Pediatric, Geriatric and Special-Needs Patients

Pediatric Assessment and Airway Fundamentals

Caring for pediatric patients begins before you ever touch the patient. The Pediatric Assessment Triangle allows the emergency medical technician to evaluate appearance, work of breathing, and circulation to the skin from across the room. An everyday example of this initial check is pausing at the doorway of a bedroom to observe whether an ill toddler is actively looking around, how hard their chest is moving, and whether their skin appears pale or mottled. To prepare for hands-on care, a length-based resuscitation tape is utilized to estimate pediatric weight and identify appropriately sized medical equipment.

Anatomical differences in infants and young children require specific positioning adjustments during airway management. In these young patients, a proportionally larger occiput causes the head to flex forward when lying flat, which can occlude the airway. Position the infant’s airway neutrally, using a small pad under the shoulders if needed; shoulder padding is not required for every patient. In addition, physical assessment of the infant cranium provides valuable clues: a sunken fontanelle in an infant can be a sign of dehydration, though it should always be assessed alongside other physical findings. A bulging fontanelle in a calm infant, on the other hand, may indicate increased intracranial pressure or a serious infection.

Respiratory failure is the most common cause of cardiopulmonary arrest in pediatric patients, making respiratory evaluation a critical responsibility for the EMT. Signs of pediatric respiratory distress include tachypnea, nasal flaring, intercostal retractions, and grunting, with grunting serving as an indicator of more severe distress. The EMT must recognize that decompensation can occur rapidly: bradycardia in a pediatric patient with respiratory distress is an ominous indicator of impending cardiopulmonary arrest. Furthermore, hypotension in a pediatric patient is a late and severe sign of decompensated shock, indicating that compensatory mechanisms have failed.