TAEM10: Pediatric Emergency

อาจารย์อรัญญา ไทยแท้

1. Nursing Care of
Pediatric Emergency
AranYa Thaitae
Queen Sirikit National Institute of Child Health

2. Pediatric emergency
•Respiratory emergency
•Fever group
•Anaphylaxis
•GI emergency
•Neurological emergency
•Surgical emergency
•Accident
•Eye emergency
•ENT emergency

3. Top 5 diseases at ER of QSNICH
0
2000
4000
6000
8000
10000
12000
respiratoryfever groupGIaccidentDHF,DF
2548
2549
2550

4. Respiratory assessment
1.Physical assessment
2. Oxygen therapy

5. Physical assessment

6. Physical assessment
1.Observation
- Dyspnea : grunting, flaring,
retraction
- Cyanosis
- Tachypnea, bradypnea
- Chest movement

7. Normal respiratory rate
< 60
< 50
< 40
< 30
2 months
2 – 12 months
1 – 5 years
6 – 8 years
Respiratory rateAge

8. Physical assessment
1.Ausculation
- Aspiratory
- Expiratory
3. Pulse oxymetry
- perfusion
- motion
4. Arterial blood gas analysis

9. Nursing Care in Respiratory
emergency
1.Airway management
1.1 Open airway using;
- head till-chin lift
- jaw thrust maneuver
1.2 Clear airway : suction

10. Indication of suction
1.More frequent or congested
sounding cough
2.Coarse audible secretions
3.Visible secretions
4.Increased pressures or decreased
tidal volumes on the ventilator
5.Indication by the patient that
suctioning is necessary

11. Indication of suction

6. Suspected aspiration of gastric or
upper airway secretions
7. Otherwise unexplained increase in
shortness of breath.
8. Decreased oxygen saturations
thought to be related to mucus
plugging where oxygen saturations
are monitored.

12. Table of ET Tube & suction
5 – 6
6 – 8
8
8
8
10
10
10
12
12
12
8
9 – 10
10
11
12
14
15
16
17
18
19
2.5,3.0 uc
3.0,3.5 uc
3.5,4.0 uc
4.0,4.5 uc
4.5,5.0 uc
5.0,5.5 uc
5.5 uc
6.0 c or uc
6.5 c or uc
7.0 c
7.0,8.0 c
Premature infant
Term infant
6 months
1 year
2 years
4 years
6 years
8 years
10 years
12 years
Adolescent
Suction
NO.
DistanceET tubePatient age

13. Complication of suction
1.Hypoxia
2.Tissue hypoxia
3.Atelectasis
4.Hypotension
5.Airway constriction

14. Nursing Care
•Airway management
1.3 Oropharyngeal airway

15. Method of insertion
oropharyngeal airway

•depress the tongue
with a tongue blade
and slide the
airway in.   
•Insert  the  airway
upside  down  into
 the victim’s mouth
•Rotate it 180° as it
slides into the
pharynx

16. Oxygen therapy

17. Oxygen therapy
•Oxygen may be classified as an
element, a gas, and a drug. Oxygen
therapy is the administration of
oxygen at concentrations greater
than that in room air to treat or prev
ent hypoxemia (not enough oxygen in
the blood).
•Oxygen therapy is beneficial in all
types of hypoxia, cyanosis, asphyxia,
hypotonia.

18. Oxygen therapy
Some of the conditions oxygen therapy
is used to treat include:
•Hypoxemia
•Severe respiratory distress (e.g.,
acute asthma or pneumonia)
•Severe trauma
•Shronic
obstructive pulmonary disease
(COPD, including chronic bronchitis,
emphysema, and chronic asthma)

19. Oxygen therapy

•pulmonary hypertension
•cor pulmonale
•acute myocardial infarction (heart
attack)
•short-term therapy, such as post-
anesthesia recovery
•Oxygen may also be used to treat
chronic lung disease patients during
exercise.

20. Oxygen therapy
•Too much O2 can cause respiratory
arrest
•A COPD patient in severe distress O2
is limited to two liters a minute by
nasal catheter and given O2 under
pressure with regulation of O2 and
CO2.

21. Type of oxygen therapy
2 systems
•Low flow system
•High flow system

22. Low flow system
•Nasal cannula
•Nasopharyngeal catheter
•Simple mask
•Partial rebreathing mask
•Non rebreathing mask

23. Low flow system
Nassal cannula Simple mask

24. Low flow system
partial rebreathing
mask
Non-rebreathing mask

25. High flow system

•Venturi masks (mask without bag)
•Oxygen hood
•tracheostomy collars
•Oxygen T- Piece
•Tent face
•Oxygen tent

26. High flow system
Venturi mask

27. Low flow system
Oxygen hood

tracheostomy
collar

28. High flow system
•Oxygen t- piece Tent face

29. High flow system
Oxygen tent

30. Complications from oxygen
therapy
•Respiratory depression
•Oxygen toxicity
•Absorption atelectasis are the most
serious complications with overuse of
oxygen.
•Perforation of the nasal septum as a
result of using a nasal cannula
•Bacterial contamination of nebulizer
and humidification systems

31. Nursing in Oxygen Therapy
•Check order for flow rate and oxygen
concentrations required
•Place the mask over patient’s nose,
mouth and chin
•Check that the
- Oxygen is flow freely
- Patient is comfortable with freedom
movement

32. Nursing in Oxygen Therapy
•Observe patient for signs of
discomfort
•Monitor and record vital signs
•Monitor Sa0
2
•Check the patient’s face for signs of
pressure mouth and nose for dryness

33. Nurses’ role
Nurses are responsible for
•Assessing patients
•Ensuring that oxygen therapy is
initiated as prescribed
•Monitoring oxygen delivery systems
•Recommending changes in therapy

34. Question

35. THANK YOU