Ped Accidents and Injuries - Exam 2 Flashcards
trauma is ___ times more likely in males than females. ______ is the most common preventable cause of mortality in trauma
2 times greater in males
Hemorrhage
What are the top 6 accidents/injuries for infants? _____ is specifically for kids less than 1
bedding if less than one
sleep positioning
feeding safety
car seat
crib
co-sleeping
What are the top 7 accidents/injuries for toddlers?
Crib Safety
Choking Foods & Toys
Cords and Cribs
Electrical Sockets
Stairs / Windows
Burns
Poisoning
aka the kiddo is 1-3 years old and learning to walk
What are the top 6 accidents/injuries for preschoolers?
Drowning - 1 - 4 years
Toy Safety
Traffic Safety / Pedestrian Injury
Bicycle / Tricycle Safety
Gun Safety
Stranger Safety
What are the top 5 accidents/injuries for school aged children?
Bike and ATV safety
Pool safety
Sports
Gun safety
Stranger Safety
What are the top ones for early teen/adolescent? **Which one is the starred one?
Vehicle Safety / Seat Belt - 5 - 19 years
Helmets and Protective Gear
Sports
Drug & Alcohol Abuse
Bike & ATV Safety
Gun Safety
______ is the #1 cause of death due to accidents in children 5-19 years old. 60% are due to _______. _______ are the MC among severe injuries due to improper use of safety belts
motor vehicle crash
unrestrained child
head injuries
What are some important questions to ask if a child has been in a MVC?
What are some trauma mechanisms that are associated with a high risk of injury?
What is the car seat recommendation for infants and toddlers? What is the law in WV?
Rear-facing Car Seat until 2 years old or highest weight or height allowed by car seat manufacturer
2 years of age AND up to 35 lbs.
What is the car seat rule for toddlers and preschoolers?
Forward facing with 5-point harness for as long as possible and at least to 4 years of age AND 40 lbs
What is the car seat recommendation for school aged children? How should the seat belt sit?
Belt positioning booster seats until reaching 4 feet 9 inches in height AND at least 8 years old
Seat belts with shoulder and lap belt
How old should the child be until they can sit in the front seat?
Backseat only until 13 years of age
**What is the infant seat belt recommendation? Once a car seat has been involved in a MVC, what should you do?
rear facing until 2 AND 35 lbs
needs to be discarded
_______ is a serious cervical and lumbar spinal cord injuries as well as intra-abdominal injuries in children in MVC resulting from poorly fitting seat belts
seat belt syndrome
aka their seat belt was NOT fitted properly and it caused serious injuries
How should a properly fitted seat belt sit on a child?
Shoulder belt across mid chest not neck
Lap belt low across hips and pelvis, not the abdomen
Tall enough to sit in backseat with knees bent without slouching
60% of pedestrian injuries are ______ at highest risk, happen in own driveway when family backs over them
under age 5, toddlers
_____ is the second most common childhood injury due to a consumer product, next to _____
bicycle injuries - #2
MVC - #1
_____ is the single most effective measure for prevention of significant injury in bicycle accidents. When do bike accidents have the highest mortality?
helmet
Highest morbidity and mortality occur from collision of a cycle and an automobile
60-90% reduction in head injury with use of helmet -
What are the risk factors that increase bike accidents?
Non-daylight hours
Exposure time
Riding on sidewalk
Using for play
Male gender
under 3 years old
risky bicyclist behavior
Why are kids less than 3 at the highest risk for bike accidents?
<3 years old: no cognitive ability to both pedal and steer: bicycle with training wheels under age 3 with foot brakes. No bike hand brakes until at least 6 years old
What are the 3 reasons to discard a bike helmet?
head hits hard surface
fall results in marks on shell
greater than 5 years old
______ is the second leading cause of accidental trauma in children next to MVC, especially under age 5
drowning/submersion injuries
______ is the leading cause of death between ages 1 - 4 - even greater than birth defects. Which gender is more likely?
drowning/submersion injuries
Males 6 times more likely
If the kiddo is less than 4, what type of water? older than 4?
<4-year-old - bathtubs or pool (42% home pool)
> 4-year-old - pools or bodies of water
What is the immediate treatment for drowning on site?
CPR started immediately with 100% oxygen administered
Protection of C-spine
Breaths without Heimlich: don’t delay
What is the tx for a cold water drowning at the hospital?
Resuscitation with aggressive attempts made to restore temp - do not abandon until warmed to 30 degrees C / 86 degrees F (but not above 34 degrees - ischemic brain injury)
NG tube, catheter - core rewarming, warm O2, lavage at 40 degrees C (104 degrees F)
100% oxygen 15 Liters non-rebreathing mask
Intubation and mechanical ventilation if unable to keep oxygen above 80 on 15 L
IVF (20 ml/kg)
NG tube for water removal
Temperature management
Outcome
What is the tx for a warm water drowning at the hospital?
100% oxygen 15 Liters non-rebreathing mask
Intubation and mechanical ventilation if unable to keep oxygen above 80 on 15 L
IVF (20 ml/kg)
NG tube for water removal
What is the temp cutoff for a cold vs warm water drowning? Which one has WORSE outcomes?
cold: <20 degrees Celsius
warm: water temp >20 degrees C
warm has the WORSE outcomes
What are some prevention strategies to avoid drowning?
swim lessons
lifejackets
fencing for pool
“touch supervision”
What age does the AAP recommend swim lessons? Does the kid normally scream or splash?
AAP recommends formal swimming lessons after the 4th birthday
Most children who drown in pools are found silently floating with NO screaming or splashing being noted, were last seen in their home, were missing at least 5 minutes, and in care of one or both parents at time of drowning
What are the 3 different types of burns?
First degree - superficial
Only epidermis
Second degree – partial thickness
Epidermis and dermis – blisters
Third degree – full thickness
Destroys epidermis and dermis
_____ are the leading cause of injury-related death in the home. What are some younger children more likely to be burned from? older kids?
burns
Scald burns - hot liquids - most common
Hot water from faucet, microwave oven and toaster, cooking and pulling items off stove, oven doors
Open flame
What type of burn. What is the tx?
first degree
Cool compresses, analgesics
What type of burn? What is the tx?
second degree
Silvadene and analgesics with sterile non-adhesive dressings
What type of burn? What is the tx?
third degree
Referrals
Immediate: IVF, monitor airway, Foley and transfer
according to the burn chart, what is considered a minor burn?
Minor burns are <10% of the body surface area for first/second degree burns and <2% for third degree burns
**Draw the burn chart for children
What is the tx for an electrocution?
Watch for entrance and exit wounds
ECG for arrhythmias, CK for muscle injury, UA for myoglobinuria, BMP to monitor kidney function and check for rhabdomyolysis
What is the pt education for burns?
keep water temps less than 120 degrees
sun protection: protective clothing, hats, sunscreen if over 6 months old and needs to be at greater than 15 spf
outlet covers
smoke detectors and fire extinguishers
What is the tx for a dog/cat bite? **What is the MC canine microbe? What abx?
All require high pressure, high volume irrigation with saline, scrubbing and debridement
tetanus prophylaxis
+/- rabies vaccine
+/- closure of wound only if on the face or large wound
**Pasteurella multocida
Augmentin
**What type of sutures are preferred for bite injuries? What should you NOT use?
**Interrupted sutures with frequent wound checks
**Never Dermabond!!!
_____ is the leading cause of non-fatal injury in children 0 - 19 years of age. What is considered a “serious” fall?
fall injuries
Trauma centers generally use “fall >10 - 15 feet” as serious as most less than 10 feet not life-threatening. (or 2-3 times the patient height)
What are some prevention strategies for falls in kiddos?
What age range has the highest risk of choking? What is the tx if the kiddo is under 1? Over 1?
Children 6 months - 4 years - highest risk
Under age 1 - Hard back blows
Over age 1 - Abdominal thrusts / Heimlich maneuver)
What are the top 10 MC cause of choking?
What organ is the coin in?
esophagus
toy related injuries: Risk ages 4 and under for ______. _____ for children 14 and under
choking on toys
Riding toys
_____ leading risk of death for toy related injuries, especially if ______ or _____ are involved. Most deaths are from ______
Non-powered scooters
child falls from toy or struck by vehicle
asphyxiation
How old should your kiddo be to ride a skateboard?
Children <5 years old should not ride skateboards
What age range is at the highest risk for ATV injury? What area of the spine for younger children? older children?
11 - 15 years of age most at risk
Younger children: lumbar fractures
Older children: thoracic fractures
When are ATV injuries worse?
the a child was involved in an accident and were driving an ADULT sized ATV
According to the AAP, how old should you be to drive an ATV? **What are the 3 pt education points?
must be 16!!
Off road use only on non-paved surfaces
HELMET!!
do NOT ride double, no passengers
______ is the MC sports injury
Inversion ankle injuries
**_____ is the most dangerous athletic activity. What 3 additional ones?
football
then rugby, hockey then soccer
**_____ is the MC neck injury
cervical spine
Children through high school age take _____ to recover from a concussion and should be managed conservatively. What makes the recover process take longer?
longer
hx of previous concussion
**If you suspect a concussion, what are the recommendations?
Remove from play immediately and do not return to game with a suspected concussion
**Draw the SCAT5 recommendations chart
Where do the majority of poisonings take place? What age group?
at home
under 5 years old and the child exposes themself to the poison
What is the tx for a chemical ingestion?
0.5 - 1 g/kg (max 50 g) per dose
Repeated every 2-6 hours until passed through rectum
**What is the absolute CI for activated charcoal?
Presence of intestinal obstruction
What are the 5 CI for activated charcoal?
Depressed mental status
Late presentation
Increased risk and severity of aspiration with AC use (Hydrocarbon ingestion)
need for endoscopy
heavy metals (do not absorb AC)
alcohols
Read the list for specific things to not use AC on
**What is the medication for an acetaminophen overdose?
N-Acetylcysteine (Acetadote)
PO or IV
What is the chart called for when or when not to treat an tylenol overdose?
Rumack Matthew Nomogram
**What is the medication dosage for a Tylenol overdose? What do you need to monitor? When are liver abnormalities going to peak?
150 mg/kg loading dose over 15 - 60 minutes
Second infusion 50 mg/kg over 4 hours
Third infusion 100 mg/kg over 16 hours
Daily AST, ALT, serum bilirubin, PT
Liver abnormalities may not peak until 72 - 96 hours
What dose of iron will cause iron overdose symptoms? ______ is likely to occur
Dose >20 mg/kg will cause symptoms
Hemorrhagic gastroenteritis 30 - 60 minutes after ingestion
What is the timing of an iron overdose?
Hemorrhagic gastroenteritis 30 - 60 minutes after ingestion
Shock, acidosis, coagulation defects and coma lasting 4 - 6 hours
Phase of improvement 2 - 12 hours
Delayed shock 12 - 48 hours, liver damage and hepatic failure
Metabolic acidosis, fever, leukocytosis, liver damage with hepatic failure, or coma
What is the tx of shock associated with iron overdose?
Gastric lavage and whole bowel irrigation;
What will lead poisoning present like?
Symptoms of weakness, irritability, weight loss, vomiting, ataxia, headache, colicky abdominal pain, developmental delays
What is a big offended for a source of lead in a kiddos life? When do you screen for lead?
Lead paint, specifically homes built before 1960
CBC and Lead in every child around 12-month WCC
What is considered a positive lead level? What should you do next?
Positive levels: ≥ 5 - 9 mcg/dl should be confirmed within 1 - 3 months and repeated after 3 months, then 6 - 9 months after environmental changes are initiated
When is chelation therapy recommended in high lead levels? What is the name of the rx?
Chelation therapy - blood lead level ≥ 45 mcg/dL
Succimer - 10 mg/kg every 8 hours for 5 days; then every 12 hours for 4 days
How long does it take a disk-shaped battery to pass through GI tract? When should you repeat the xray?
Over 80% pass through GI tract in 48 - 72 hours
Repeat x-rays if doesn’t pass within 7 days
When is a disk-shaped battery an emergency?
remove button battery if it is the esophagus
If in esophagus more than 24 hours, greater risk for erosion
What are the pt education points for poison prevention
Poison Control
Storage of pills and household cleaning supplies
Avoid taking medications in child’s presence
Never refer to pills as candy
Child-proof pill bottles and locks on cabinets
Recognition of risk at grandparent or relative home
Lead screening
What is the prevention for firearm injury?
Removal from home
unloaded in safe with ammunition in SEPARATE location
gun locks
Kids and adolescents are at an increased risk for _____ when there is a gun in the home too
suicide
