Emergency Splinting and Trauma First Aid. Coburn H. Allen, MD Pediatric Emergency Medicine Pediatric Infectious Diseases. Objectives. Review the most common injuries in children Discuss what to ask, examine and do for each process Suggest who needs further care and who can return to class.
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Emergency Splinting and Trauma First Aid Coburn H. Allen, MD Pediatric Emergency Medicine Pediatric Infectious Diseases
Objectives Review the most common injuries in children Discuss what to ask, examine and do for each process Suggest who needs further care and who can return to class
Common Injuries Bumps and Bruises Scrapes Sprains Strains Fractures Oral Trauma Nose Bleeds Lacerations Head Injuries Overheating
Bumps and Bruises Bobby Bobo, a 5 y/o boy, fell down in class while chasing the teacher’s lost hamster. He hit his right thigh on the corner of a desk and now complains of pain and swelling to the leg. By the time he arrives his right thigh is tight from the swelling. He says he has “Christmas Disease.”
Bumps and Bruises What to ask? What happened and when? Abuse vs. accidental Inconsistent mechanism, frequent bruising Abnormal locations Abnormal patterns No trauma? Think mass, infection, clotting d.o. Anything else hurt? PMHx? (Aspirin, coumadin, bleeding…)
Bumps and Bruises What to examine? Entire body Look for patterns Suspicious locations Trunk Face Scalp Multiple stages of bruises? Bone pain?
Nonaccidental Trauma Bite
Bumps and Bruises What to do? Cold pack Tylenol Most need nothing CPS? Law is “if suspicious…report.” You are protected Confidential
Texas Law • Child abuse and neglect are against the law in Texas, and so is failure to report it. • If you suspect a child has been abused or mistreated, you are required to report it to the Texas Department of Family and Protective Services or to a law enforcement agency. • You are required to make a report within 48 hours of the time you suspected the child has been or may be abused or neglected. Abuse Hotline 1-800-252-5400
Bumps and Bruises Where to send them? Back to class Most Not rapidly expanding Not suspicious Doctor Large/deep, multiple, expanding Uncertain of etiology (mass/infection/abuse)
Scrapes A 9 y/o girl, Terri Tawmboi, is brought to you after she got “a huge raspberry” playing kickball at recess. Her right knee is bleeding and covered with grass and dirt.
Scrapes What to ask? What happened? What did you fall on? Hard versus soft Loose objects = foreign bodies Able to bear weight? Anything else hurt? Vaccinations (Tetanus)?
Scrapes What to examine? Wound Deep vs. superficial Clean vs. contaminated If old, infected? Impetigo Range of motion Weight bearing
Scrapes What to do? Gently clean Saline and gauze Clean wet washcloth Running tap water Remove debris Antibiotic ointment Bandage
Scrapes Where to send them? Back to class almost always Doctor Retained foreign body Restricted use of extremity Concern for joint penetration
Sprains Trey Studmuffin, your transfer, red-shirt, freshman, power-forward, “came down wrong” on a teammate's shoe during tryouts. He hops into the office on one foot asking you to “tape me up!”
Sprains What to ask? What happened? Mechanism Twist or turn Blunt trauma “Something popped” or “gave way” Could you walk on it (even with a limp)? Old injury, ask if fever, chills, medical hx.
Sprains What to examine? Entire involved extremity Pain Swelling Bruising Redness Warmth ROM, gait Other joints
Sprains What to do? “pRICEmmms” Protect the joint = crutches, slings, tape… Rest Ice Compression Elevation Medication, modality (PT), motion (keep loose) Strength
Sprains Where to send them? Back to class Most Pain under control Doctor Suspect fracture, infection, systemic disease Not weight bearing Pain poorly controlled
Strains Coach Oldskool, your legendary, and older than he wants to admit, football coach crawls into your clinic complaining, “I popped my back showing my History Class how to chop block on a double reverse.”
Strains What to ask? What happened? Sudden jerking movements? Lifting? Sprinting? Jumping? Did you feel a pop? Tear? Numbness/tingling/weakness?
Strains What to examine? Where it hurts Spasm Swelling Bruising Joints above and below Neuorologic function (back injuries) Gait
Strains What to do? Similar to strains Massage/stretch if spasm
Strains Where to send them? Back to class Most Pain controlled Doctor Not bearing weight Severe pain Any numbness/tingling/weakness
Fractures Morgan Fleahopper, the 85 lb. head cheerleader, and the one always at the top of all those stacks of girls, fell off the infamous “Pyramid of Victory” at the 7 a.m. walk through. Her left elbow is pointing the wrong way but her make-up remains flawless.
Fractures What to ask? Describe the injury? Fall vs. blunt trauma vs. twist How did you land? Where is the worst pain (use one finger)? Could you walk right afterward? Anything else hurt? Neck pain/back pain if severe fracture(s)?
Fractures What to examine? Point tenderness/deformity Open fracture Joint swelling Muscle spasms Function/sensation below fracture ROM/walk Neck/back if “distracting injury”
Fractures What to do? Stabilize = Splinting Joint above and below fracture Not too tight, use padding Not too loose, shouldn’t wiggle Don’t hide the extremity, not circumferential Pain control Ice Medications
Fractures Where to send them? Doctor Most EMS if severe, neurovascular changes, spine Back to class Broken hearts Shattered dreams Crushed morale
Oral Trauma Dirk Noteeski catches an elbow during a scrimmage and comes in grinning, with his two front teeth in his hand. His mouth is full of blood.
Oral Trauma What to ask? What happened? Tooth/jaw/lip/tongue hurt? What hit you? (BAD if it is another person) How long ago? Permanent teeth? Where are the teeth? Have a dentist?
Oral Trauma What to examine? Teeth Avulsed (knocked out, loose) Fractured Chipped Intrusion Jaw/face: feel for “crunchy” sensation Mucosal/tongue injury