Burns/Submersion/hypo and hyperthermia Flashcards
What is the most common cause of paediatric deaths in children aged 1- 4 years?
a) Congenital heart disease
b) Trauma
c) Submersion injury
d) Sepsis
Trauma first then submersion
Submersion is the most common cause of preventable death, it affects (Males/females) 5:1
Children < X years of age are at greatest risk
- Most common cause preventable cause of death
- Males > Females (5x)
- Children < 5 years at greatest risk
What is the most effective strategy to prevent submersion injuries in children?
a) Personal flotation device in children > 12 months
b) 4 sided fence with self-locking, self-closing gates
c) Swimming instruction to bronze level
d) Parent/caregiver CPR instruction
b) 4 sided fence with self-locking, self-closing gates
Toddlers should always be within X distance of an adult, even in a bathtub
X is recommended number of adults per baby or 2 young children
Swimming programs for children < 4 years (do/do not) decrease rates of drowning
arm’s length
1 adult per baby and 1 adult per 2 young children
Swimming programs for children < 4 years DO NOT decrease rates of drowning
T/F a PFD will flip someone supine
A lifejacket or PFD should be worn by all infants at least X kg
Life jacket can flip someone to supine, PFD will not
9kg
- Babies who cannot sit unsupported are too young to wear PFDs
- Water wings, inflatable undies, pool noodles are not safety devices
Risk factors for drowning
- Leaving children unattended
- Alcohol or drug abuse (50% of adult drownings)
- Limited swimming ability
- Underlying medical conditions: Seizure disorder, toxin, prolonged QT, syncope
T/F - Always delay removal from water until c spine precautions in place
Cervical Spine Immobilization
o Should not delay removal from water
o Only indicated under certain circumstances: Diving, alcohol or other substances, trauma
ABCs - submersion specific interventions
o Use an AED if possible but dry victim first
o Discontinue resuscitative efforts only after temp 35C
Avoid abdominal thrusts if possible
Investigations for submersion injuries
- Early arterial blood gas to assess degree of hypoxemia
- Electrolytes, urea, creatinine
- CXR to look for signs of ARDs
- ECG
- Ethanol level
- Core temperature
A 14-year-old male is pulled from an icy lake after being found face down. What is the most important strategy influencing survival?
a) Immediate c-spine immobilization
b) Immediate CPR by rescuers
c) Passive external rewarming, EMS activation, and transport to health care facility for core rewarming
d) Early placement of a definitive airway
b) Immediate CPR by rescuers
Prognostic Factors in Submersion
• Immediate bystander CPR is most important factor influencing survival
o Return of spontaneous circulation in < 10 min
o Submersion < 5 min
o Pupils equal and reactive at scene
o Normal sinus rhythm at scene
• What are poor prognostic indicators?
o Delayed CPR
o Return of spontaneous circulation > 25 min
o Submersion > 10 min
Complications in Submersion
Complications • ARDS • Pulmonary edema • Pneumonia • Cerebral edema leading to increased ICP • Trauma • Hypothermia
- Defined as core temp < X
- Can occur in water as warm as X
- Shivering stops at core temp < X
- Defined as core temp < 35C
- Can occur in water as warm as 21C
- Shivering stops at core temp < 32C
Complications
Hypoglycemia, hypocalcemia, hypokalemia, metabolic acidosis
Associated with pancreatitis
Findings:
o 31-32 C
o 28-31 C
o < 28 C
o 31-32 C - Normal ECG, ↑ HR, ↑ BP, loss of shivering
o 28-31 C - ↓ HR, ↓ BP, flipped T, atrial fibrillation, sluggish, dilated pupils
o < 28 C - absent pulse and BP, VF, coma, fixed dilated pupils
ECG findings in hypothermia:
• Marked sinus bradycardia • First degree AV block • Osborn or J waves • Associated with prolonged QT and bradycardia Seen in core T < 32
Principles of Rewarming
- Correct hypoglycemia. Tolerate hyperglycemia
- Acidosis is corrected as patient is rewarmed
- Watch for coagulopathy → Fresh frozen plasma
- IVF warmed to 43C
- Expect hypovolemia with rewarming (peripheral vasodilation)
- Avoid CPR in T < 28 and good pulse
- If pulseless → CPR
- If VF → defibrillation x 3 but no more until T > 30
- Drugs rarely effective until T > 30
- Can trigger dysrhythmia if T < 30 just by bumping bed!
Rewarming with a Pulse
• If 34-36C
• If 30-34C
• If <30C
Rewarming with a Pulse
• If 34-36C: Passive rewarming – remove wet clothes, dry
• If 30-34C: Passive and active external warming of truncal areas only - electric blanket, overhead warmer, hot water bottles, heating pads; Minimizes “after-drop” or shock associated with peripheral vasodilation
• If <30C: Active external and internal rewarming
o Warmed IV or intraosseous (IO) fluid (without K+) at 43 C
o Warm humidified oxygen at 42-46 C
o Peritoneal lavage, ECMO, esophageal warming tubes
o Do not delay advanced airway placement
Rewarming without a Pulse
- T ≥ 30C
- T < 30C
Rewarming without a Pulse
• CPR and warming with cardiopulmonary bypass
• Defibrillate all cases of pulseless VT or VF to max of 3 shocks if T < 30C
• Gentle endotracheal intubation
• Warm, humidified O2, warm IVF
• T ≥ 30C: Continue CPR, IV meds as needed, defibrillation as needed
• T < 30C: Continue CPR but no IV meds, limit defibrillation to 3 shocks
A 5-year-old male is pulled from a lake and presents to the ED apneic and pulseless in PEA. His core temp is 29C. The most reasonable course of action is?
a) BVM, CPR and IV epinephrine 1:10 000
b) BVM, CPR and IV bretylium
c) RSI, CPR and active external and internal rewarming
d) RSI, CPR and defibrillation to a maximum of 3 shocks
c) RSI, CPR and active external and internal rewarming
ED treatment of frostbite
- En route avoid warming if significant time to ER
* In ER, 42C water bath, do not rub, keep rewarmed areas open, dry, and sterile
