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Childhood Accidents Accidents are the most common cause of death - PowerPoint PPT Presentation

Dr. K.M. Abul Hasan, M.S., M.Ch., Childhood Accidents Accidents are the most common cause of death among children aged 1 to 14 years. Accidents cause a third of deaths of children aged between 10 and 14 years. Accidents result in


  1. Dr. K.M. Abul Hasan, M.S., M.Ch.,

  2. Childhood Accidents  Accidents are the most common cause of death among children aged 1 to 14 years.  Accidents cause a third of deaths of children aged between 10 and 14 years.  Accidents result in about 10,000 children being permanently disabled annually.  Accidents cause one child in five to attend an accident and emergency department every year.  Accidents lead to one fifth of all hospital paediatric admissions.

  3. CAUSE OF DEATH IN 1-14 YEAR OLD AGE GROUP Cause %  Accidents 52  Cancer 10  Congenital Anomalies 5  Others 33

  4. ACCIDENTS  Vehicular Accidents  Fall from a height  Burns  Drowning  Snake & Insect Bites  Poisoning / FB Ingestion  Birth Trauma

  5. Kids aren’t small adults! Characteristic Result Large BSA Hypothermia Poor neck musculature Flex/ext injury Large blood vol in head Cerebral edema Dec alveolar surf area Rapid desats High metabolic rate Rapid desats Small airway Inc airway resistance Heart high in chest Injury/tamponade Small pericardial sac Injury/tamponade Compliant skeleton Fractures less common Thin walled, small abd Organs not protected Poorly dev renal fnx Risk renal failure

  6. Need specific supplies  Central lines  Monitors  Urinary catheters  ETT  NGT/OGT  Laryngoscopes  Resuscitation drugs  Bronchoscopes  Resuscitation devices  IV  IO trocars

  7. Paediatric trauma score + 2 + 1 - 1 Wt > 20 kg 10-20 kg < 10 kg Airway Patent Maintain Unmaint SBP > 90 50-90 < 50 Pulses Radial Carotid Nonpalp CNS Awake + LOC Unresp Frx None Closed Mult/op Wounds None Minor Major Total -6 to +12

  8. Initial management  Primary survey  Evaluate life-threatening conditions  Immediate intervention  Secondary survey  Evaluate other injuries requiring treatment  Paediatric trauma score  May be useful for triage  9-12 Minor trauma  6-8 Potentially life threatening  0-5 Life threatening  < 0 Usually fatal

  9. Primary survey  Cornerstone of trauma care  Life threatening conditions  Evaluate  Stabilize  Treat  Moves forward on all fronts by team  Often listed sequentially ABCDE

  10. Paediatric airway  Narrow oropharynx  Large tongue  Stiff, short epiglottis  Larynx anterior and cephalad  Cord view is difficult  Trachea shorter  Mainstem intubation more common  Extubation more common

  11. Paediatric intubation view  Larynx  Anterior  Cephalad  C 4 level  Epiglottis long & U shaped  Trachea short  Neonates → 2 cm cords to carina  Cricoid → Narrowest point until 10 yo

  12. Resuscitation  Give first priority of treating to life – threatening problems, identify during primary survey.  Pt with cardiorespiratory compromise should be provided with high – flow oxygen  Endotracheal intubation and ventilation are required if O 2 is inadequate in child with severe head injury or to control flail chest.  Pneumothorax & haemothorax are best treated by chest tube drainage.  Two large peripheral IV canulae require in severely injured children.  Central venous access should only be assess by expert.

  13. Resuscitation  Overextension of the neck during the maintenance of airway result in respiratory compromisation (short neck and relatively larger tongue)  Circulation is evaluated from vital signs, capillary refill time, skin color, temperature and mental status.  Systolic BP is normal until 25% of circulatory volume has been lost.  Intraosseous vascular assess is helpful in children  Cervical spine injury can be present without radiological signs, after major trauma cervical spine injury should be assumed until it can be excluded by full neurological assessment, the neck must be immobilized.

  14. Secondary Survey & Emergency Management  When pt become stable, the secondary survey attempt to identify all injuries in a systemic way by detailed clinical examination and appropriate investigation.  Emergency treatment involve 1- Treatment of chest injuries 2- Treatment of abdominal injuries.

  15. Chest injuries  Mediastinum less well affixed  Compliant chest wall  Fractures less common  PTX  Pulmonary contusion  Hemothorax

  16. Pneumothorax  Symptoms  Not Moving Chest wall  Tracheal shift  Cardiac shift  Air entry absent  Treat  Intercostal Drainage

  17. Pulmonary contusion  Worsening oxygenation & ventilation  Decreasing pulmonary compliance  Progressively more aggressive vent strategy  Increase FiO 2  Increase vent pressures and PEEP  Volutrauma typically avoided with plateau pressures < 40.  Hemodynamic compromise possible with increasing vent pressures

  18. Circulation  Control blood loss  Vascular access  Apparent  Early vascular access  Hidden  Supradiaphragmatic  Long bone fractures  Alternatives to PIV  Pelvic fractures  Central  Hemothorax  Hemoperitoneum  Surgical cutdown  ICH (prior to fontanelle  Intraosseous closure)  Consider A-line  Tissue perfusion  Shock symptoms

  19. Cardiac Tamponade  Cardiac tamponade may follow blunt or penetrating chest injury.  It requires emergency needle “pericardiocentesis”.

  20. Emergency Management Of Abdominal Trauma  Blunt abdominal trauma is generally more common than penetrating injury.  In children more vulnerable organs are liver and spleen because less protected by pliable rib cage.  Intra-abdominal or intra-thoracic bleeding is likely in shock child with no obvious source of hemorrhage.  The abdomen must be carefully inspected for sign of patterned bruising which indicate forceful compression against rigid skeleton.

  21. Investigations used In Abdominal Trauma  The definitive radiological investigation of major abdominal trauma in haemodynamically stable child is CT – scan with IV – contrast.  Expert ultrasound scanning is readily available it can demonstrate free abdominal fluid and solid organ injuries but it is not valuable as CT  Diagnostic peritoneal lavage is obsolete in children because modern imaging is superior  Laprotomy is indicated for bowl perforation and penetrating trauma.

  22. Non-operative Management Of Isolated Splenic or Liver Injuries  Haemodynamic stability after resuscitation with fluid not more than 40 – 60 ml/kg.  Good quality of CT-scan.  No evidences of hollow visceral injury.  Frequent careful monitoring and immediate availability of necessary surgical expertise.

  23. Children With Intra-abdominal Bleeding  Child with ongoing intra-abdominal bleeding require laparotomy.  Preliminary angiography and arterial embolization can be useful in some cases of hepatic trauma.  Bile leak is uncommon and managed with radiological techniques

  24. INJURY TO THE EXTERNAL GENITALIA • Penile Trauma • Zipper Injuries • Degloving Injuries • Strangulation Injuries • Scrotum & Testis • Avulsion of scorted skin • Hematocele

  25. Electr Electrocution in ocution in Childr Children en  Rare but life threatening – more common in the west.  Ventilation (1) Quickens Stabilization (2) Prevents Neurological sequalae

  26.  33% of children died of Electrocution are < 5 Years  80% are injured at Home  Source: Child Accident Prevention Foundation of Australia  86% of Electrocution Injuries involve 1-4 Years Old  Highest frequency at meal time  Insertion of keys, hairpins into the outlets common types CPSC – Consumer Product Safety Commission

  27. Prevention Children A dangerous mix Water & Electricity

  28. Drowning Death from asphyxia associated with submersion in a fluid Near Drowning If there is any recovery following a submersion incident

  29. Epidemiology  3 rd most common cause of death in U.K.  Swimming pools, Garden ponds & inland water ways.  SUBMERSION IN A SUMP

  30. Pathophysiology Submersion Diving reflex 20 Seconds Apnoea Bradycardia Hypoxia - Acidosis 20 Sec. to 2.5 Mts Breathing Occurs Fluid is Inhaled Laryngospasm, Secondary Apnoea Water, Mud, Debris enter the lung Bradycardia Cardiac Arrest Death

  31. Primary Survey & Ressuscitation  Protect Spine  Protect Airway & Ventilation.  Empty the stomach.  Deep Body Temp Resusscitation at temp < 30 0 c is useless

  32. Rewarming If core temp > 32 0 c – External Warming If core temp < 32 0 c – Core Rewarming - Arrhythmias

  33. External Rewarming  Remove cold, wet clothing  Warm Blankets  Infrared radiant lamp  Heating blanket

  34. Core Rewarming  Warm intravenous fluids to 39 0 c  Warm ventilator gases to 42 0 c  Gastric or bladder lavage with normal saline at 42 0 c  Peritoneal lavage with potassium free dialysate  Pleural or Pericardia lavage  Extracorporeal blood rewarming

  35. Out Come  70% survive – if resuscitations is done water side  40% survive – if not done quickly  25% with sequalae

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