EMT Lesson Plans

7.06– Special Populations Skills/Scenario Lab Station: Pediatric Airway Scenarios Instructor Guidance

Objectives: 1. Demonstrate how to position the airway in a pediatric patient. (pp 1160–1161, Skill Drill 32-1)

2. Demonstrate how to palpate the pulse and estimate the capillary refill time in a pediatric patient. (pp 1162–1163) 3. Demonstrate how to insert an oropharyngeal airway in a pediatric patient. (pp 1173–1174, Skill Drill 32-2) 4. Demonstrate how to insert a nasopharyngeal airway in a pediatric patient. (pp 1174–1176, Skill Drill 32-3) 5. Demonstrate how to administer blow-by oxygen to a pediatric patient. (p 1176) 6. Demonstrate how to apply a nasal cannula to a pediatric patient. (p 1177) 7. Demonstrate how to apply a nonrebreathing mask to a pediatric patient. (p 1177) 8. Demonstrate how to assist ventilation of an infant or child using a bag-mask device. (pp 1177–1179) 9. Demonstrate how to perform one-rescuer bag-mask device ventilation on a pediatric patient. (pp 1178–1179, Skill Drill 32-4) 10. Demonstrate how to perform two-rescuer bag-mask device ventilation on a pediatric patient. (p 1179)

Setup: You will need your cohort bag, an AED, suction, and a pediatric and infant BVMs. You will also need infant and child manikins

Deployment: DO NOT LECTURE – your students should be working hands-on within 5 minutes of arriving Deploy your students in one team – have the rescuers do each station individually.

Scenario II: Conscious Child

Scenario I: Conscious infant

Event: You are called to a daycare center for a 5 year old who is choking. A very cyanotic child is attended by a daycare provider who is having the child raise her arms in the air to relieve the choking. This patient will go unconscious after 4 abdominal thrusts. When the team first looks in her mouth they will find a goldfish cracker. The next breaths still don’t go in. After another round of CPR, when they look in the mouth they will see two more crackers. Upon removing them they will get air in and chest rise. The patient will then be: The patient will need BVM ventilation, and then vomit. After suctioning and 2 more minutes of BVM, she will breathe on her own and eventually become conscious. Debrief: - What caused the problem (foreign body obstruction) - What is the difference between conscious and unconscious choking management (abdominal thrusts vs. CPR, and the unsconscious patient will not spit it out, so you need to check his mouth every time before you breathe). - Why didn’t she breathe right away when the object came out (there was more than one object) - Why didn’t she breathe right away when all objects were out (some insult to the brain or general hypoxia depressed his breathing) Vitals at this point will be 92/68, HR 102, RR 4, SPO2 81%

Event: You are eating at a local restaurant with your crew when a woman begins screaming “My baby is choking!”. You turn around to see an infant in a high chair with eyes wide open and a panicked look on his face. This patient will go through 4 rounds of 5 backblows and 5 chest thrusts before going unconscious. The object will come out after the first round of compressions. After he is unconscious the patient will have no respirations, but a strong brachial pulse at 102. BVM ventilations for 2 minutes will resume breathing for the patient at a rate of 6. Continuing 1 minute of ventilations will create a breathing rate of 25 per minute with visible chest rise. Debrief: - What caused the problem (foreign body obstruction) - Why didn’t the object come out right away (hard to tell, but it happens)? - What is the difference between conscious and unconscious choking management (backblows/chest thrusts vs. CPR, and the unsconscious patient will not spit it out, so you need to check his mouth every time before you breathe). - Why didn’t he breathe right away when the object came out (some insult to the brain or general hypoxia depressed his breathing) Vitals at this point will be 96/70, HR 122, RR 25, SPO2 96%