Pediatric accidents & injuries Flashcards
classifications of injuries according to age
- infants
- toddlers
- preschool
- school-age
- early teens and adolescents
common infant injuries (6)
- Bedding - < 1yo
- Sleep Positioning
- Feeding Safety
- Car seat Safety
- Crib Safety
- Co-sleeping
common toddler injuries (7)
- Crib Safety
- Choking Foods & Toys
- Cords and Cribs
- Electrical Sockets
- Stairs / Windows
- Burns
- Poisoning
common preschooler injuries
- Drowning - 1-4 yrs
- Toy Safety
- Traffic Safety / Pedestrian Injury
- Bicycle / Tricycle Safety
- Gun Safety
- Stranger Safety
common school age injuries (5)
- Bike and ATV safety
- Pool safety
- Sports
- Gun safety
- Stranger Safety
common early teen/adolescent injuries (6)
- Vehicle Safety / Seat Belt - 5 - 19 years
- Helmets and Protective Gear
- Sports
- Drug & Alcohol Abuse
- Bike & ATV Safety
- Gun Safety
- #1 cause of death d/t accidents in 5-9 y/o?
- MC injury out of this incident?
- MVA
- head injury d/t improper use of seat belts
MVA - important hx questions to ask
- blunt trauma
- description of crash
- seat bleat/car seat use
- airbag deployment
- direction of impact
- where was the pt
- damage to car
- MPH (>20 high risk)
- distance of ejection from car
- body part hit/injured
guideline for rear-facing car seat?
until 2 years old or highest wt or ht allowed by car seat manufacturer (AAP recommended)
Forward facing with 5-point harness for as long as possible and at least what of age and weights how much?
- 4 years
- 40 lbs
Belt positioning booster seats until reaching ? in height and at least ? old
- 4 feet 9 inches
- 8 years
school-aged kids should be in the backseat only until how old
13 years of age
T/F: Any car seat involved in an MVC must be discarded
T
what condition makes fitting in a seat properly in a vehicle an obstacle?
obesity
Need to support the young child’s __, __, ___, and ___ and to distribute crash forces over the entire body
posterior torso, neck, head and pelvis
what is seat belt syndrome?
serious cervical and lumbar spinal cord injuries as well as intra-abdominal injuries in children in MVC resulting from poorly fitting seat belts
proper way to wear a seat belt
- 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
Second most common childhood injury due to a consumer product, next to MVC
Bicycle Injuries - MC d/t head injury
the single most effective measure for prevention of significant head injury
helmet
RF for bike injuries
- Non-daylight hours
- Exposure time
- Riding on sidewalk
- Using for play
- Male gender
- Age
- < 3 years oldno cognitive ability to both pedal and steer
- > 80% d/t bicyclist’s behavior: not following rules, riding against traffic flow, riding into street without stopping
< 3 y/o should have what type of bike?
- bike w/ training wheels w/ foot brakes.
- No bike hand brakes until 6 years old
discard bike helment if:
- head hits hard surface
- fall results in marks on shell
- greater than 5 years old
- 2nd leading cause of accidental trauma in children next to MVC, esp under age 5
- Leading cause of death ages 1-4 - even > birth defects
drowning
Non-fatal or near-drowning often results in ?
brain damage or long-term disability
MC places of drowning in < 4y & >4y?
- < 4y - bathtubs or pool (42% home pool)
- > 4y - pools or bodies of water
Males 6x more likely
mgmt for drowning
at site: CPR + 100% O2; protect C-spine
- Cold water (< 20 C): resuscitation + restore temp to 30-34C; NG tube, cath-core rewarming, warm O2, lavage at 40C
- warm water: poorer prognosis, arrives comatose
- 100% O2 15 L non-rebreathing mask
- Intubation and mech vent if < 80 on 15 L - IVF (20 ml/kg)
- NG tube for water removal
- Temp management
- Outcome
how to prevent drownings
- learn to swim after 4/yo
- lifejackets
- fencing for pools
- Anticipatory Guidance - “Touch Supervision” - within reach
if child drowns in cold water, why only restore their temp below 34C?
if above can cause ischemic brain injury
how are most children found after drowning?
silently floating with NO screaming or splashing being noted
degree of burns
- 1st degree - superficial; Only epidermis
- 2nd degree – partial thickness; Epidermis and dermis – blisters
- 3rd degree – full thickness; Destroys epidermis and dermis
Leading cause of injury-related death in home
burns
- MCC burns in younger children?
- older children & teens?
- Younger child: Scald burns - hot liquids
- Older child and teens: Open flame
what is the burn chart?
- Letters are differentiated by age
- Numbers are constant
- Minor burns are < 10% of body surface area for 1st/2nd degree burns; < 2% for 3rd degree burns
tx for 1st degree burn
Cool compresses, analgesics
tx for 2nd degree
Silvadene and analgesics with sterile non-adhesive dressings
tx for Third degree burns
Referrals
Immediate: IVF, monitor airway, Foley and transfer
tx for electrocutions
- 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
anticipatory guidance to prevent burns?
- water temp: < 120 degrees
- sun - wear protective clothing, SPF >15 for >6 months old
- outlet covers
- smoke detectors
dog and cat bites are MC in who?
Dog bites - Boys
Cat bites - Girls
mgmt for bite injuries
- All require high pressure, high volume irrigation with saline, scrubbing and debridement
- Tetanus prophylaxis/Rabies vaccine - Quarantine x 10 d or brain tested at DHHR
- Closure of wound (face, large wounds)
- Augmentin - Pasteurella multocida common canine microbe
Leading cause of non-fatal injury in children 0 - 19 years of age
falls
MC ways to fall based of age groups?
- Infants - furniture or stairs
- Toddlers - windows, crib, shopping carts
- Older children - playground, trees, ladders
Trauma centers generally use “fall ____ feet” as most serious (or ___ times pt ht)
- > 10-15
- 2-3
< 10 ft not life-threatening.
MC types/locations from falls
- baby walkers
- tubs
- playground
- shopping carts
- furniture
prevention for falls
- Baby gates & guards
- Never leave baby or infant unattended on bed/furniture
- restraints on highchairs and shopping carts
- Guard rails on cribs and lower mattress with age - Beds moved away from cords and drapery
- Infant seats on floor instead of furniture
- Kids in shopping carts should wear seat belt and should not ride in basket, stand in cart or climb on side
choking/FB is MC in what age group?
6 months - 4 years - highest risk; limit certain snacks under age 4
s/s of choking/FB?
mgmt?
- Acute onset of coughing, choking, wheezing, cyanosis, drooling or stridor
- < 1 y - Hard back blows; >1 - Abd thrusts / Heimlich; Anticipatory Guidance
10 MCC of choking (food & toys)
- hot dogs
- candy -hard foods
- peanutes, grapes - whole
- popcorn
- chewy sticky foods (peanut butter, raisins, etc)
- batteries
- coins, marbles, stones
- balloons
- magnets
- art supplies, small toys
T/F: Toy-related injuries MC do require hospitalization
F - 97% do not need
MC leading risk of death from toy-related injuries
non-powered scooters
Almost how many injuries occur to head and face when child falls from toy or struck by vehicle?
1/2 injuries
Most deaths from toy-related injuries are from ?
asphyxiation
age restriction for skateboards?
< 5 y
who is more susceptible to spinal injury in ATV accidents?
- females
- Injury rate for boys’ double that of girls however
- 11 - 15 years of age most at risk
Compared to MVC injuries, ATV-related injuries are how likely to be hospitalized
twice as likely
MC fractures in ATV accidents?
- Younger children: lumbar fractures
- Older children: thoracic fractures
Anticipatory Guidance for ATV rides
- Off road use only on non-paved surfaces
- Always wear a helmet - Reduces head and neck injuries by 50%
- Not having a passenger
- Prohibiting < 16 y as recommended by AAP
- ATVs are NOT toys
MC injury from sports incident?
sprains and strains - Inversion ankle injuries
MC sports to cause concussions and neck injuries?
MC neck injury?
- Football and rugby, hockey; then soccer
- Cervical spine
mgmt for concussions - return to play
- Kids through HS age take longer to recover; conservative tx
- H/o concussion or younger age - associated with longer recovery after a concussion
- h/o one concussion more likely to experience another, esp during next 10 days
- Field concussion assessment - “Concussion Quick Check”
- Return to play guidelines
- SCAT5 Guidelines
- Remove from play immediately and do not return to game
90% poisonings occur where?
- home
- Majority under the age of 5 and unintentional
MCC of poisoning
- cosmetics / personal care products
- analgesics
- household cleaning products
mgmt for poisonings
- lavage ONLY IF within 1-2 of ingestion
- activated charcoal - Repeated q 2-6h until pooped out
CI to activated charcoal
- Depressed mental status
- Late presentation
- Incr risk and severity of aspiration with AC use - Hydrocarbon ingestion
- Need for endoscopy - AC impairs visibility
- Toxins poorly absorbed by AC - Metals - iron, lithium, alkali, mineral acids and alcohols
- Presence of intestinal obstruction (Absolute CI)
Poisoning – Common Threats
- Acetaminophen (Tylenol)
- iron
- lead
- disk-shaped batteries
mgmt for acetaminophen toxicity
- N-Acetylcysteine (Acetadote)
- Plot on chart
- 150 mg/kg loading dose over 15-60 min
- 2nd infusion 50 mg/kg x 4 h
- 3rd infusion 100 mg/kg x 16 h
- Daily AST, ALT, serum bilirubin, PT
- Liver abnormalities may not peak until 72 - 96 h
iron Dose ? mg/kg will cause sx
poisoning
> 20
s/s of iron toxicity?
mgmt?
- Hemorrhagic gastroenteritis 30-60 min 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
- Met. acidosis, F, leukocytosis, liver damage with hepatic failure, or coma
- Gastric lavage and whole bowel irrigation; tx of shock
s/s of lead poisoning
mgmt?
- weakness, irritability, wt loss, V, ataxia, HA, colicky abd pain, developmental delays
- Lead paint, esp homes built before 1960
- CBC and Lead in every child 12-month WCC
- Positive: ≥ 5-9 mcg/dl; confirmed in 1-3 months and repeated after 3 mo, then 6-9 mo after environmental changes
- Chelation therapy (Succimer) - blood lead lvl ≥45 mcg/dL
mgmt for disk-shaped battery poisoning
- X-rays - MC pass through GI tract in 48 - 72 hoursl Repeat if doesn’t pass within 7 days
- Removal if in esophagus; If in esophagus >24 hrs, greater risk for erosion
firearm injury and safety?
- Nearly all occur in or around the home
- Screening and Anticipatory Guidance at WCC
- Removal from home, unloaded in safe with ammunition in separate location, gun locks
