First Aid Forward Dr. Vimal Desai

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Presentation transcript:

First Aid Forward Dr. Vimal Desai Paediatric Trauma First Aid Forward Dr. Vimal Desai

?ABC

AIMS Common Paediatric Injuries How to safely manage them Hospital or Home

Head Injuries

Head Injuries What are the worrying signs?

Head Injuries NICE Guidelines / CHALICE Different from adults

Head Injuries Witnessed LOC > 5 minutes

Head Injuries Witnessed LOC > 5 minutes Amnesia > 5 minutes

Head Injuries Witnessed LOC > 5 minutes Amnesia > 5 minutes > 2 episodes of vomiting

Head Injuries Witnessed LOC > 5 minutes Amnesia > 5 minutes > 2 episodes of vomiting Suspicion of NAI

Suspicion of NAI Fingertip bruising to chest & arms Bruising to cheeks (forcing mouth open) Torn frenulum Scratched palate by objects pushed in Black eyes Strap marks Bite marks, scratches & cigarette burns Banging of head → haemorrhages in eyes and blindness

Head Injuries Witnessed LOC > 5 minutes Amnesia > 5 minutes > 2 episodes of vomiting Suspicion of NAI

Head Injuries Witnessed LOC > 5 minutes Amnesia > 5 minutes > 2 episodes of vomiting Suspicion of NAI Age > 1 year: GCS < 14

Head Injuries Witnessed LOC > 5 minutes Amnesia > 5 minutes > 2 episodes of vomiting Suspicion of NAI Age > 1 year: GCS < 14

Head Injuries Witnessed LOC > 5 minutes Amnesia > 5 minutes > 2 episodes of vomiting Suspicion of NAI Age > 1 year: GCS < 14 Age < 1 year: GCS < 15

Head Injuries Witnessed LOC > 5 minutes Amnesia > 5 minutes > 2 episodes of vomiting Suspicion of NAI Age > 1 year: GCS < 14 Age < 1 year: GCS < 15 ?Open or depressed skull #

Head Injuries Tense fontanelle

Head Injuries Tense fontanelle ?Basal skull #

Basal Skull #

Basal Skull #

Basal Skull #

Basal Skull #

Basal Skull #

Head Injuries Tense fontanelle ?Basal skull #

Head Injuries Tense fontanelle ?Basal skull # Focal neurological deficit

Head Injuries Tense fontanelle ?Basal skull # Focal neurological deficit Age < 1 year: bruise, swelling or laceration on head > 5cm

Head Injuries Tense fontanelle ?Basal skull # Focal neurological deficit Age < 1 year: bruise, swelling or laceration on head > 5cm Dangerous mechanism (high-speed RTA (>40mph) / fall > 3m / high speed injury from a projectile or an object)

Head Injuries Post-traumatic seizure

Head Injuries Risks Advice

Head Injuries Risks Advice 1. Blacking out 2. Vomiting 3. Change of vision 4. Convulsions 5. Persistent headache 6. Irrational behaviour

Head Injuries Pediatric Emergency Care Applied Research Network (PECARN) 42,412 children between June 2004 and September 2006 HI in previous 24 hours and GCs = 14 - 15

Head Injuries For age < 2 years: For age > 2 years Normal mental status (inc. GCS = 15) No scalp haematoma or only frontal No LOC or < 5 secs Non-severe mech. No palpable skull # Acting normally (according to parents) For age > 2 years Normal mental status (inc. GCS = 15) No LOC No vomiting Non-severe mech. No signs of basal skull # No severe headache

Head Injuries For age < 2 years: For age > 2 years NPV = 100% Sensitivity = 100% For age > 2 years NPV = 99.95% Sensitivity = 96.8%

Epistaxis

Nasal Foreign Bodies

Nasal Foreign Bodies EMJ (September 2010) ‘Kissing Technique’ Ctibor (1965) 48.8% success rate

Neck Injuries

Neck Injuries Alert & orientated (NOT intoxicated) No distracting injuries No neurological deficit No midline neck pain Full active ROM

Neck Injuries SCIWORAs

Neck Injuries SCIWORAs C1 - 3

Limb Injuries

Limb Injuries

Limb Injuries Greenstick, Torus and Buckle Fractures

Limb Injuries

Limb Injuries Salter-Harris Fracture

Limb Injuries

Limb Injuries

Limb Injuries Toddler’s Fractures

Limb Injuries

Limb Injuries Initial management

Limb Injuries Initial management If it’s dislocated, try to reduce it

Limb Injuries Initial management If it’s dislocated, try to reduce it Try to get limb back into the correct position

Limb Injuries Initial management If it’s dislocated, try to reduce it Try to get limb back into the correct position Splint and support it

Limb Injuries Initial management DON’T FORGET ANALGESIA

Limb Injuries Shoulders – dislocation vs fracture

Limb Injuries 2nd – 5th toes Coccyx

If at all concerned, send to hospital However… If at all concerned, send to hospital

Any Questions?

Thank You (and Goodbye!)