PDLS © : Disaster Specific Patterns of Injury

Learning Objectives Identify potential injuries of the pediatric disaster victim. Identify potential injuries of the pediatric disaster victim. Describe appropriate interventions for managing these injuries. Describe appropriate interventions for managing these injuries.

Classification of Emergencies Traumatic Emergencies Traumatic Emergencies Environmental Emergencies Environmental Emergencies Psychological and Social Emergencies Psychological and Social Emergencies

Traumatic Emergencies Head Trauma Head Trauma Spine and Spinal Cord Trauma Spine and Spinal Cord Trauma Thoracic Trauma Thoracic Trauma Abdominal Trauma Abdominal Trauma Soft Tissue Injuries Soft Tissue Injuries Musculoskeletal Injuries Musculoskeletal Injuries

Classification of Traumatic Injuries Extent - multiple or local Extent - multiple or local Nature - blunt or penetrating Nature - blunt or penetrating Severity - mild, moderate or severe Severity - mild, moderate or severe

Classification of Trauma by Severity CategoryHistoryVital SignFindings MildMinimalNormalSuperficial MildMinimalNormalSuperficial ForceOnly ModerateSignificantNormalSuspicious for ModerateSignificantNormalSuspicious for ForceInternal Injury SevereCriticalAbnormalIndicative of SevereCriticalAbnormalIndicative of ForceInternal Injury

Localized Head Trauma Assessment Assessment - history - vital signs - local findings Treatment Goals Treatment Goals - prevent secondary brain damage - maintain good cerebral perfusion pressure Treatment Treatment - control external bleeding - oxygenate & hyperventilate as needed - fluid resuscitate to maintain adequate perfusion - keep head in midline position and HOB elevated 30 degrees - control seizures if possible

Isolated Spinal Trauma Assessment Assessment - history (mechanism, amount of force) - vital signs - local findings (thorough neuro exam, palpation etc.) Treatment Goals Treatment Goals - immobilization of the cervical spine and the child Treatment Treatment - appropriate size hard collar or rolls to immobilize the neck - back board or modified board with proper restraints

Localized Thoracic Trauma Assessment Assessment - history (penetrating or blunt, amount of force) - vital signs - local findings (bony tenderness, decreased breath sounds etc.) Treatment Goal Treatment Goal - maintenance of adequate oxygenation and ventilation Treatment Treatment - close monitoring of oxygenation - maintenance of adequate ventilation with assist if needed - oxygen delivery as needed - restore intravascular volume if needed for excessive blood loss

Isolated Abdominal Trauma Assessment Assessment - history - vital signs - local findings Goal of Treatment Goal of Treatment - early assessment and prevention of complications Treatment Treatment - monitor ventilatory status and assist when necessary - decompress abdomen

Soft Tissue Injuries Assessment Assessment - visual and palpation exam - vital signs Treatment Goals Treatment Goals - prevention of complications Treatment Treatment - close monitoring of oxygenation - maintenance of adequate ventilation with assist if needed - oxygen delivery as needed - restore intravascular volume if needed for excessive blood loss

Musculoskeletal Injuries Assessment Assessment - history (mechanism, force) - vital signs (peripheral perfusion) - local findings (discoloration, deformity etc.) Goal of Treatment Goal of Treatment - prevention of complications - minimize discomfort Treatment Treatment - ice, elevation, immobilization - frequent evaluation of peripheral vascular perfusion - reassess neuromuscular function

Environmental Emergencies Burns and Thermal Injuries Burns and Thermal Injuries Smoke and Inhalation Injuries Smoke and Inhalation Injuries Hyperthermia Hyperthermia Hypothermia Hypothermia

Burns & Thermal Injuries Airway..Breathing..Circulation Airway..Breathing..Circulation Assessment Assessment Fluid Therapy Fluid Therapy Care of the Burn Wound Care of the Burn Wound Pain Management Pain Management

Parkland Formula Parkland Formula - 4 ml/kg/%BSA of crystalloid over the first 24 hours. - Half during the first 8 hours and half over the next 16 hours Fluid Therapy for the Burn Victim

Rule of Thumb Children should produce 1 ml/kg/hr of urine...

Care of the Burn Wound Goals Goals - promote rapid healing, prevent infection Cleanse Cleanse - using large volumes of lukewarm sterile saline Cover Cover - with loose, clean, preferably sterile dressings or sheets

Pain Management for Burn Victim Covering burn from moving air Covering burn from moving air Analgesic medications Analgesic medications Drug of Choice Drug of Choice - Morphine mg/kg

Smoke & Inhalation Injuries Assessment Assessment - Clinical Manifestations Treatment Treatment

Hints of Smoke Inhalation Exam may show: Exam may show: - facial burns - singed nasal hairs - soot in pharynx - mental confusion Tachypnea, cough or stridor may or may not be present.

Treatment of Smoke Inhalation Remove from contaminated environment Remove from contaminated environment CPR as needed CPR as needed Provide 100% supplemental oxygen Provide 100% supplemental oxygen Ensure patent airway Ensure patent airway Intubate early Intubate early

Hyperthermia Assessment Heat exhaustion Heat exhaustion - T < 39C, lethargy, thirst, headache, increased heart rate Heat stroke Heat stroke - T > 41C, hot skin, severe CNS dysfunction, circulatory collapse

Treatment of Hyperthermia Remove clothing Remove clothing Begin active cooling Begin active cooling Transport to cool environment Transport to cool environment Cardiovascular support Cardiovascular support Fluid Resuscitation < 20 mg/kg lactated Ringers or 0.9% sodium chloride Fluid Resuscitation < 20 mg/kg lactated Ringers or 0.9% sodium chloride

Hypothermia Exam Pale or cyanotic, CNS function progressively impaired with falling temp. Frank coma occurs at approximately 27 C. Pale or cyanotic, CNS function progressively impaired with falling temp. Frank coma occurs at approximately 27 C. Decreased BP, heart rate, or both Decreased BP, heart rate, or both

Treatment for Hypothermia External Warming (for temp > 33C) External Warming (for temp > 33C) - Blankets, warm baths Internal Warming (for temp < 32C) Internal Warming (for temp < 32C) - Warm peritoneal lavage, warm nasogastric lavage, warm IV fluids

Hazardous Materials Exposure Goal: to provide guidelines for scene management, care and transportation of patients contaminated by radiation or hazardous chemicals

General Instructions Upon discovery of Hazmat scene, notify communication center to dispatch Hazmat expert Upon discovery of Hazmat scene, notify communication center to dispatch Hazmat expert Delay entry until appropriate team and protective equipment is available Delay entry until appropriate team and protective equipment is available Expect the Hazmat team to initially remove any patients Expect the Hazmat team to initially remove any patients Follow advice of Hazmat team regarding personal protection or patient decontamination Follow advice of Hazmat team regarding personal protection or patient decontamination

Additional Rules Don’t be a hero... Don’t be a hero... Always maintain a high index of suspicion Always maintain a high index of suspicion

General Signs and Symptoms of Hazmat Exposure Local Effects Local Effects - complaints of burning skin, teary eyes, dry or sore throat, a cough or sneezing. Systemic Effects Systemic Effects - complaints of difficulty breathing, bizarre behavior, stupor, seizures, coma.

Psychological & Social Emergencies Separation Anxiety Separation Anxiety Child Safety Child Safety Lack of Communication and Comprehension Skills Lack of Communication and Comprehension Skills