EMT Exam: Tips for Dealing with Medical Situations with a Pediatric Patient

By Arthur Hsieh

Several pediatric medical conditions are commonly seen by EMTs. In the majority of cases, your care is supportive — ensure that problems with airway, breathing, and circulation are identified and managed, and help maintain body temperature and oxygenation during transport. In some situations, you may need to intervene quickly.

Problem Signs and Symptoms Action Steps
Foreign body airway obstruction No air exchange; no crying or other sounds; rapid loss of
consciousness, skin turns pale and then cyanotic.
Infant, conscious: Five back blows and chest thrusts.
Child, conscious: Abdominal thrusts.
Child, unconscious: Perform CPR and attempt to ventilate, check
airway to see whether obstruction can be removed.
Croup Fever; hoarseness; barky cough; difficulty breathing. Provide supplemental oxygen. Change in air temperature or
humidity may reduce symptoms.
Epiglottitis High fever; difficult, painful swallowing; drooling; tripod
positioning.
Maintain patient’s position of comfort. Do not inspect or
probe mouth. Provide supplemental oxygen, humidified if possible,
using blow-by method.
Asthma Wheezing lung sounds; difficulty breathing, especially during
exhalation; pursed lips, accessory muscle use; coughing.
Maintain patient’s position of comfort. Assist with
patient’s metered dose inhaler if prescribed. Administer
oxygen if saturation level is low or patient is having difficulty
breathing.
Fever Very warm skin, especially on the chest and abdomen; high
temperature using a thermometer; may cause a febrile seizure.
Dehydration may be associated with the fever.
Remove most clothing. Be alert for shivering as it may cause
the fever to rise. Ice chips may provide comfort.
Meningitis (inflammation of the membranes surrounding the brain
and spinal cord)
High fever; neck pain, tenderness, or rigidity; severe
headache; hypersensitivity to bright light; nausea, vomiting.
Meningitis can be highly contagious. Wear respiratory
protection. Prepare to manage airway and ventilations if
respiratory failure occurs.
Diarrhea and vomiting If serious, dehydration may set in and cause signs of shock:
tachycardia; cool, pale skin; eyes that appear sunken; altered
mental status or unconsciousness.
Treat for shock: Maintain body temperature, provide
supplemental oxygen, and ventilate if needed. Provide nothing by
mouth.
Seizures Patients with generalized seizures are unconscious during the
seizure. Tonic-clonic muscle activity; patient may be incontinent
and/or have bitten the tongue. Will be postictal after seizure
ends; may be hard to arouse, confused, and frightened.
Most seizures only last several seconds to a minute. Care is
supportive — prevent further harm during the seizure,
maintain airway, and provide supplemental oxygen.
Status epilepticus are seizures that last more than a couple of
minutes or a series of seizures that occur without the patient
regaining consciousness. These may be life-threatening. Transport
immediately, maintain airway patency, and ventilate with a
bag-valve mask and oxygen. Suction may be necessary if secretions
become significant.
Altered mental status (AMS) Younger children: sleepy, lethargic, difficult to arouse from
sleep. Unable to maintain interest, easy to separate from
caregiver. Irritated, inconsolable. Older children: confusion,
lethargy, sleepy. Evaluate for underlying cause: Shock, hypoxia,
hypoglycemia, drug ingestion, and head trauma are some
possibilities.
Maintain airway patency. Ventilate with a bag-valve mask if in
respiratory failure. Use an oropharyngeal airway (OPA) and position
the child’s airway carefully if unconscious. Keep suction
immediately available in case vomiting occurs. Maintain body
temperature and transport immediately.
Poisoning Possible causes of poisoning include medications, household
chemicals, intoxicants, and other recreational drugs. Immediate
concern is altered mental status (AMS) and loss of airway
patency.
Maintain airway, using manual maneuvers and an OPA if
necessary. Ventilate if needed. If breathing is adequate, provide
supplemental oxygen. Be alert for vomiting. Maintain safety
precautions if a hazardous material is the cause of the
poisoning.
Respiratory arrest Not breathing or agonal breaths. Cyanosis. Will cause heart
rate to slow.
Insert an OPA and manually position the airway to keep open.
Ventilate with bag-valve mask once every 3 to 5 seconds and provide
supplemental oxygen. Keep suction immediately available in case
patient vomits. Assess for underlying cause. Begin immediate
transport.
Cardiac arrest No pulse, no breathing or agonal breaths. Single-person CPR, infant: Use two fingers to compress.
Two-person CPR, infant: Use thumb-encircling technique.
Single-person CPR, child: Use heel of one or both hands. Compress
chest to 1/3 to 1/2 depth of chest at a rate of at least 100 beats
per minute. Ventilate at a ratio of 30 compressions to 2
ventilations.
Two-person CPR, child: Adjust compressions-to-breaths ratio to
15:2.
If arrest is unwitnessed, attach an automated external
defibrillator (AED) with appropriate size pads after five cycles of
compressions and ventilations. Analyze heart rhythm every 2 minutes
and administer a shock if indicated. Transport as soon as
possible.
Sudden infant death syndrome (SIDS) No pulse, no breathing. May have signs of death: pooling of
blood in lower areas of body; stiffening of limbs. Generally no
report of any unusual circumstances or events prior to death.
In most situations where death is obvious, treatment is
directed toward the family. Try not to disturb the death scene. If
there are no obvious signs of death, begin CPR and transport.
Child abuse/neglect Patient may be quiet, withdrawn, fearful. Most often there are
physical signs of trauma. Other abuse patterns may show signs of
neglect such as poor nutrition.
Provide supportive care for any injury. Do not confront
caregiver on-scene. Observe the scene and take mental notes. As a
mandated reporter, notify child protective services and advise
hospital staff of your findings.

A 4-year-old male is sitting in a chair. The parent reports the patient stayed home from school today because of a bad cold. He is looking at you quietly, breathing quickly through his mouth, and drooling. His skin is pale and feels hot. You should

  • (A)ask him to swallow.

  • (B)gently insert a flexible suction catheter.

  • (C)suction with a rigid catheter.

  • (D)evaluate the patient further.

The best choice is (D). The patient is showing signs of epiglottitis; there is enough swelling of the soft tissues in the back of the throat that he is unable to swallow his saliva without blocking his airway.