Mike Smith is a featured speaker at EMS EXPO, October 26-30, Georgia World Congress Center, Atlanta, GA. For more information, visit www.emsexpoevents.com.
Quality prehospital medicine is at once a blend of both science and art. Splints, airways, monitors and all the rest of our tools represent the best that science and technology have to offer. However, it's all for naught if the art of medicine fails us. A big part of that art is having the ability to work with people of all ages and sizes, some with one problem and some with lots of problems, some alert and oriented and others far from it. We have to be able to connect with all of our patients, win their trust and get the information we need to adequately meet their patient care needs.
This month we'll look at a handful of tricks I picked up over the years specific to younger patients. Here's hoping you will find something useful as you read on.
As a young child becomes increasingly aware of his surroundings, one thing becomes increasingly obvious early on: Most everything in the world appears large, while they are quite small. In their world, size does have meaning, and it's often equated with threat.
You can help to mitigate this perceived threat by reducing your profile as you approach the child. If the child is lying down, you should lie down. You are then eye-to-eye and, size-wise, no apparent threat. If lying down is unnecessary or impractical, kneeling or taking a seat on the drug box still reduces your overall size and presence markedly, and that often is the start of winning the child's trust, getting them to relax, and getting your assessment off to a smooth start.
Use Original Source Information
Obtaining an accurate history is often the most difficult element of ANY pediatric call, especially if the child is past age 3 or so, when communication skills are reasonably developed, and Mom is involved as the third leg of the communication triangle. Getting Mom to sit back and chill for a few moments while you query the child can be challenging. Suppressing the desire to chime in every half-sentence or so as the child tries to explain what happened can go from difficult to impossible for the mom who is trying to do as you ask.
Still in all, get as much of the history from the child as possible, because he is the source, making his statements arguably the most valid. Keep in mind that, in some cases, it isn't the volume of information you extract from the child. It may be just a single statement, like "I woke up and I couldn't breathe," that raises the red flag, tightens your diagnosis and gets you moving toward the appropriate intervention.
What Is Different Today?
During the process of information-gathering, you may get a lot of it in a hurry: lung sounds, blood sugar, blood pressure, current meds and so on. Arguably, when it's all said and done, the single most important piece of information you gather is often as simple as determining "What is different today?" Whether the answer is, "I've never seen my son looking this tired," "No, his inhaler always worked before," or "That rash started about 30 minutes after he took that new antibiotic," it is often the most important fact to consider.
Continuously Assess Breathing
Of all the things I've learned about taking care of sick and injured children, it's to make certain that you monitor the child's breathing on an ongoing basis. A young child can double or triple his heart rate in the blink of an eye to meet a physiologic challenge. With no pathophysiology to hinder his body's ability to compensate, a child is a finely tuned biological machine.
But when they run out of steam, things can, and often do, go south in a hurry. A child in ventilatory fatigue is a very high-risk patient. Whenever possible, it is better to recognize when it's coming than to have an epiphany that the child is crashing and you are behind the curve.
Have a Diversion