Trauma part 2 Flashcards
What are worried about with spinal injuries?
What is tx focused on?
the level because the higher the injury, greater impact of function
- affects respiratory function
The primary issue has happened (again) and so we need to work on the aftermath
Spinal cord injury causes
flexion
extension
distraction
T/F
wearing a waist seatbelt without a booster seat or putting seatbelt behind you causes extra risk for spinal cord injury
true
How do we assess for spinal injury?
What do we need to be aware of?
diagnostic tests like X-ray and CT
Protect the spine during diagnostics
- do C collar for spine. You aren’t allowed to take this off until they’re awake and alert
What positioning is needed for spinal injuries?
How do we move them?
midline
log rolling
-which requires another person to stabilize head and neck for safety
Initial treatment for spinal column injury?
What if there’s structure issues like fractures?
Steroids - to decrease inflammation and reduce damage from swelling, edema, and pressure.
- reduction of edema to see what the likelihood of functioning is for normal state
Go in and clean it up to decrees risk of bone fx with surgical intervention to prevent further injury
With spinal injuries what might the patient lose?
How do you monitor?
What if there’s hypotension?
Loss of Autonomic maintenance responses
- spinal shock
- loss of vasodilation
Monitor them very carefully as far as overall response
- vitals
- trends
- fluid changes
If there’s hypotension could mean trauma bleeding somewhere else
Long bones injury description
Marked blood loss from fracture that leaves damage to vessels and structures around bones
pelvic fractures need to consider?
consider structures beneath the the fx could hurt
- bone movement or splintering essentially
How do we apply compartment syndrome to spinal injury?
P’s to asses this?
Spinal injury can cause edema and bleeding into interaction that causes extra pressure and loss of give of the body and so pressure pushes back internally and causes damage
- assess for paresthesia
- pallor
- pain
- puffiness
- paralysis
- pulse
What does Child maltreatment include?
Physical abuse or neglect Emotion abuse or neglect
Sexual abuse of childern
Why are children and elderly at higher risk of abuse?
Bc they can’t help themselves
Example of how many kids go through maltreatment
678k were determined to be victims of maltreatment in 2015
- so there could be more that weren’t reported
Majority of maltreatment cases are what?
what is the other trend?
Neglect at 61%
They often can experience more than one tho - neglect, sexual , physical, or emotional
-often 2
T/F
There’s a specific group of people that are abusers
false actually no group
How does the decrease of extended family ties impact maltreatment?
How does chronic stress affect maltreatment?
That has added to occurrence of maltreatment from lack of support
It increases the risk of maltreatment
How does the use of substances affect maltreatment?
The increased alcohol and more substances increases risk of maltreatment
What is corporal punishment? How does this affect maltreatment?
Physical punishment like spanking.
It can possibly lead to more abuse.
How does the media and literature affect maltreatment?
The level of violence displayed can make it to where there’s more conditioning to accept violence and then it comes out in behaviors.
- the permanence of seeing violence and death doesn’t resonance with us anymore
Which is abuse more likely in:
Old or young parents
types of families
marriage/realtionship situations
isolation of what kind
amount of support
young parents
single family
single family with unrelated partner
- the partner isn’t always the abuser tho . it could be the bio parent
social isolation
only a few supportive relationships
alcohol
stress
the cycle
substance abuse especially alcohol bc it affects behavior
more stress means less coping and so then it comes out in your own treatment of people
those who have experienced it before turn around do it to their own kid bc they dontknow problem solving skills
esteem
knowledge
low self esteem
lack of ability to cope
age of children most abused
term or preterm
under age of 1 year bc they cant defend themselves
preterm infants are more likely bc of increased care needs and may have increased financial burden
- parent infant bond may not be normal as well
developmental risk for maltreatment
amount of children
was the pG planned?
having disabilities bc it is more stressful
multiples, triplets etc bc that add s more stress
if PG wasn’t planned, it is stressful
common trend of those who do maltreatment
- stressed for whatever reason
- no coping skills
- no support from other family to deal with kids
What if the injury and the situation doesn’t match up?
consider it could be abuse
- 2 mo old left in center of king size bed and fell off the bed when they were in the center
injury inconsistent with developmental age
the child was walking and fell but they aren’t even supposed to be able to walk yet
Adult reluctant to give info
Gives a story buts cagy
What if a child comes I more than normal?
Could be abuse but it could also be wild kid or anxious parent
Accessing treatment after delayed period for time
obvious fx that didn’t get looked at for 3 days alter
Come in with symptoms but no injury
comes in w vomiting and abdominal pain but no blow to abdomen
should a child reporting abuse be a sign
What if parent/caregiver reports it
yes the child can be honest
- gather info carefully. not every concept of abuse by the child is actually abuse but ask for details
gather details and report suspected abuse
Behavioral indication of abuse in kid
Aggressive extreme
Or shy and anxious extreme
different ends of spectrum
fear of caregiver
if you notice this this can be a sign
why might a kid be apprehensive with other kids
42:45
Signs of abuse in older kids
running away
drug abuse
gang or cult activity
what is emotional abuse
when the caretaker has attitudes towards kid that harms development of a sound health personality
signs of emotional abuse
rejection ignoring blaming terrorizing corrupting the child contradiction messages threatening
behaviors of child with emotional abuse
habits?
fears?
sleep?
biting
rocking
thumb sucking in older kids
anxiety and unrealistic fears
irrational fears , dreads or hatreds
sleep problems nightmares
Perpetrator behaviors of sexual abuse
Overprotective, jealous individual of child
- doesn’t allow others to interact with kid
Signs of sexual abuse health signs
STD’s
pregnancy
PID
foreign matter in bladder, rectum , utretha, vagina
signs of sexual abuse hints
torn, stained, bloody underwear
can’t walk or sit
verbal behaviors of kids
knowing more about sexual acts and just acting seductive in play
fear of person
neglect indicators
poor supervisor/abandoment lack of necessities like clothing and food failure to thrive stealing food fatigue extended stays at school
why are kids with fatigue a concern
if kid is unsupervised are they not on a schedule
extended stays at school as neglect
parents forget to pick them up
kids not coming to school
if no one makes a kid go to school then they won’t go
why are infant head injuries common?
heavy large head, underdeveloped neck that is weak
- bruises on forheads are common but need to know the difference
AHT abuse head trauma meaning
shaken baby syndrome where the head snaps back and forth that causes damage to brain from bouncing off skull and vessels, nerves are shifted and sheered
common manifestations of AHT abuse head trauma
bilateral, subdural maybe
subarachnoid hematomas
retinal hemorrhage (1 or 2)
- last 2 are classic
where else should you look for AHT signs
look at upper arms and rib cage for bruising where they were held
- can do skeletal x ray
- look at current and older injuries
rib fracture location with AHT
others?
posterior mid posterior lateral anterior - may not show up on X-ray early on until they try to repair themselves
clavicular/scapula
how is AHT figured out or diagnosed?
interviews Pred AHT (sort of like a screening tool)
what are intentional burns like
more surface area
bilateral and patterns
well defined edge
signs of water scalding
protective areas where the kid withdrew to protect themselves
comfortable infant bath degrees
100 degrees
why is the abdomen a common place for abuse
because it is hidden with clothes
T/F
a stair fall is common reason for abdominal ages
false - the anatomy just doesn’t make sense
Signs and symptoms of abdominal injury rt abdominal abuse
fever
sepsis
low blood pressure
hypovolemic shock
spiral fractures
torsion or twisting
transverse fracture
direct blow or bending
why are fractures a cause of concern in kids
bc it is hard to break their bones bc they are more flexible
what do we need to consider with genital exam for kids suspected of abuse
it may make them uncomfortable
- may have to do sedation meds, anesthesia, and analgesics
when can forensic kits be gathered for sexual abuse
Up to 72-96 hours after abuse
female assessment position for sexual abuse
will there be the injuries with sexual abuse?
frog legs
no u may not see any
- r/o other causes
is abuse by poisoning common
no but it can happen
body state associated with poisoning
persistent acidosis
- can be through vomit or all over the place?
What bruising is more from conditions and not abuse?
Conditions that make bruising easy
- leukemia
- thrombocytopenia can make more bruising
why might impetigo be mistaken for abuse
it looks like a burn but its an infectious agent
osteogenesis imperfecta
leads to frequent fractures and so may think it is abuse
Mongolian spots
can look like bruises
Cao Gio scratch the wind and coining
rubbing coin in oil on neck, spine, ribs to release bad spirits and restore health
- could leave markings but not abuse
Cupping
heated rim of a glass applied to skin but it is not abuse
Moxibustion
Chinese practice cone of wool is ignited and applied to skin as a counterirritation when ill but not abuse
when there is a cultural practice that is happening what do you need to consider
does it just leave a mark or is it harming harming the kid
Caida de Mollera
hold chin upside down but not abuse
Data gathering for abuse
Details and be exact
and ask open ended questions to get them to share info
who do you interview first?
adults asap and do them seperately
dynamics between adult and child
note this when it comes to abuse
documentation
only facts not your opinion , quoatations give charts, and photo
confidential admits
we leave info of kids ad confidential to protect them and instead give a code
- intensive care unit bc it is easier to supervise there and it is smaller
locked units
police
Peds units are locked down
police protective custody orders
head to toe assessment for documentation
is important to get all the information
is it just nurses involved with abuse cases?
no
social work, DA, law enforcement, home health , SRS
misdemeanor for failure to report
class B - 1000$ fine or up to 6 months in jail
you must still report even if someone doesn’t
good faith is not a problem
