Category Archives: Child Emergencies

Posted in Roy on Rescue • AED • Child Emergencies

Can I Use Adult AED Pads on a Child or Infant?

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Hello Rescue Fans!AEDPadplace

I received a question via email about using an adult AED on a pediatric patient if there were no pediatric AED pads available.  The quick answer?  Yes, you can.  Remember, many newer AED’s are now attenuated and will usually give as much electricity as needed to accomplish de-fibrillation.  If at all possible, use an AED with pediatric pads and place them correctly on the chest and back of the pediatric patient.  If no pediatric pads are available, place the adult size AED pads on the front center of chest and in the middle of the child’s back approximately between the shoulder blades to ensure most effective de-fibrillation even with adult AED.  In the end, when a person is suffering sudden cardiac arrest, the majority of the time, they are in a some form of de-fibrillatable rythm and an AED is of great benefit,  even if the size of the pads don’t match.  Ages for the child ranges between 1-8 or first signs of puberty, after that, treat as an adult and if under 1 year of age, treat as an infant.  There’s some question as to the effectiveness of de-fibrillation in infants under 1 year.  See the above links for more details regarding this subject.

I hope this helps.

Keep On Rescuing!

Posted in Roy on Rescue • AED • CPR for Instructors • CPR for Providers • Child Emergencies

Should CPR and AED’s Be Required In Schools?

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Students Train Free!

Every couple of minutes, someone suffers sudden cardiac arrest.  95% of these victims are dead before they make it to the Emergency Room doors.  In North Carolina, the Governor is trying to change that statistic.  She’s signed a bill that requires all highschoolers to be CPR trained prior to receiving their diploma.    Is it a good or bad idea and why do you feel the way you do?
Keep in mind that ProTrainings.com has already implemented a program that offers CPR training and certification to all high school students for FREE! ProTrainings.com and the StudentsTrainFree.com program reported that over 3000 high schoolers this year alone have already been trained and certified. If you know of any school desiring to implement a similar program, please contact ProTrainings.com and ask for the Student CPR department.

Posted in Roy on Rescue • Child Emergencies • CPR for Instructors • CPR for Providers • Seizures

My Baby Is Having A Seizure, What Do I Do?

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Hello Everyone!

I received a question regarding infants having seizures and the proper treatment for them.  

The person asked if  it’s proper to handle the patient the same as an adult?  This is a great question and one I wanted to address a little more in depth than a simple reply by email.

First, it’s important to understand what a seizure is.  The following is a quote by  physician, Dr. Fawn Leigh from Duke Health who did a great job describing the two different categories of seizures and how they manifest themselves.

Click here to see the complete article located at:  http://www.dukehealth.org/health_library/advice_from_doctors/your_childs_health/childhoodseizures

“Seizures are divided into two major categories (based on 1981 international classification):

  • Generalized seizures affect the whole brain or both hemispheres of the brain
  • Partial seizures, also known as focal seizures, affect one part or one side of the brain

Generalized Seizures

Generalized seizures are divided into convulsive and nonconvulsive. Convulsive means that there is muscle movement such as stiffening (also known as tonic) or jerking (clonic) activity. When these movements are combined it may be called “grand mal.”

Other types of convulsive seizure activity include myoclonic and atonic seizure activity. Myoclonus is usually characterized by sudden, single jerks. Atonic seizure activity is typically characterized by dropping quickly to the floor as if suddenly asleep or paralyzed. The child then quickly recovers.

These two latter convulsive seizure types can both be difficult to diagnose and treat because often they are the manifestation of a mixed seizure disorder. In infants these seizures may be called infantile spasms.

Nonconvulsive means that there is alteration of consciousness without muscle movement. This form of seizure activity was formerly called “petit mal,” and is now commonly referred to as “absence.”

Absence seizures are unique in that typically they are characterized by an abrupt onset of staring and end just as abruptly with no confused state following the events. Parents usually report that the child looks like they are “spacing out.” (Teenagers who look like this often are not having seizures — they are simply bored.)

Partial Seizures

Partial seizures can be simple or complex. Simple partial seizures are focal seizures that involve movement or sensation on one side of the body without altered consciousness. Simple partial seizures are commonly localized to areas in the brain called the motor or sensory strip.

Partial seizures may be with or without aura, which involves associated states such as fear, or changes in heart rate, flushing, or abdominal discomfort.

Complex partial seizures commonly originate from the frontal and temporal lobes of the brain where there are many complex interconnections, resulting in alteration of conscious. Typical complex partial seizures manifest as sudden change in level of alertness with or without aura, blank stare, confusional state, or aimless movements such as wandering around or repetitive behavior.”

DukeHealth.org (http://www.dukehealth.org/health_library/advice_from_doctors/your_childs_health/childhoodseizures)

 

Second, it’s important to understand what the main cuases of seizures are:

  • Fever
  • Infection such as meningitis
  • Trauma
  • Hemorrhage
  • Brain malformations
  • Brain dysmaturity
  • Genetic disorder

Thirdly, when it comes to treating an infant compared to an adult, it’s a bit easier, though not any less intense especially if it’s your child.  It’s physically easier because baby is smaller and easier to manage.

If this seizure is with a child who has never had a seizure before, 911 or Emergency Medical Services should be activated.  The rescuer is going to  follow National and International guidelines for treating a seizure patient.  Protect the baby from hurting itself while seizing.  If it’s in a bath tub, drain the bath tub of water so as to reduce the risk of drowning and then protect the child from hurting itself while seizing.  Nothing should be put into it’s mouth which is old school for seizure management in trying to prevent “swallowing the tongue” or biting the tongue off.  It is also important that we not try and prevent the baby’s body from convulsing by holding it still or wrapping them tightly.  Simply protect it’s head and other parts of it’s body from hitting anything during the convulsive stage of the seizure.  After the seizure is over, the baby will usually go into a post seizure phase called the “postictal” phase, and there may be some frothy sputum(spit) around the baby’s mouth or in its nose. A bulb syringe normally used for suctioning mucous or sinus congestion could be used to suction or clear the baby’s nasal passage but it is probably not as necessary as we’d like to think.  As a general rule, baby’s have a great gag reflex and if they have any mucous or sputum in their upper airway, it will probably be coughed clear.  If the baby begins to breath after the seizure, it could be irregular with some grunting for a short time and then increasingly get more normal.  Skin color if it has changed during the seizure to a dusky, purple or blue color should improve as the baby begins breathing more normal and it is perfectly acceptable to comfort the baby in a natural position while maintaining a neutral airway in order for it to recover from the seizure.

If it does not begin breathing, begin basic cardiac life support according to the latest ECC/ILCOR and American Heart Association guidelines. Courtesy of ProFirstAid.com, a Free Online infant CPR training video is available by clicking here!

As many as 2-5% of all children will experience at least one seizure related to a fever over 102 degrees Fahrenheit.  The seizure itself is usually harmless and does not cause brain damage nor lead to epilepsy.

Seizures in any age patient can be very scary, and the causes of a seizure are many.  Therefore, if it’s the first seizure the person has ever had, we should plan for the worst and hope for the best.  This can be done by calling the emergency medical services or 911 depending on your area.  Support the patient with basic first aid procedures while waiting for rescuers to arrive and then follow up with your pediatrician after the baby is stable.

If your baby is having a high fever and your afraid that it may cause a febrile seizure, there are some basic steps to help lower your baby’s temperature.  Click here to read an article about how to lower a body temperature from a fever.

 

Well,  I hope this helps and I appreciate the great questions so many of you have been asking.  Keep them coming and while your waiting for a response, keep on saving lives!

 

Best Wishes,

Roy

RoyOnRescue.com

royonrescue@gmail.com

 

Posted in Medical • Illness • Roy on Rescue • Child Emergencies

Blast That Thrush!

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I just recently had a question that isn’t really within my expertise as a paramedic, but ironically ranks high with me because it’s so common with people who use inhaled steroids or take antibiotics. You guessed it Thrush.   Thrush is the more common name for a more technical problem called Candida or Yeast infection on the tongue. It’s painful, it’s unsightly and it’s a pain in the neck. Oh sure, you can get medicine from the physician for it, but it was probably a visit to the physician and their prescription for antibiotics or an inhaled steroid that go this nice little complication. Not because you wouldn’t want to go back to the doctor for their help, it’s just that you may not want a piggyback bill. So, one of the readers emailed in a question regarding their 82 year old relative that has inhalers and developed “Thrush”. They asked if there were any home remedies that might help heal this without a prescription. I gave my advice below.

Hello,

Oral Thrush

Thrush has got to rank as one of the most aggravating and painful side effects I’ve encountered when dealing with something as sensitive as the tongue. It’s unfortunate that some of the life saving medications like inhaled steroids can cause this frustrating and painful complication. I agree with you regarding the spacer. I think it’s wise not only for getting more of the medication off the back of the patients tongue but also getting more of the medication into the patients lungs where we really want it to go anyway. I’ve found that spacers become one of those important items that are not used due to the terrible cost. I’ve encountered prices close to $100 just for the spacer. Crazy!

Anyway…regarding natural remedies for thrush(Candida). There is a lot of natural ideas but of course none of them have been tested in a non-bias lab or do they carry the FDA approval. I also want to re-instate that I’m a licensed paramedic and not a licensed homeopathic expert. That being said, there’s at least three of my own family members that struggle with thrush or yeast complications from time to time and I’ve found a couple of ideas pretty useful.

The first would be liquid Acidophilus with Bulgaricus and Bifidus. This is usually located in health food stores and would be located in the refrigerator section. I personally believe that this keeps the cultures alive longer and therefore more effective. The flavors are nothing to report to the press about but it tastes a little better than good old fashioned organic plain yogurt. We like strawberry or blueberry. I have the kids take a tablespoon or two several times per day and then again just before bed time. I make sure that they do it after they brush and drink so that they will leave the film coating in their mouth. This usually heals the condition within a couple of days and begins showing relief sometimes as early as 24 hours just from my experience.

Secondly, though I’ve known about the benefits of virgin, non processed coconut oil for health purposes, I’ve only recently heard about it’s ability to promote a healthy immune system and it’s natural properties(caprylic acid) for anti fungal assistance. This tropical oil can be melted over vegetables, spread on toast instead of butter or mixed into smoothies where you really don’t notice much of it at all. Because coconut oil melts at around room temperature, a 98.6 degree mouth melts the oil quite quickly. Just a quarter or half a teaspoon melted in the mouth might be an aid to help get rid of the thrush/yeast and give some soothing relief to your sweet relative. Again, I’m no expert in this area and nothing I’ve said is meant to be a prescription or a diagnosis, but I have used the Acidophilus before with great results.
Regarding the Tea Tree Oil, I’ve read several sources that voice some health concerns when using tea tree oil in or outside the body. I would take a look at this website (LiveStrong.com) and then do your own study. Then if you are still planning on using it, I would consult your relatives physician prior to administering any of the oil.

Best wishes in your quest to find a home remedy that’s effective and safe. I hope that what I’ve shared with you will help in some way.

Roy Shaw, RoyOnRescue.com
royonrescue@gmail.com

Posted in Roy on Rescue • Training Questions • Child Emergencies • CPR for Instructors • CPR for Providers

How Can A Child Do CPR?

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In this episode of RoyOnRescue, Roy get’s asked the best way to have a child do CPR on a person who is larger then them.  Other than a bit of bad videography while Roy’s on the fly…I think it will help answer a question many people have about the best way that a small person can help someone in cardiac arrest.
Best Wishes,
The RoyOnRescue Team

Posted in Roy on Rescue • Child Emergencies • Eye Injury • Impaled Objects • Trauma

Knitting Needles and Puncture Wounds?

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Knitting Needles can be the source of warm mittens, cozy scarves and comforting winter sweaters.  They can also become sharp pointed weapons or injury causing spikes when fallen upon or when they are thrust into the face, neck, chest or abdomen due to a car accident or accidentally falling onto them.  In this RoyOnRescue episode, we take a look at the hidden danger of sharp pointed objects that usually remain harmless but when not respected and carried safely, they could cause great harm.  Learn about the dangers of pointed objects and how to keep knitting needles a source of pleasure not pain.

Posted in Roy on Rescue • Sports Related • Child Emergencies • CPR for Instructors • CPR for Providers

Can a Ball Hitting My Childs Chest Kill Him?

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In some cases it has!  The velocity of an object striking one’s chest can cause a phenomenon that could disrupt the normal beating heart.  If this happens, everyone standing by should hope they can recognize it, and treat it.  Here’s how I got on this subject.

An email came in to our offices asking about more information regarding what happens when a child is struck in the chest or abdomen ,ith a ball, puck, bat or other hard object.

Sports can be fun but not when someone gets seriously hurt or dies.  One type of injury that is a real concern to everyone is cardiac arrest secondary to  chest trauma from a blunt object.  This can happen when a baseball, soccer ball, basketball, hockey puck, bat or person hits another persons chest with a great deal of velocity or force.(http://pediatrics.aappublications.org/cgi/content/full/122/2/437)   In some cases, it is suspected that if a ball or other object hits a person chest over the top of the location of the heart, the strike works somewhat like a technique that was once used to mechanically cardiovert a heart called a precordial thump(http://www.heartrhythmjournal.com/article/S1547-5271%2809%2900687-0/abstract).  This technique used force vs. electricity to create some form of rhythm or Arrhythmia/ Ventricular Fibrillation in order for the heart to be corrected so as to regain a purposeful and organized heart rhythm.  This technique though used rarely today, may be the effect that is causing sudden cardiac arrest in children and adults who are involved in a chest trauma from sports.   If this does happen, the person may collapse immediately and stop breathing with no palpable(you can’t feel it) pulse. If the person is in cardiac arrest or is not showing signs of life,  911/Activation of EMS and CPR should be started immediately and an AED may be very useful if the person is in a shockable condition.  If an AED is not present, CPR will be done continuously without interruption unless the person becomes conscious and begins to move or attempts to speak(signs of life).   Be on guard, bruising, punctured lung or other underlying conditions could cause the person to return to a state of cardiac arrest so frequent reassessments will be required until the person is turned fully over to the care of emergency medical services.   The best cure for this injury is prevention.  Many companies are designing and selling chest guards and protective devices to help prevent this condition from happening.(http://www.allsportsarmour.com/CHEST_ARMOUR_SHIRT_p/asa100%20dual.htm A well trained professional or volunteer coaching team in CPR and First Aid (http://www.profirstaid.com)would be highly suggested and an AED can be purchased for less than a laptop today.(ProFirstAid.com)

In comparison another condition related to a blunt trauma to the abdomen is a condition nick named, “getting the wind knocked out”.  This condition usually occurs when a person receives a blow to the upper center abdomen which is approximately where we provide inward and upward abdominal thrusts for a choking victim.  This area is physiologically perfect for compressing the diaphragm and compressing the lower lobes of the lungs.  This forces residual air out of the lungs and feels scary.  Normally, after a few minutes of one trying to breath deeply, fighting hard for that first real deep breath, the spasm releases in the diaphragm and air is gradually brought back into a normal state.  Complications related to this fairly common condition could include ruptured or torn internal organs.  If a person is hit hard enough, as in situations where a bat or object was used, or the lower half of a steering wheel which is common in unrestrained, non airbag vehicular accidents, the trauma could rupture/tear internal organs and even the descending aorta.  If the Aorta is torn or ruptured, it is well know to be a usually fatal injury as time to surgery is quite a few minutes away and one can loose enough blood internally to die from hypovolemia.  A condition where there is not enough blood to circulate oxygenated blood or maintain an adequate blood pressure  which leads to death if not corrected.  Treatment for this more serious condition is activation of emergency medical services while providing CPR, Shock Therapy(http://www.profirstaid.com) and minimization of movement.  A way to prevent this injury is to avoid the types of conditions that could present it.  Another way is to incorporate an aggressive core strength training program which will build strength in the abdominal muscles so as to help protect against sport related injuries.

It is important to consult with your health care professional or physician before beginning any intense workout program and if you are at all concerned that you or someone you know may have internal injuries, call 911/EMS and seek medical help.

Most of the signs and symptoms related to an internal injury in the chest or abdomen are severe pain that disables a person from performing normal behaviors.  Tender abdomen to touch, distending(bulging) belly, rigid or hard belly) bruising or marks over the abdomen or chest, shortness of breath or difficulty breathing, pale, cool, sweaty, increased anxiety, increased respiratory rate, dizziness, fear of dying and unconsciousness.  If any of these signs or symptoms are present or appear after an injury, activate the Emergency Medical Services immediately and/or seek medical help right away.

I hope this answers the question and I hope the next time you are by someone who is struck in the chest or simply gets the wind knocked out of them, you’ll better know what it is, what to do, and how to help.

Best Wishes,

Roy Shaw, EMT-P, RoyOnRescue

www.royonrescue.com

Tweet:  @royonrescue

P.S.  Here’s a link to  a real life scenario.  It’s worth the read Mom and Dad.
http://www.huffingtonpost.com/2008/05/19/family-of-boy-hit-by-base_n_102439.html

Posted in Roy on Rescue • Cardiac • CPR for Instructors • CPR for Providers • Child Emergencies • Choking

Infant Choking, Back Slaps or Chest Thrusts?

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Ever wonder what to do if an infant began choking next to you?   Ever wonder if one procedure was more effective than another?  Well, one of our students did and emailed me a question about his topic.  In this video blog entry I open up the discussion about back slaps and chest thrusts, what they do, and how they work to help a choking victim.  Then at the end, I give you the secret about which one is more effective.  Enjoy!

Clinical Pediatrics

The Choking Child—A Life-Threatening Emergency

Evaluation of Current Recommendations

Susan B. Torrey, MD

http://cpj.sagepub.com/cgi/content/abstract/22/11/751

Volume 44, Issue 2, Pages 105-108 (April 2000)

Airway pressure with chest compressions versus Heimlich

manoeuvre in recently dead adults with complete airway

obstruction

A. Langhelleab, K. Sundeab, L. Wikc, P.A. Steend

Accepted 22 November 1999. published online 17 August 2004.

Abstract

In a previous case report a standard chest compression successfully removed a foreign body from the airway after the Heimlich manoeuvre had failed. Based on this case, standard chest compressions and Heimlich manoeuvres were performed by emergency physicians on 12 unselected cadavers with a simulated complete airway obstruction in a randomised crossover design. The mean peak airway pressure was significantly lower with abdominal thrusts compared to chest compressions, 26.4±19.8 cmH2O versus 40.8±16.4 cmH2O, respectively (P=0.005, 95% confidence interval for the mean difference 5.3–23.4 cmH2O). Standard chest compressions therefore have the potential of being more effective than the Heimlich manoeuvre for the management of complete airway obstruction by a foreign body in an unconscious patient. Removal of the Heimlich manoeuvre from the resuscitation algorithm for unconscious patients with suspected airway obstruction will also simplify training.

http://www.resuscitationjournal.com/article/S0300-9572%2800%2900161-1/abstract

Heimlich vs Back Blows/Chest Thrusts

http://medfraud.info/Koop.html

Consensus Guidelines Not Followed in 1985 Release Encouraging Heimlich Maneuver