Page 174 - PJ MED OPS Handbook 8th Ed

10. Pediatric Care and OB-GYN

Pediatrics
Anatomic Differences:
• Airway:
○ Large head – may obstruct airway if child is supine  elevate shoulders/thorax
○ Smaller oropharyngeal space due to larger tongue to mouth ratio
○ Epiglottis is long/narrow and cords are anterior and cephalad
○ Subglottic area narrows so tube that will pass thru cords may encounter resistance before
entering bronchus
○ <12 years old have small/pliable larynx, do not perform surgical airway on child less than
8 years old
• Head and Spine:
○ Risk of head injury increased:
n Larger head to body ratio
n Open fontanelles and mobile sutures allow for massive intracranial bleeding
○ Decreased risk of spinal injury due to more flexible spinal ligaments
• Skeleton and Physiology:
○ More pliable skeleton  increased risk of internal organ injury without overlying physical
findings (ex. no rib fractures over lung contusion)
○ Increased metabolic activity  more maintenance fluids
○ Higher risk for hypoglycemia so feed if able to take oral or give dextrose in fluids
○ Meds: refer to HB sections and Broselow tape for dose adjustments
n Require more frequent redosing due to increased metabolism
TRAUMA
M: – Direct pressure with hemostatic bandage
– Tissues are more compressible  Can achieve tourniquet effect with hand tightened cravat
– Rubber tubing tourniquet is appropriate for children
A: – Immediately reposition to open airway  elevate shoulders if supine to avoid obstruction
– Perform back blows/Heimlich for foreign body
– Tip: if Broselow bag unavailable, ET tube should be approximately the diameter of the outer
rim of the child’s nares (nose)
○ Estimating ETT size:
16 + age in years
4
– DO NOT PERFORM CRICOTHYROIDOTOMY IN CHILDREN UNDER 8 YEARS OF AGE.
R: – “Normal” vital signs change with age – refer to below chart when assessing breathing:
– Avoid hyperventilation
– Smaller lung volumes so use peds ambubag
– Decreased oxygen reserve  rapid desaturation so keep on O2 if available

172 n Pararescue Medical Operations Handbook / 8th Edition