Tia Dickson, RN, BSN

Primary Children's Hospital

While not typically a 911 call, vomiting and diarrhea are frequent complaints seen in the ER and in the pediatric population.

Gastroenteritis, also known as the stomach flu or gastro, is a common, short-term illness that causes inflammation of the stomach and intestines which can lead to vomiting and diarrhea. It is highly contagious and we are seeing many cases at Primary Children's Hospital (PCH) right now.

Most cases of gastro in the U.S. are not harmful but it can become dangerous if it leads to dehydration. Children are particularly susceptible to this complication. There are other complications to monitor for as well. We recently had 2 cases of hemolytic uremic syndrome (HUS) in Utah. HUS is a rare but serious disease that affects the kidneys and blood clotting functions of people who are infected. Infection with HUS causes destruction of red blood cells, which can then cause kidney failure. HUS occurs as a complication of a diarrheal infection (cases in Utah were tied to drinking unpasteurized milk).

https://www.osmosis.org/learn/Infectious_gastroenteritis_and_enterocolitis:_Clinical_sciences

Expert from webMD summary

Written by Matt McMillen, Lori M. King, PhD

Gastro begins with inflammation typically triggered by your immune system's response to a viral or bacterial infection. However, infections caused by fungi or parasites or irritation from chemicals can also lead to gastroenteritis.

You may have heard the term "stomach flu." When people say this, they usually mean gastroenteritis caused by a virus. However, it's not actually related to the flu, or influenza, which is a different virus that affects your upper respiratory system (nose, throat, and lungs).

Gastroenteritis symptoms often start with little warning. You usually get nausea, cramps, diarrhea, and vomiting. Expect to make several trips to the toilet in rapid succession. Other symptoms tend to develop a little later on and include:

• Belly pain
• Loss of appetite
• Chills
• Fatigue
• Body aches
• Fever

Because of diarrhea and vomiting, you also can become dehydrated. Watch for signs of dehydration, such as dry skin, a dry mouth, feeling lightheaded, and being really thirsty.

How long symptoms last depends on what caused it. But generally, acute gastroenteritis lasts about 14 days. Persistent gastroenteritis lasts between 14 and 30 days, and chronic gastroenteritis lasts more than 30 days.

Children and infants can get dehydrated quickly. If they do, they need to go to the doctor as soon as possible. Some signs of dehydration in kids include:

• Sunken soft spot on your baby's head
• Sunken eyes
• Dry mouth
• No tears come out when they cry
• Not peeing or peeing very little
• Low alertness and energy (lethargy)
• Irritability

Keep children with gastroenteritis out of day care or school until all their symptoms are gone.

Check with your doctor before you give your child any medicine. Doctors don't usually recommend giving kids younger than age 5 over-the-counter drugs to control vomiting. They also don't recommend giving kids younger than age 12 drugs to control diarrhea (some doctors won't recommend them for people younger than age 18).

Go to the doctor or ER if:

• Your child age 2 and older vomits for more than 1 day, has severe diarrhea (passing large amounts of loose or watery poop every 1-2 hours), or has a fever over 104 F that lasts more than 2-3 days.
• Your child younger than age 2 vomits or has diarrhea for more than 12 hours or has a fever with vomiting and diarrhea.
• Your child has any signs or symptoms of dehydration.
• Your vomit or diarrhea turns bloody or tarry (black and thick).
• You have kidney, liver, or heart disease and you can't keep anything down.
• You have sudden, severe abdominal pain.
• Your symptoms last longer than about 5 days.

Seek emergency care or call 911 if your child is dehydrated. Signs and symptoms of dehydration include:

• Feeling very thirsty
• Not needing to pee or only pees a little
• Crying without producing any tears
• Dry mouth
• Sunken eyes
• Dizziness or lightheadedness
• Rapid breathing and heartbeat
• Lack of alertness
• Blurred or double vision
• Trouble swallowing or breathing
• Muscle weakness

Most people won't need specific treatment for gastroenteritis and will get better on their own after a few days. The best thing you can do to speed up your recovery is to rest at home, stay hydrated, and eat bland food.

To keep yourself hydrated:

• Drink as much clear fluid as possible. If you're nauseated, try frequent small sips throughout the day or suck on ice chips.
• If you can, eat small amounts of foods that are easy to digest and have electrolytes, such as fruit juice, popsicles, broths, and saltine crackers.
• Children can get dehydrated very quickly, so give a child with gastroenteritis a hydration solution, such as Pedialyte, to drink.

Gastroenteritis medication

To help ease your symptoms, your doctor may recommend medicines such as:

• Anti-nausea medications like Zofran to ease your vomiting.
• Antibiotics can’t treat viral gastroenteritis. They are not often used for bacterial gastroenteritis, either. However, some bacteria do require antibiotic treatment. Your doctor may do tests to help decide if you need antibiotics.
  

As your symptoms start to ease:

• Gradually ease back into eating a regular diet.
• Start by eating bland easy-to-digest food such as crackers, bananas, toast, rice, and chicken or follow the BRAT diet.
• Avoid dairy and caffeine until you completely recover.

For infants and children

Infants and children can get dehydrated faster than adults. Kids who are dehydrated need to see a doctor. Keep them hydrated with a hydration solution, and avoid drinks with too much caffeine and sugar, which can make their diarrhea worse, such as:

• Carbonated sodas
• Caffeinated drinks
• Sports drinks
• Tea with sugar
• Juices

•Bloody or green vomit

•Bloody stool

•Severe pain

•No urine for >8 hours for infants or >12 hours for children older than age 1

•Lethargy

When you evaluate these children check the blood glucose. Treat when blood glucose is <60 mg/dl for children, and <40 mg/dl for the term neonate (<30 days of age) with any degree of altered mentation.

EMTs

• Use oral glucose 7.5 grams if patient is able to protect airway. Repeat in 15 minutes as needed.

AEMTs

Infants up to age 1

• Dextrose 10% 5 mL/kg (0.5 grams/kg) IV/IO. May repeat as necessary up to a MAX of 125 mL (12.5 grams).

Children older than age 1

• Dextrose 25% 2 mL/kg IV/IO: repeat as necessary (max 12.5G/ 50mL)
• Dextrose 10% 5 mL/kg (0.5 grams/kg) IV/IO. May repeat as necessary up to a MAX of 25 mL (12.5 grams).
• Glucagon 0.01 mg/kg (max dose of 1 mg) IM if no IV/IO access available.

For additional guideline direction check out the UPTN website or the new app, "Utah PTN" on android and apple devices.

Training officers may review the topic above as a team training AND perform a simulation/skills check as directed here. Once complete, send a roster of participants to Utah.PETOS@gmail.com and those listed will be issued 1-hour of CME credit from the DHHS Office of EMS and Preparedness.

Individuals who don't have a training officer can get CME credit on their own by viewing PETOS in our archives and completing the instructions on the webpage.

1. Review your agencies dextrose administration policies.
   
2. Using the videos above, practice diluting D50 for the D25 and D10 administration.

June is LGBTQ Pride Month. In early April, CSN released an infographic and a fact sheet focused on injury and violence gaps among specific youth. More information about these resources can be found below.

Last month, to provide Title V agencies with information on nationally-focused public health organizations that focus on child safety, CSN, in collaboration with the Children's Safety Now Alliance, published a new resource guide, "Child Safety National Public Health Partners." The guide presents a brief description of each agency or organization, followed by topic areas and activities related to child safety that may provide opportunities for collaboration.

National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!

If your agency is interested in Jeff's autism training or in receiving the free John Wilson autism kits, contact Jeff @jeffwilson122615@gmail.com.

The Medical Home Portal is a unique source of reliable information about children and youth who have special health care needs (CYSHCN) and offers a “one-stop shop” for their:

· families

· physicians and medical home teams

· other professionals and caregivers

We are into our second month for this prehospital survey. This is the big one and will help us identify pediatric gaps so we can zero in on the state's needs. It will also determine whether your agency is peds ready and tell you where to direct your efforts in the PECC role.

EMS and fire-rescue agencies across the nation are encouraged to participate in the Prehospital Pediatric Readiness Project Assessment to help them understand their pediatric capabilities and gaps. The online assessment is open now for EMS and fire-rescue agencies that respond to public 911 calls. It takes an average of 30 minutes to complete. Learn more about or complete the assessment at https://emspedsready.org/. You may also reach out to our state program manager with any questions, Jared.wright@utah.gov.

At this site you will find tools to help you explain the survey to your agency leadership. Make sure they understand the importance of this data collection.

https://emscimprovement.center/domains/prehospital-care/prehospital-pediatric-readiness/spread-word/

PECCs, the Western Pediatric Trauma Conference returns to Utah this year and is an excellent opportunity to associate with the state's trauma and ED MDs while learning all the latest in pediatric trauma. While in-person attendance is pricey, there is a special virtual option for EMS that is just $25 (RN's virtual option is $100). Spread the word and consider participating yourselves.

July 10-12, 2024 in Sundance, UT.

https://www.pedtrauma.org/

See below the information on a new webinar series designed for emergency managers and hospital PECCs on topics like decontamination operations, reunification, behavioral health, isolation/quarantine, and more! The goal is to better help you plan for pediatric patients at your facilities! All are welcome.

For hospital PECCs

• EMSC has launched its first pediatric emergency care coordinator (PECC) learning module for ED-based PECCs. You are invited to view the module and provide feedback.

For EMS PECCs

• EMS PECC resources can be found on the EIIC website here.

The Emergency Medical Services for Children (EMSC) Program aims to ensure emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure the system is backed by optimal resources and that the entire spectrum of emergency services (prevention, acute care, and rehabilitation) is provided to children and adolescents, regardless of where they live, attend school, or travel.

Email: tdickson@utah.gov
Website: https://bemsp.utah.gov/
Phone: 801-707-3763
Facebook: facebook.com/Chirp-UtahDepartmentofHealth