physical exam as needed. Complete ongoingassessments. Note the heart rate. Provide mouth-to-mask barrier device ventilations.Comfort, calm, and reassure the patient and family.c. Circulatory FailureUncorrected circulatory failure results in shock followed by death. Uncorrectedcirculatory failure is a cause of cardiac arrest in infants and children. Common causes ofcirculatory failure and shock in infants and children include dehydration from vomitingand diarrhea, infection, trauma, and blood loss. Signs and symptoms of circulatoryfailure include an increased heart rate, unequal central and distal pulses, poor skinperfusion resulting in pallor or cyanosis, and mental status changes.The role of the First Responder is to complete the First Responder assessment.Complete a scene size-up before initiating emergency medical care. Complete an initialassessment on all patients. Support oxygenation and ventilation. Observe signs ofcardiac arrest. Complete a physical exam as needed. Complete ongoing assessments.Comfort, calm, and reassure the patient and family.First Responder EMS Curriculum/AIHA, July 2002 209