By Maveric Vu
EMS1 Staff
 Photo by Maveric Vu Scott DeBoer speaks with other providers after his lecture at EMS EXPO. |
LAS VEGAS — Scott DeBoer wants providers to consider one simple fact when approaching patient care: kids are a lot like dogs.
When left in a hot car, dogs will pant 104 times a minute, and infants with a high temperature will exhibit a similar tendency, the lecturer and nurse/paramedic said.
DeBoer discussed considerations and practical tips for pediatric care during his education session Wednesday at EMS EXPO in Las Vegas. The three-day event featured a wide range of CE courses, as well as a large exhibit hall.
DeBoer’s session focused on a range of pediatric-related topics, from intubation to how to place a child in a stretcher.
“Many EMS professionals are scared to death of sick kids and understandably so,” DeBoer said. “Looking at EMS providers, the majority of patients are overwhelmingly adults. That’s who we regularly take care of and are most comfortable with.”
During the session, DeBoer offered providers practical tips to be used in the field.
“If you are going to take blood pressure, you have to use the right cuff,” DeBoer said, giving visual examples of infant and child-sized cuffs.
However, he noted that providers probably won’t need to take a blood pressure in more than 90 percent of pediatric cases since visually assessing the child is an adequate tool.
Addressing trauma and medical related pediatric deaths, DeBoer said the main cause is respiratory problems.
While not perfect, using the Broselow-Luten Color Coding system is a great starting point for determining care, he said. The system typically factors a child’s weight and designates proper medication dosing and equipment sizes for that color/weight range.
“When Mom sees a color-coded ‘watch me grow’ chart and Motrin paired with a color-coded syringe or spoon, Mom gives the appropriate amount of Motrin and hopefully does not call 911,” DeBoer said.
DeBoer also addressed the issue of correct immobilization for pediatric patients. Due to a child’s large head and smaller body frame, the airway can often be constricted when using typical spine boards, he said.
DeBoer suggested placing a diaper or towel beneath the child’s back and shoulders, or the use of a specifically designed pediatric spine board or pediatric papoose, in order to lift the torso and straighten the airway path.
For pediatric patients, it’s important to consider ways to give oxygen without intubation, DeBoer said. Options he outlined were:
- A “well-placed” binky
- Blow-by oxygen in combination with a binky
- Applying nasal cannulas, since children typically dislike face masks and prefer breathing through their noses
DeBoer also offered the following guidelines for defibrillating younger patients:
- For ages 2 and older: “Pick up your paddles and count them.”
2 j/kg on first attempt
2 j/kg x 2 = 4 j/kg thereafter
When attempting to administer treatment for any situation, providers should note that if a child is resistant, DeBoer said, it’s a good indication the child probably isn’t in imminent danger of coding.
He went on to highlight a number of issues that can complicate patient care for children, such as how to treat and assess obese youngsters. Obesity can conflict with proper color coding identification, as well as with trying to start an IV.
 Photo courtesy of Ossur Americas Trauma & Spine An infant Papoose by Ossur Americas |
DeBoer said that the IO drill or gun is the best way to deliver drugs and fluids to critically ill or injured pediatric patients.
Paramedic Robbie MacClue, with Colonie NY EMS, said he found the lecture very informative, especially the tip to assess the patient’s feet for pulse, color and perfusion.
“Color of the feet is something I haven’t really heard talked about before,” MacClue said.
MacClue said he tries to approach pediatric calls calmly, despite not dealing with these types of cases often.
“People look to us to help them relax and calm down and let hem know that we can figure out what’s wrong,” he said.
MacClue’s last pediatric call was about two months ago for a non-serious child presenting with just an infection, he said.
All providers should focus on ensuring that the child they transport to the hospital is “pink, warm and sweet,” DeBoer said, which refers to proper oxygen and sugar levels, as well as appropriate pain management and sedation strategies.
DeBoer, who has been transporting patients by air and ground for more than 17 years, suggested an easy approach to help overcome the nerves and emotions associated with pediatric emergency calls.
“Many providers are way too into remembering numbers,” he said. “Take what you know about assessing and treating adults, with few exceptions, and do the exact same things for kids.”
Scott DeBoer, RN, MSN, CEN, CCRN, CFRN EMT-P, is a flight nurse with the University of Chicago Hospitals, a Critical Care Transport Nurse with Superior Ambulance Service, and is the author of the newborn emergencies handbook “Emergency Newborn Care: The First Moments of Life.” For more information, visit www.peds-r-us.com.