Case presentation 19
Download
1 / 27

Case Presentation 19 - PowerPoint PPT Presentation


  • 282 Views
  • Uploaded on

Only one person per skateboard. Never hitch a ride from a car, bus, truck or bicycle ... to wear safety equipment when riding scooters, skateboards or skating ...

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Case Presentation 19' - Kelvin_Ajay


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Case presentation 19 l.jpg

Alameda County EMS

Case Presentation #19

Jim Pointer, M.D., FACEP

Medical Director

Alameda County EMS


The call l.jpg

Alameda County EMS

The Call

  • You respond to a 9-1-1 call on a busy suburban street for “traumatic injury.” Your patient, a seven year-old male, is lying prone on the street with his head nodding in confusion. An electric microscooter lies on its side in the middle of the street.


Initial assessment l.jpg

Alameda County EMS

Initial Assessment

  • ABCs:

    • Airway – open

    • Breathing – labored

    • Circulation – no bleeding

  • Glasgow - 9:

    • Eyes – 2

    • Verbal – 3

    • Motor – 4


Focused h p l.jpg

Alameda County EMS

Focused H & P

  • On lookers state the patient attempted to avoid a car, swerved and fell, striking his head and “legs.”

  • Child was wearing no safety equipment and was traveling about 10 mph on the wrong side of the street.

  • No other history available and the parents are at work.


Pertinent findings l.jpg

Alameda County EMS

Pertinent Findings

  • Vital Signs:

    • B/P – 80/50

    • RR – 32

    • HR – 145

    • Pulse Ox – 96%

  • Young male obviously seriously injured


Pertinent findings cont l.jpg

Alameda County EMS

Pertinent Findings (cont.)

  • HEENT:

    • Head – large abrasion left fronto-temporal area

    • Ears – no blood from ears

    • Eyes – pupils 4 mm, slightly sluggish, reactive

    • Nose – WNL

    • Teeth – WNL

  • Neck – no obvious injuries, unable to assess pain or tenderness


Pertinent findings cont7 l.jpg

Alameda County EMS

Pertinent Findings (cont.)

  • Chest and abdomen: no significant trauma

  • Pelvis: stable

  • Extremities: deformity left lower leg, distal pulses intact

  • Neuro: GCS – 9

    • Patient does not answer questions but is seen to move all four extremities

  • Skin: cool and moist


Initial treatment l.jpg

Alameda County EMS

Initial Treatment

  • Attempts at intubation unsuccessful

  • Non-rebreather mask - 100% O2

  • Two large bore IVs started

  • Spinal immobilization

  • Left lower leg splinted

  • Transported to Children’s Hospital



Hospital findings l.jpg

Alameda County EMS

Hospital Findings

  • Young, white male in acute distress

  • Vital signs: B/P – 120/82, RR – 40, HR – 142, Pulse Ox – 98% on O2

  • Physical findings essential the same as yours


Lab studies l.jpg

Alameda County EMS

Lab Studies

  • CBC: WBC – 17.2 K, H & H – 15.3 / 47.2

  • Chemistries, glucose, urinalysis: WNL

  • X-rays: Spinal, chest, pelvic and Left lower leg

  • Plain CT of the head

  • Hospital staff can not find the parents



Extremity x ray l.jpg

Alameda County EMS

Extremity X-Ray


Hospital outcome l.jpg

Alameda County EMS

Hospital Outcome

  • Patient taken to OR for evacuation of subdural hematoma

  • Open reduction, internal fixation (ORIF) of the tibial fracture

  • Discharged eight days later on crutches with case, neurologically intact!


Addendum l.jpg

Alameda County EMS

Addendum

  • Parents were cited by local police for allowing a child under 16 to operate a motorized scooter and for failure to provide safety equipment.


Discussion l.jpg

Alameda County EMS

Discussion

  • Skateboard and scooter injuries:

    • Skateboards

      • 56,000 ED visits

      • 1,900 hospitalized

    • Scooters (all)

      • 15,800 ED visits

  • 90% of all injuries occur in kids < 15 years old.

    Source: American Academy of Pediatrics


Skateboard injuries l.jpg

Alameda County EMS

Skateboard Injuries

  • 87% - male

  • Distribution of Injuries:

    • 74% - extremities

    • 21% - head & neck

    • 5% - trunk

  • Injuries occur more frequently in the younger child

    Source: US Consumer Product Safety Committee


Skateboard injuries cont l.jpg

Alameda County EMS

Skateboard Injuries (cont.)

  • Most common Injuries:

    • Wrist fractures

    • Ankle sprains

    • Face lacerations

    • Lower arm fractures

    • Wrist sprains

      Source: US Consumer Product Safety Committee


Motorized scooters l.jpg

Alameda County EMS

Motorized Scooters

  • Rising in popularity

  • Gasoline or battery powered

  • Cost: $200 - $1500

  • Cost of protective gear: $35

  • Gas models against the law in many jurisdictions

  • Many areas have restrictions

    • California’s age is 16

  • US CPSC issued warning in 2001

  • Parents poor judgment a major factor in injuries.


Motorized scooter injuries l.jpg

Alameda County EMS

Motorized Scooter Injuries

  • 39% are kids < 15 years old

  • At least three deaths associated with motorized scooters

    • 6 year old boy who fell off

    • 11 year old boy who crashed with a truck

    • 46 year old man who was struck by a car

  • Fractures the most common injury

  • Over 5000 injuries requiring ED treatment in 2002


Slide21 l.jpg

Alameda County EMS

SCOOTER

SAFETY


Injury prevention skateboards scooters l.jpg

Alameda County EMS

Injury PreventionSkateboards & Scooters

  • Never ride in the street

  • Never ride at night

  • Obey all traffic laws


Injury prevention cont l.jpg

Don’t take chances

Complicated tricks require careful practice and a specially designed area

Only one person per skateboard

Never hitch a ride from a car, bus, truck or bicycle

Alameda County EMS

Injury Prevention (cont.)


Injury prevention cont24 l.jpg

Alameda County EMS

Injury Prevention (cont.)

  • Learn how to fall – it may help reduce serious injury

    • Losing balance – crouch down so you won’t have as far to fall

    • If you fall –

      • try to land on “fleshy” parts of your body

      • try to roll rather than absorb the force with your arms

      • try to relax your body rather than stiffen


Injury prevention cont25 l.jpg

Alameda County EMS

Injury Prevention (cont.)

  • Use Safety equipment!

    • helmet

    • Slip resistant shoes

    • Padding (knee, elbow and wrist guards)

  • Children < 5 should not use skateboards or scooters

  • Children < 16 should not ride motorized scooters


California law l.jpg

Alameda County EMS

California Law

  • January 1, 2000:

    • Children under 16 prohibited from operating motorized vehicles, including scooters, and requiring helmet.

  • January 1, 2003:

    • Bicycle helmet law expanded to require children under 18 to wear safety equipment when riding scooters, skateboards or skating


Ems helmet bicycle safety brochure l.jpg

Alameda County EMS

EMS Helmet & Bicycle Safety Brochure

Alameda County

Emergency

Medical

Services

Agency

Helmet &

Bicycle

Safety

Program

(510) 618-2050


ad