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

2. ?ABC

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

4. Head Injuries

5. Head Injuries
What are the worrying signs?

6. Head Injuries
NICE Guidelines / CHALICE
Different from adults

7. Head Injuries
Witnessed LOC > 5 minutes

8. Head Injuries
Witnessed LOC > 5 minutes
Amnesia > 5 minutes

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

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

11. 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

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

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

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

17. 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

18. 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 #

19. Head Injuries
Tense fontanelle

20. Head Injuries
Tense fontanelle
?Basal skull #

21. Basal Skull #

22. Basal Skull #

23. Basal Skull #

24. Basal Skull #

25. Basal Skull #

26. Head Injuries
Tense fontanelle
?Basal skull #

27. Head Injuries Tense fontanelle ?Basal skull #
Focal neurological deficit

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

29. 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)

30. Head Injuries
Post-traumatic seizure

31. Head Injuries
Risks
Advice

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

33. 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 =

34. 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

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

36. Epistaxis

37. Nasal Foreign Bodies

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

39. Neck Injuries

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

41. Neck Injuries
SCIWORAs

42. Neck Injuries
SCIWORAs
C1 - 3

43. Limb Injuries

44. Limb Injuries

45. Limb Injuries
Greenstick, Torus and Buckle Fractures

46. Limb Injuries

47. Limb Injuries
Salter-Harris Fracture

48. Limb Injuries

49. Limb Injuries

50. Limb Injuries
Toddler’s Fractures

51. Limb Injuries

52. Limb Injuries
Initial management

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

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

55. 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

56. Limb Injuries
Initial management
DON’T FORGET ANALGESIA

57. Limb Injuries
Shoulders – dislocation vs fracture

58. Limb Injuries
2nd – 5th toes
Coccyx

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

60. Any Questions?

61. Thank You (and Goodbye!)