PREHOSPITAL EMERGENCY CARE TENTH EDITION CHAPTER 9 Life

PREHOSPITAL EMERGENCY CARE TENTH EDITION CHAPTER 9 Life Span Development Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Learning Readiness • EMS Education Standards, text p. 190 Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Learning Readiness Objectives • Please refer to page 190 of your text to view the objectives for this chapter. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Learning Readiness Key Terms • Please refer to page 190 of your text to view the key terms for this chapter. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Setting the Stage • Overview of Lesson Topics § Life span development • • • Neonates and infants Toddlers Preschool-age School-age Adolescence Early, middle, and late adulthood Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Introduction EMTs Michael Hitchens and Jo Levitt are finishing their daily vehicle checklist when their dispatch tones sound. "Ambulance 10, Engine 10, Ambulance 14, and Rescue 14. Respond for a vehicle crash with entrapment on Highway 15 at the 132 mile marker. " continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Introduction The EMTs arrive and size up the scene. Michael and Jo have two patients, a 32 year-old female and a 2 -year-old male. Both require extrication. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • What differences are there in the way an adult and 2 -year-old are approached for assessment? • What differences should be expected in vital signs? Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Introduction • People change physically and psychosocially throughout their lifetimes. • EMTs must be able to incorporate knowledge of each stage into patient assessment and management. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Life Span Development • Vital signs change throughout the life span. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Table 9 -1 Normal Vital Signs Throughout a Life Span Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • A neonate is from birth to 1 month of age. • An infant is from 1 month to 1 year of age. • During this period, a child undergoes rapid growth and development. Prehospital Emergency Care, 10 th edition Mistovich | Karren continued on next slide Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • Neonatal characteristics § Respiratory rate 40– 60/min. at birth, decreasing to 30– 40/min. within minutes § Tidal volume 6– 8 m. L/kg § Heart rate 140– 160/min. at birth, decreasing to 100– 160/min. in minutes § Systolic BP 70 mm. Hg § Temperature 98°F to 100°F continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • By age 1 year § Respiratory rate 20– 30/min. § Tidal volume 10– 15 m. L/kg § Heart rate 120/min. § Systolic BP 90 mm. Hg § Temperature 98°F to 100°F continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • Physiological development § Average birth weight is 3. 0– 3. 5 kg. § The head accounts for 25% of the body weight. § Birth weight drops 5– 10% in the first 2 weeks. § Thereafter, the weight continues to increase. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • Physiological development § Diet of breast milk or formula, transitioning to soft foods § Primarily nose breathers until 4 weeks of age continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • Physiological development § Airways are easily obstructed. § There are fewer alveoli and lung tissue is fragile. § The chest wall is soft with weak accessory muscles. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • Physiological development § Fatigue can occur easily from respiratory distress. § Observe the abdomen for work of breathing. § Increased respirations can lead to dehydration and heat loss. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • Physiological development § Immune system is immature; immunizations are important. § Infants have several important reflexes. § Movement of extremities should be symmetrical. § Inability to localize pain continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • Physiological development § Posterior fontanelle closes at 3 months. § Anterior fontanelle closes between 9 and 18 months. § Examine the fontanelles for assessment of hydration. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • 2 -month milestones Track objects with eyes. Focus on objects 8– 12 inches away. Recognize familiar faces. Display primary emotions and facial expressions. § Hear and recognize some familiar sounds and voices. § Move in response to stimuli. § § continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • 6 -month milestones § Sit upright in a high chair. § Make one-syllable sounds (e. g. , ma, mu, da, di). § Raise and support upper body when on stomach. § Grasp and shake hand toys. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • 6 -month milestones § Push down on legs and feet when held over a firm surface. § Follow moving objects with eyes. § Recognize familiar objects at a distance. § Begin to babble and try to imitate familiar sounds. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • 12 -month milestones § § § Walk with help. Know own name. Sit without assistance. Crawl and creep on hands and knees. Put objects into containers. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • 12 -month milestones Poke objects with fingers. Respond to simple requests and "no". Say "mama" or "dada". Imitate some words, gestures, and facial expressions. § Begin to use objects like brushes, cups, or phones correctly. § Finger feed self. § § continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Neonates and Infants • Psychosocial changes § Parents must meet the infant's physical, emotional, and psychological needs for healthy development. § Infants do not like to be separated from caregivers. § Infants communicate through crying. § Can detect and respond to parents' emotions Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • A toddler is 1 to 3 years of age. • A preschooler 3 to 6 years of age. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • Toddler characteristics § § Heart rate 80– 130/min. Respiratory rate 20– 30/min. Systolic BP 70– 100 mm. Hg Temperature 98. 6°F– 99. 6°F continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • Preschooler characteristics § § Heart rate 80– 120/min. Respiratory rate 20– 30/min. Systolic BP 80– 110 mm. Hg Temperature 98. 6°F– 99. 6°F continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • Physiological changes § Increased body mass with decreased body fat § Primary teeth have emerged § Increased number of alveoli in the lungs § Loss of passive immunity, but active immunity develops through exposure to pathogens continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • Physiological changes § Brain develops quickly, as do motor skills. § Toilet training is complete around 28 months. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • 3 -year milestones § Walk alone and begin to run. § Pull or carry several toys when walking. § Climb up and down furniture or stairs with minimal support. § Scribble and play with toys. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • 3 -year milestones § Recognize names, faces, voices, objects, and body parts. § Find hidden objects. § Sort objects by shape or color. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • 5 -year milestones § Stand on one foot for more than 10 seconds. § Hop, jump, swing, climb, and do somersaults. § Dress and undress without assistance. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • 5 -year milestones § Use forks, spoons, and sometimes knives appropriately. § Count ten or more objects. § Trace and draw pictures. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Toddlers and Preschoolers • Psychosocial changes § Language develops. § Development of separation anxiety at about 18 months § Playtime helps with social skills. § Speak at the child's level. § Allow him to touch equipment, if appropriate. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Both patients are conscious. The woman is very anxious and is concerned with the condition of her two-year-old son. The two-year-old is crying, and screams when Michael gets close to him. Michael sees a toy on the floor of the car, and hands it to the boy, whose name is Blake. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study The toy, along with some reassuring words from the mother, calm Blake, although he still is scared and reluctant to cooperate with Michael. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study • What other actions could Michael take to gain Blake's cooperation? Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Click the age by which the developmental milestone below should be accomplished. 2 months Recognize familiar faces and sounds. 6 months 12 months 3 years Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Click the age by which the developmental milestone below should be accomplished. 2 months Walk with help. 6 months 12 months 3 years Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Click the age by which the developmental milestone below should be accomplished. 2 months Say "mama" or "dada. " 6 months 12 months 3 years Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

School-Age Children • A child between 6 and 12 years of age continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

School-Age Children • Vital signs § § Heart rate 70– 110/min. Respiratory rate 20– 30/min. Systolic BP 80– 120 mm. Hg Temperature 98. 6°F continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

School-Age Children • Physiological changes § Bones increase in density and grow large. § Primary teeth are replaced with permanent teeth. § Ability to read and write § Nocturnal enuresis may continue after the age of 10. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

School-Age Children • Psychosocial changes § Friendships are important. § Problem-solving skills develop. § Self-concept, self-esteem, and morals develop. § Increased understanding of pain, illness, injury, and death Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Adolescents • Adolescents are between 12 and 18 years old. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Adolescents • Vital signs § § Heart rate 55– 105/min. Respiratory rate 12– 20/min. Systolic BP 100– 120 mm. Hg Temperature 98. 6°F continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Adolescents • Physiological changes § 2 - to 3 -year growth spurt § Girls are typically done growing by age 16, boys by age 18. § Puberty and reproductive maturity continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Adolescents • Psychosocial changes § Changes can result in family conflict. § Believe they are the focus of others' attention and have a feeling of invulnerability § Desire to be treated as adults, but legally cannot make medical decisions § Privacy is important. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Adolescents • Psychosocial changes § Experimentation with alternate identities § Understand there are consequences for actions § May engage in self-destructive behaviors; depression and suicide increase § Concerned with body image § May engage in sexual behavior Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Early Adulthood • Ages 20 to 40 years continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Early Adulthood • Vital signs § § Heart rate 70/min. Respiratory rate 16– 20/min. BP 120/80 mm. Hg Temperature 98. 6°F continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Early Adulthood • Physiological changes § Optimum function of body systems § Physical peak between 19 and 26 years § Accidents are the leading cause of death. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Early Adulthood • Psychosocial changes § Increased responsibility and independence § May marry and begin families § Beginning careers, high levels of job stress Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Middle Adulthood • Vital signs § § Heart rate 70/min. Respiratory rate 16– 20/min. BP 120/80 mm. Hg Temperature 98. 6°F continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Middle Adulthood • Physiological changes § Some decline in body systems and concerns with chronic disease § Weight gain may occur. § Vision changes § Women undergo menopause in their late 40 s to 50 s. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Middle Adulthood • Psychosocial changes § Problems seen more as challenges than threats. § More developed coping skills § Aware of time limits § Focus on others, rather than self § Transitions in parenting Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Late Adulthood • Ages 61 years and older • Vital signs depend on the underlying physical and health status. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Late Adulthood • Physiological changes § § Maximum life span is 120 years Life expectancy varies with year of birth. Incidence of disease increases. Cardiovascular system changes increase the myocardial workload. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Late Adulthood • Physiological changes § Respiratory system changes diminish ability to cough, lung capacity, and gas exchange. § The brain becomes smaller, with some neuron loss. § There may be memory problems and disruption of sleep cycle. § Reaction time slows. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Late Adulthood • Physiological changes § Diminished smell, taste, hearing, vision § Diminished pain perception and kinesthetic sense § Prone to falls continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Late Adulthood • Physiological changes § Problems with hydration and nutrition § Changes in ability to communicate § Health status varies widely. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Late Adulthood • Psychosocial changes § May be satisfied with the outcome of life, or regrets can lead to depression § Feelings of isolation may occur. § Financial difficulties may occur. § Decreased independence can affect feelings of well-being. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Conclusion Michael allows Blake to hold his penlight, and shows him how to turn it on. Within a few moments, he has gained enough cooperation to complete an assessment. With the assessment done, Michael prepares the patients for the extrication process, anticipating that both will be frightened. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Case Study Conclusion The patients are freed and, fortunately, do not have life-threatening injuries. Michael and Jo keep the mother and child together for transport. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Lesson Summary • People develop and change throughout their life span. • Changes are both physical and psychosocial. • It is important to know what is normal for each stage. continued on next slide Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved

Lesson Summary • Be aware of the risks associated with emergency response. • Use Standard Precautions for protection from communicable disease. • Assess all scenes for potential hazards and make sure they have been addressed before entering the scene. Prehospital Emergency Care, 10 th edition Mistovich | Karren Copyright © 2014, 2010, 2008 by Pearson Education, Inc. All Rights Reserved