Lecture 12: Pediatric Accidents & Injuries Flashcards
Which gender dies more?
Male 2x more
What is the leading cause of pediatric mortality?
Trauma
At the scene or 4 hours post arrival
What is the MC preventable cause of mortality in trauma?
Hemorrhage
What is the most common injury factor in infants < 1 yo?
Bedding
What is the main risk factor for mortality in preschoolers? (age 1-4)
Drowning
What is the primary injury factor for early teens/adolescents?
Vehicle safety/Safety belt (5-19y)
What is the MCC of death due to accident in children aged 5-19?
Motor vehicle crash
60% due to unrestrained child ):
What MPH is concerning for a high risk injury in a crash?
> 20 MPH
When is a rear-facing car seat indicated? (2)
- Until 2 years old OR
- Highest ht/wt allowed
When is a forward facing carseat indicated until? (2)
- Up to 4 years old AND
- 40 lbs
What are the 2 criteria that make a booster seat needed?
- Shorter than 4’9”
- 8 years old at minimum
Backseat only until 13 years old
What is seat belt syndrome?
Serious cervical and lumbar spinal cord injuries + intra-abdominal injuries
All due to poorly fitted seat belts
Image of proper seat belt fitting
What is the 2nd MCC of childhood injury due to consumer product?
Bicycles
What is the most effective measure for prevention of significant injury with bicycles?
Helmet
When should you discard a helmet?
- Head hit a hard surface
- Fall resulted in marks on shell
- Greater than 5 years old
What is the 2nd leading cause of accidental trauma?
Drowning, esp under age 5!
From age 1-4, it is the leading cause
Which water temperature tends to have a worse prognosis?
Warm water > 20C
How do most children drown?
Silently ):
What is the leading cause of injury-related death at home?
Burn injuries
Should you pop burn blisters?
No
What should you monitor with electrocution injuries? (4)
- EKG
- CK
- UA
- BMP
How do you treat a second degree burn? (3)
- Silvadene
- Analgesics
- Sterile non-adhesive dressings
Who do dogs bite the most?
Boys
When do you close a bite wound? (2)
- Only suture if large or facial
- NEVER DERMABOND
Tx of a bite wound (2)
- Intense, high volume irrigation
- Augmentin for 10d
What is the MC canine microbe in bite wounds?
Pastereulla multocida
What is the MCC of non-lethal injuries in children?
Falls
Where do most falls occur?
Home
What fall height is concerning?
10-15 ft or 2-3x the patient’s height
What are the common environments/ways in which children fall?
- Baby walkers
- Bathtubs
- Playground equipment
- Shopping carts
- Furniture
When is choking highest risk in children?
6 months - 4 years old
How do you tx a choking child under age 1? After age 1?
- Under age 1: Hard back blows
- After age 1: Abdominal thrusts/Heimlich
How does choking present usually? (6)
Acute onset of…
- Coughing
- Choking
- Wheezing
- Cyanosis
- Drooling
- Stridor
What is the leading risk of death among toys?
Non-powered scooters
What age should a child NOT ride a skateboard?
Less than age 5
What age range is most at risk for ATV injuries?
11-15
What is the primary underlying factor for ATV injuries?
Riding an ATV bigger than you
What is the recommended minimum age to ride an ATV?
16 years old per AAP
When is risk of recurrent concussion highest?
Within 10 days of first concussion
What are the return to play guidelines?
SCAT5 is the professional criteria
General criteria
5 days of no symptoms as you ramp up. Need approval on day 3.
When and where do the majority of poisonings occur?
- Under age 5
- At home
Most are unintentional
How do you treat an ingested poison?
Activated charcoal
Gastric lavage is rarely used now.
When is activated charcoal contraindicated? (6)
- Depressed mental status
- Late presentation
- Increased risk and severity of aspiration if used (hydrocarbons)
- Need for endoscopy (impaired visibility)
- Toxins that are poorly absorbed by charcoal (metals)
- Presence of intestinal obstruction (ABSOLUTE CI)
How is tylenol poisoning treated? (2)
- Activated Charcoal
- N-acetylcysteine (Acetadote)
How is N-acetylcysteine dosed?
- Loading dose of 150mg/kg over 15-60m
- 2nd infusion of 50mg/kg over 4 hrs
- Third infusion of 100mg/kg over 16 hrs
150, 50, 100
Must monitor liver enzymes daily
What iron dosage tends to cause symptoms?
> 20mg/kg
What is the initial condition that occurs from iron OD?
Hemorrhagic gastroenteritis
Can lead to shock, coma, hepatic failure
How is lead poisoning treated?
Chelation via IV Succimer
When is chelation therapy indicated for lead poisoning?
Blood lead level >= 45mcg/dl
When are blood lead levels checked?
12 month WCC
Where can you remove disc-shaped batteries?
If it is in the esophagus
Otherwise, XR in 7 days
