Compartments of bleeding similar to adults: thorax, abdomen, retroperitoneum, long bones (less severe), head (infants), “the street”.Thoracic skeleton and abdominal musculature not as developed or protective- more damage to internal organs.More difficult to obtain IV access due to smaller vessels, small gauge IV or IO often necessary.To increase cardiac output (CO), infants are heart rate (HR) dependent.Hypotension is a late (ominous) sign- can indicate pre-arrest!.Extremely pliable and compliant chest wall- allows for significant internal injury without external signs of trauma.Smaller functional residual capacity (FRC), desaturate more quickly than adults.High basal metabolic rate (BMR), high O2 demand.Cricoid is narrowest point in the airway.Larynx is superior and anterior (C3-C4).Relatively larger tongue and smaller oral cavity.Larger occiput- causes flexion of airway, especially when on a flat backboard.What are some specific considerations unique to pediatric patients in trauma? His obvious injuries on primary assessment include bruising to the anterior chest wall, a deformed left wrist (closed), and tenderness to palpation over the abdominal area. He comes into the ED via EMS with vitals as follows: T 36.8 HR 140, BP 90/60, RR 25, SpO2 98% RA. He was riding on a trail at approximately 40 km/hr and hit a large wood telephone pole.
A 10-year-old boy is brought into the Pediatric ED after he has been in a collision on an ATV. For more information and further pediatric emergency medicine guidelines, please visit the TREKK website. Ashley Lubberdink and Kaif Pardhan translating the pediatric guidelines that have been developed by TREKK (TRanslating Emergency Knowledge for Kids).
BROSELOW TAPE 2017 CHANGES SERIES
RJ Frascone.Editor’s note: This post represents the second in a series led by Drs.
From 2010-2011 I completed a prehospital medicine/EMS fellowship under the medical direction of Dr. Paul where I had the privilege to serve as chief resident in 2009. Residency training in Emergency Medicine brought me to Regions Hospital in St. For medical school I returned to NY and completed my MD degree at SUNY Upstate Medical University in Syracuse, NY. During undergrad I transferred my certification to Massachusetts and was employed by several private EMS agencies over the next 4 years. I earned my EMT at 18 while I was employed by the Vestal Volunteer Emergency Squad as a BLS crew chief. My career in medicine started with my certified first responder-defibrillation (CFR-D) certification by NYS at age 16. I am a practicing Emergency Physician and the Assistant Medicl Director for Regions Hospital EMS in St. We host an EMS fellowship and are affiliated with Regions Hospital EM residency. Regions EMS is an academic department providing medical direction to over 1500 prehospital provders. There are now LMA sizes for each color listed. Green- Nasopharyngeal airway is now -26 FR The major changes are with drug dosing and alittle different estimate of weights for our ‘growing’ pediatric population. The new 2011 Braselow tape has now been released. Once the new tape is considered the reference we may want to consider to having the medics change the equipment to make it match the tape. The tape does recommend some changes in equipment. Equipment is done by ideal weight, so it is reccamended to still use the measured size for the child for equipment selection. There is a reccomendation that if you have an obese child to consider going up in size for medications.
The sizing and placement of the colors have changed to go along with the increased weight of kids. I think using it as is for reference is fine. The biggest I see is the change from 15mg/kg/dose to 20 mg/kg/dose for Fosphenytoin and Phenytoin. Other changes include some small changes in medications. It has the new dosing for defibrillation that go along with the new AHA guidelines. The new Braselow tape has now been released.
BROSELOW TAPE 2017 CHANGES UPDATE
Regions Hospital Emergency Medical Services Critical Care Education Specialist gives us an update on the recently released 2012 Braselow tape.
0 kommentar(er)
