Emergency 2 Flashcards
What are the risk factors for adolescents who overdose or self harm?
- Men are more likely to complete suicide, but women engage in more parasuicidal activity
- Rates highest in men 19-34 years old
- Divorced > widowed > single
- Social class V
- Living alone
- Psychiatric illness
- Previous deliberate self-harm
- Alcohol dependence
- Physical illness- especially terminal illness and debilitating or chronically painful conditions
- Family history of depression, alcohol dependence or suicide
- Recent adverse life events- especially bereavement
What is SIDS?
sudden and unexpected death of an infant or young child for which no adequate cause is found after a thorough postmortem examination
the commonest cause of death in children aged 1 month to 1 year (2-4 months)
Which factors are associated with SIDS?
Age 1-6 months, peak at 12 weeks Low birthweight and preterm, but 60% are normal birthweight term infants Sex boys 60% Multiple births o The Parents Low income Poor or overcrowded housing Maternal age (<20y/o has x3 risk of a mother age 25-29, but 80% of affected mothers are >20years old Single unsupported mother x2 the rate of supported mothers High maternal parity Maternal smoking during pregnancy Parental smoking after baby’s birth o The Environment The infant sleeps lying prone The infant is overheated from high room temperature and too many clothes and covers, particularly when ill
What advice is given in the back to sleep campaign for SIDS?
o Infants should be put to sleep on their back, not their front or side
o Overheating by heavy wrapping and high room temperature should be avoided
o Infants should be place in the ‘feet to foot’ position
o Parents should not smoke near their infant
o Parents should seek medical advice promptly if their infant becomes unwell
o Parents should have the baby in their bedroom for the first 6 months of life
o Parents should avoid bringing the baby into their bed when they are tired or have taken alcohol, sedative medicines or drugs
o Parents should avoid sleeping with their infant on a sofa, sette or armchair
What occurs after an unexpected death in a child?
Breaking bad news- police (not their fault) and coroner will be involved
Opportunity to donate tissues and organs
Opportunity to see and hold the child, minister of religion can be called
Social services review
Police visit home and examine where baby died
Postmortem performed
Multi-agency meeting- possibility of abuse discussed. Detailed letter for parents
Bereavement counselling
Genetic counselling may be indicated
What investigations should be performed when a baby is pronounced dead?
Nasopharyngela aspirate for virology and bacteriology
Blood for toxicology, metabolic screen, chromosomes if dysmorphic
Urine- biochemistry, toxicology and freeze immediately
Lumbar puncture- CSF for virology and routine culture if indicated
What can be the features in burns/scalds?
o Blisters o Pain o Peeling skin o Shock o Airway obstruction o Wheezing o Swelling
What are the risk factors for burns/scalds?
- Low economic status and low education levels of the mother are the main demographic factors associated with a high risk of burn injury
- Other associated factors are a high population density, household crowding and psychological stress in the family
- Single parents and younger mothers are more at risk, especially if they are unemployed
What is the first aid for burns/scalds out of hospital?
• Cool the burn under cold running water for at least ten minutes.
• Cooling the burn will reduce pain, swelling and the risk of scarring. The faster and longer a burn is cooled, the less the impact of the injury
• After the burn has been cooled, cover it with cling film or a clean plastic bag.
• This helps prevent infection by keeping the area clean. Cling film or plastic bags provide an ideal covering
because they don’t stick to the burn and reduce pain by keeping air from the skin’s surface.
• Call 999 if necessary.
• The burn may need urgent medical treatment. Always seek medical advice for a baby or child that has been burned
What occurs in different depths of burns?
Superficial burns- the skin will be epithelialised from surviving cells
In partial thickness burns- there is some damage to the dermis with blistering, and the skin is pink or mottled
Regeneration for superficial and partial thickness burns is from the margins of the wound and from the residual epithelial layer surrounding the hair follicles deep within the dermis
In deep burns (full thickness). the skin is destroyed down to and including the dermis and looks white or charred, is painless and involves hair follicles, hence skin grating is often required, need assessment and treatment in hospital
How is the surface area of the burn calculated?
surface area chart
the palm and adducted fingers cover about 1% of the body surface
burns covering more than 5% full thickness and 10% partial thickness need assessment by burns specialist
involvement of more than 70% of body surface carries a poor chance of survival
What is the treatment for burns?
o Relieving pain, assessed with a pain score
o Treating shock with IV fluids, preferably plasma expanders and close monitoring of haematocrit and urinary output, children with more than 10% burns will require IV fluids
o Providing wound care- burns should be covered with cling film, which reduces pain from contact with cold air and reduces the risk of infection, blisters should be left alone
tetanus immunization status must be ascertained and a booster given if required, ongoing care involves removal of dead tissue and placement of sterile dressings
What are the preventative measures to reduced the prevalence of burns injuries?
- Install smoke alarms in the house
- Teach a child about fire safety and the hazards of matches & fireworks
- Keep children from being able to climb near stoves or from reaching and pulling pans, irons and oven doors
- Turn pot handles towards the back of the stove
- Place fire extinguishers in key locations
- Remove electrical cords from the floor and keep them out of reach
- Use plug covers to prevent against electrical burns
What are the features of an airway burn?
o Upper airway swelling
o Acute respiratory failure
o Carbon monoxide intoxication
• Oedema typically occurs 12-24hrs after injury and hence early intubation is recommended rather than observation
• Oxygen at a high flow should be given- if respiratory effort fails due to damage, then mechanical ventilation should be started in the aim to blow off any excess CO
what’s the difference with electrical burns?
- Electrical injuries should be assessed according to the power source and type of current
- Most are low tension injuries (<110 volts) and occur on the hands or mouth
- Electrocution generates heat and follows the path of least resistance, this can cause characteristic burns in children as well as muscle damage and cardiac anomalies
- Injuries also often result from being thrown from the electrical source if it is AC- there may be tetanic contraction of muscles, which results in muscle damage or tearing
