EMERGENCY TELEPHONE CALLS
Dial 911 (Emergency Medical Services). In larger cities, this call will dispatch an emergency vehicle staffed by a rescue squad and based at the nearest fire department. In smaller towns and counties, the operator will connect you with an emergency ambulance service. The direct number for this service is usually found on the first page of your telephone directory. In areas that use 911, children should be taught to dial this number for crises. Increasingly, 911 is being linked to a computer system (“enhanced 911”) that can determine the address of the incoming call even if the caller can’t speak.
Call Your Child’s Physician. If you don’t have a physician, call the near- est emergency room. Always call in first, rather than simply going to an emergency room. Your physician may provide you with critical first aid instructions by phone (e.g., for burns, animal bites, or fractures). Your physician also can help you decide whether a rescue squad should be sent out or if it is safe for you to drive in. In addition, your physician can also tell you if it’s safe to be seen in the office or where to take your child for the best emergency care.
If you know the phone number of the nearest Poison Center, call them now. If not, call the National Poison Center hotline at 1-800-222-1222. They will automatically connect you with your local Poison Center.
How to Cut Through Red Tape
When you call in, always state assertively, “This is an emergency.” Do not let the answering service or receptionist put you on hold before talking with you. If you are put on hold, hang up and call back immediately.
Life-Threatening or Major Emergencies
Call your rescue squad (911) or ambulance service.
Definition of a Life-Threatening Emergency—Children who may need resuscitation en route (for instance, those with severe breathing difficulty, severe choking, or not breathing) require a 911 call. Other potentially life-threatening emergencies are persistent loss of consciousness (coma), continuing seizure, or bleeding that can’t be stopped by direct pressure. Children with major trauma or possible neck injury need splinting before transportation.
The Staff of Emergency Vehicles—Emergency vehicles are staffed by EMTs (Emergency Medical Technicians) or Paramedics. EMTs are trained in Basic Life Support: cardiopulmonary resuscitation (CPR), splinting, bandaging, and so on. Paramedics are EMTs with additional training in Advanced Life Support: drawing blood, starting IVs, intubation, recording EKGs, and so on. EMTs receive 160 hours of training and Paramedics receive 1,200 hours. These pre-hospital care specialists are certified by their national associations. While providing emergency care, they are linked by two-way radio to an emergency room physician at their base hospital.
Rescue Squads Versus Ambulance Services—In larger cities, rescue squads are often available through local fire departments. Usually rescue squads can respond more rapidly than ambulances, and their service is free. After the patient’s condition has been stabilized, they will often call an ambulance company for transport to the hospital if it is warranted. In general the police do not transport sick people, so don’t call them for medical emergencies.
Go to the nearest hospital offering emergency services. Try to call your child’s physician first.
Definition of Less Severe Emergencies—These concern children who need to be seen as quickly as possible but whose condition is currently stable or at least does not pose a danger of suddenly needing resuscitation. Examples are poisonings, slow bleeding controlled by pressure, severe pain, and seizures that have stopped.
Advantage of Car over an Ambulance—A private car is quicker and less expensive than an ambulance. Another option is to call a taxi.
Driving in to Seek Emergency Care—If you are going by private car, don’t leave until you know the exact location of the emergency room you will be going to. It is a good idea to rehearse the drive by the fast- est route before an emergency occurs. Keep your sick child in a car safety seat. Try to have a friend or neighbor accompany you and do the driving. Some parents are too shaken by their child’s injury to drive safely.
What to Bring with You to the Emergency Room
•Your health insurance card
•Your child’s immunization record
•Your pharmacy’s telephone number
•Any medicines your child is taking (or a list of drugs and dosages)
•If your child has been poisoned, bring the container.
•If your child has passed blood in the urine, stool, or vomited material, bring a sample for testing.
•Your child’s security object or favorite toy
LIFE-THREATENING 911 SYMPTOMS
Every parent should learn how to identify life-threatening symptoms. You need to know in advance when to call 911 rather than trying to reach your doctor, and when it’s not safe to try to drive to the hospital. Then you will not make the tragic mistake of attempting to drive your seriously ill child to an emergency room only to have him/her stop breathing or go into shock on the way. If your child ever has any of the following symptoms, call Emergency Medical Services (911) immediately.
Severe Breathing Problems
•Breathing has stopped.
•Your child is choking and unable to breathe or is turning blue.
•Difficulty breathing follows a medicine, food, or bee sting (the concern is for severe allergic reaction or anaphylaxis).
•Blood is pumping or spurting from the wound.
•Blood is pouring out and can’t be stopped with direct pressure.
Severe Neck Injury
Try not to move your child until EMS arrives.
Seizure or Convulsion Now (hasn’t stopped)
Can’t Wake Up
Your child is unconscious (in a coma).
All the conditions discussed in this chapter are emergencies. The following emergency symptoms, however, are highlighted because they are either difficult to recognize or not considered serious by some parents. If your child has any of the following symptoms, contact your child’s physician immediately.
If your baby is less than one month old and looks or acts sick in any way, the problem could be serious (e.g., vomiting, cough, poor color).
To be tired during an illness is normal, but if your child stares off into space, won’t smile, has no interest in playing, is too weak to cry, is floppy, or is hard to awaken, these are serious symptoms.
If your child cries when you touch him or move him, this can be a symptom of meningitis. Such children also don’t want to be held. Constant screaming or the inability to sleep also points to severe pain.
If your child has learned to walk and then loses the ability to stand or walk, the most likely reason is that he or she has a serious injury to the legs or an acute problem with balance. If your child walks bent over, holding his abdomen, he probably has a serious abdominal problem such as appendicitis.
Press on your child’s belly while he or she is sitting up in your lap and looking at a book. Normally you should be able to press an inch or so in with your fingers in all parts of the belly without resistance. If he pushes your hand away or screams, this is an important finding. If the belly is also bloated and hard, the condition is even more worrisome. (See Abdominal Pain, page 596.)
Tender Testicle or Scrotum
The sudden onset of pain in the groin area can be due to twisting (torsion) of the testicle. This requires surgery within 8 hours to save the testicle.
You should assess your child’s breathing after cleaning out the nose and when he is not coughing. If your child is working hard at breathing, has tight croup, or has obvious wheezing, he or she needs to be seen immediately. Other signs of respiratory distress are a rapid breathing rate, bluish lips, or retractions (pulling in between the ribs). (See Breathing Difficulty, Severe, page 36.)
Bluish lips, gums, or tongue (cyanosis) can indicate a reduced amount of oxygen in the bloodstream. (See Bluish Lips, page 490.)
The sudden onset of drooling or spitting, especially associated with difficulty in swallowing, can mean that your child has a serious infection of the tonsils, throat, or epiglottis (top part of the windpipe).
Dehydration means that your child’s body fluids are at a low level. Dehydration usually follows severe vomiting and/or diarrhea. Suspect dehydration if your child has not urinated in 8 hours (12 hours if over 1 year old), crying produces no tears, the inside of the mouth is dry rather than moist, or the soft spot in the skull is sunken. Dehydrated children are also tired and weak. If your child is alert and active but not making much urine, he isn’t dehydrated. Dehydration requires immediate fluid replacement by mouth or intravenously.
Bulging Soft Spot
If the anterior fontanel is tense and bulging, the brain is under pressure. (See Soft Spot, Bulging, page 520.) Since the fontanel normally bulges slightly with crying, assess it when your child is quiet and in an upright position.
To test for a stiff neck: With your child lying down, lift his head until the chin touches the middle of the chest. If he is resistant to this, place a toy or other object of interest on his belly so he will have to look down in order to see it. Older children can simply be asked to look at their belly button. A stiff neck can be an early sign of meningitis.
Any injury to the neck, regardless of symptoms, should be discussed with your physician because of the risk of damage to the spinal cord.
Purple Spots or Dots
Purple or blood-red spots or dots on the skin can be a sign of a serious bloodstream infection. Explained bruises don’t count. (See Purple Spots, page 460.)
Fever Over 105°F
All the preceding symptoms are stronger indicators of serious illness than is the level of fever. All of them can occur with low fevers as well as high ones. Serious infections become a special concern only when the temperature rises above 105ºF (40.6ºC). In infants a rectal temperature less than 96.8ºF (36.0ºC) can also be serious.
Because of the marked increase in suicide attempts in adolescence, parents should be alert to any of the following warning signs: preoccupation with thoughts of death or suicide, themes of death in writing or conversation, abrupt withdrawal from friends and family, abrupt loss of interest in favorite pastimes, abrupt decline in schoolwork, reckless risk-taking behavior, depressed mood. Call either the suicide hotline or your child’s physician.
Child Abuse Concerns
Call your child’s physician or the child abuse hotline if you are afraid you might hurt your child, if someone has injured your child, or if someone has shaken your child. Child abuse has a tendency to escalate, so protect your child by seeking help early. Infants are at the greatest risk for a serious reinjury.
Sick Newborn: Subtle Symptoms (see page 130)
Sick Infant: Judging the Severity of Illness (see page 131)
RESUSCITATION (Mouth-to-Mouth Breathing)
If your child has stopped breathing or is gasping for breath (e.g., from choking, croup, carbon monoxide poisoning, drowning, or head trauma), you won’t have time to read these guidelines. So read them now. And take an approved CPR (cardiopulmonary resuscitation) or first aid course. You can’t learn external cardiac massage purely from reading. Fortunately, more than 90 percent of children who stop breathing still have a pulse and heartbeat (unlike heart attack victims) and they need only artificial respiration to revive them. The steps in mouth-to-mouth breathing are as follows.
Rescue Squad—Have someone call a rescue squad (911) immediately. You’re going to need help.
Clear the Mouth—Look for any gum, food, foreign object, or loose orthodontic retainer. If present, remove them with your fingers or a Heimlich maneuver (see Choking, page 11). If any liquid is in the mouth, remove it by turning your child on one side and using gravity.
Position the Head—With your child lying faceup, put a folded blanket or towel (1?2 inch to 2 inches thick) directly under the back of your child’s head. Do not put anything under the shoulders or neck. This “sniffing,” head-forward position opens the airway and closes the esophagus (thereby keeping air out of the stomach). The jaw and chin can also be pulled forward to open the airway more. (Note: Some adolescents and adults may require slight extension of the neck for optimal breathing.)
Pinch your child’s nostrils closed with one hand and seal the mouth with yours. (In small children, an adult can often seal both the child’s nostrils and mouth with his mouth.) Blow air with a steady pressure into your child’s lungs until you see the chest rise (the smaller the child, the smaller the volume of your puff). Then remove your mouth and your child will automatically blow the air out without any help (normal recoil of the lungs). During this time, take a breath and refill your lungs. Repeat this at the following rates:
•Under 2 years old: 20 times per minute (once every 3 seconds)
•2 to 12 years old: 15 times per minute (once every 4 seconds)
•Over 12 years old: 12 times per minute (once every 5 seconds)
Occasionally, take several quite deep breaths to bring plenty of oxy- gen into your lungs. (Note: If it is impossible to open the victim’s mouth, cover the mouth and give mouth-to-nose breathing.) If 4 or 5 breaths don’t move the chest, assume the airway is blocked and perform a Heimlich maneuver 10 times in rapid succession (see Choking, p. 11).
If the heartbeat and carotid pulse are absent, also perform external cardiac massage if you know how to do it. In general, give 5 heart compressions for every 1 breath (i.e., 1-2-3-4-5-breathe, then repeat).