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 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.

CAUSE OF DEATH IN 1-14 YEAR OLD AGE GROUP

Cause %

 Accidents

52

 Cancer

10

 Congenital Anomalies

5

 Others

33

ACCIDENTS

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

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

Need specific supplies

 Monitors  ETT  Laryngoscopes  Bronchoscopes  IV  IO trocars  Central lines  Urinary catheters  NGT/OGT  Resuscitation drugs  Resuscitation devices

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

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

Primary survey

 Cornerstone of trauma care  Life threatening conditions

 Evaluate  Stabilize  Treat

 Moves forward on all fronts by team  Often listed sequentially ABCDE

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

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

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 O2 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.

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.

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.

Chest injuries

 Mediastinum less well

affixed

 Compliant chest wall  Fractures less common  PTX  Pulmonary contusion  Hemothorax

Pneumothorax

 Symptoms

 Not Moving Chest wall  Tracheal shift  Cardiac shift  Air entry absent

 Treat

 Intercostal Drainage

Pulmonary contusion

 Worsening oxygenation & ventilation  Decreasing pulmonary compliance

 Progressively more aggressive vent strategy  Increase FiO2  Increase vent pressures and PEEP

 Volutrauma typically avoided with plateau pressures < 40.  Hemodynamic compromise possible with increasing vent

pressures

Circulation

 Control blood loss

 Apparent  Hidden

 Long bone fractures  Pelvic fractures  Hemothorax  Hemoperitoneum  ICH (prior to fontanelle

closure)

 Tissue perfusion

 Shock symptoms

 Vascular access

 Early vascular access  Supradiaphragmatic

 Alternatives to PIV

 Central  Surgical cutdown  Intraosseous

 Consider A-line

Cardiac Tamponade

 Cardiac tamponade may follow blunt or penetrating

chest injury.

 It requires emergency needle “pericardiocentesis”.

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.

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.

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.

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

INJURY TO THE EXTERNAL GENITALIA

• Penile Trauma
• Zipper Injuries
• Degloving Injuries
• Strangulation Injuries
• Scrotum & Testis
• Avulsion of scorted skin
• Hematocele

Electr Electrocution in

• cution in Childr

Children en

 Rare but life threatening – more common in the

west.



Ventilation (1) Quickens Stabilization (2) Prevents Neurological sequalae

 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

Children Water & Electricity A dangerous mix

Prevention

Drowning

Death from asphyxia associated with submersion in a fluid

Near Drowning

If there is any recovery following a submersion incident

Epidemiology

3rd most common cause of death in

U.K.

Swimming pools, Garden ponds &

inland water ways.

SUBMERSION IN A SUMP

Pathophysiology

Submersion Apnoea Bradycardia Hypoxia - Acidosis Breathing Occurs Fluid is Inhaled Laryngospasm, Secondary Apnoea Water, Mud, Debris enter the lung Bradycardia Cardiac Arrest Death Diving reflex

20 Seconds

20 Sec. to 2.5 Mts

Primary Survey & Ressuscitation

Protect Spine Protect Airway & Ventilation. Empty the stomach. Deep Body Temp

Resusscitation at temp < 300 c is useless

Rewarming

If core temp > 320 c – External Warming If core temp < 320 c – Core Rewarming

• Arrhythmias

External Rewarming

 Remove cold, wet clothing  Warm Blankets  Infrared radiant lamp  Heating blanket

Core Rewarming

 Warm intravenous fluids to 390 c  Warm ventilator gases to 420 c  Gastric or bladder lavage with normal saline at 420 c  Peritoneal lavage with potassium free dialysate  Pleural or Pericardia lavage  Extracorporeal blood rewarming

Out Come

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

Paediatr ic trauma system

$

Education Standards

• f care

Research and development Quality assurance Funding System design Prevention

Integrating needs of children into existing EMS infrastructure involves high-quality prehospital care that uses pre- established protocols Protocols must be applied by skilled EMTs with assistance of online medical control until ultimate transport to an appropriate facility capable of providing definitive care Essential Components of an Integrated Paediatric Trauma System

Thank You