Transcript 8-Patterns of Injury

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PDLS :
Disaster Specific
Patterns of Injury
Learning Objectives
 Identify potential injuries of the pediatric
disaster victim.
 Describe appropriate interventions for
managing these injuries.
Classification of Emergencies
 Traumatic Emergencies
 Environmental Emergencies
 Psychological and Social Emergencies
Traumatic Emergencies
 Head Trauma
 Spine and Spinal Cord Trauma
 Thoracic Trauma
 Abdominal Trauma
 Soft Tissue Injuries
 Musculoskeletal Injuries
Classification of Traumatic Injuries
 Extent
- multiple or local
 Nature
- blunt or penetrating
 Severity - mild, moderate or severe
Classification of Trauma by Severity
Category
History
Vital Sign
Findings
 Mild
Minimal
Force
Normal
Superficial
Only
 Moderate Significant
Force
Normal
Suspicious for
Internal Injury
 Severe
Abnormal
Indicative of
Internal Injury
Critical
Force
Localized Head Trauma
 Assessment
- history
- vital signs
- local findings
 Treatment Goals
- prevent secondary brain damage
- maintain good cerebral perfusion pressure
 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
- history (mechanism, amount of force)
- vital signs
- local findings (thorough neuro exam, palpation etc.)
 Treatment Goals
- immobilization of the cervical spine and the child
 Treatment
- appropriate size hard collar or rolls to immobilize the neck
- back board or modified board with proper restraints
Localized Thoracic Trauma
 Assessment
- history (penetrating or blunt, amount of force)
- vital signs
- local findings (bony tenderness, decreased breath sounds etc.)
 Treatment Goal
- maintenance of adequate oxygenation and ventilation
 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
- history
- vital signs
- local findings
 Goal of Treatment
- early assessment and prevention of complications
 Treatment
- monitor ventilatory status and assist when necessary
- decompress abdomen
Soft Tissue Injuries
 Assessment
- visual and palpation exam
- vital signs
 Treatment Goals
- prevention of complications
 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
- history (mechanism, force)
- vital signs (peripheral perfusion)
- local findings (discoloration, deformity etc.)
 Goal of Treatment
- prevention of complications
- minimize discomfort
 Treatment
- ice, elevation, immobilization
- frequent evaluation of peripheral vascular perfusion
- reassess neuromuscular function
Environmental Emergencies
 Burns and Thermal Injuries
 Smoke and Inhalation Injuries
 Hyperthermia
 Hypothermia
Burns & Thermal Injuries
 Airway..Breathing..Circulation
 Assessment
 Fluid Therapy
 Care of the Burn Wound
 Pain Management
Fluid Therapy for the Burn Victim
 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
Rule of Thumb
Children should produce 1 ml/kg/hr of urine ...
Care of the Burn Wound
 Goals
- promote rapid healing, prevent infection
 Cleanse
- using large volumes of lukewarm sterile saline
 Cover
- with loose, clean, preferably sterile dressings or
sheets
Pain Management for Burn Victim
 Covering burn from moving air
 Analgesic medications
 Drug of Choice
- Morphine 0.1-0.5 mg/kg
Smoke & Inhalation Injuries
 Assessment
- Clinical Manifestations
 Treatment
Hints of Smoke Inhalation
 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
 CPR as needed
 Provide 100% supplemental oxygen
 Ensure patent airway
 Intubate early
Hyperthermia
Assessment
 Heat exhaustion
- T < 39C, lethargy, thirst, headache, increased
heart rate
 Heat stroke
- T > 41C, hot skin, severe CNS dysfunction,
circulatory collapse
Treatment of Hyperthermia
 Remove clothing
 Begin active cooling
 Transport to cool environment
 Cardiovascular support
 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.
 Decreased BP, heart rate, or both
Treatment for Hypothermia
 External Warming (for temp > 33C)
- Blankets, warm baths
 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
 Delay entry until appropriate team and protective
equipment is available
 Expect the Hazmat team to initially remove any
patients
 Follow advice of Hazmat team regarding personal
protection or patient decontamination
Additional Rules
 Don’t be a hero...
 Always maintain a high index of suspicion
General Signs and Symptoms of
Hazmat Exposure
 Local Effects
- complaints of burning
skin, teary eyes,
dry or sore throat, a cough or sneezing.
 Systemic Effects
- complaints of difficulty breathing, bizarre
behavior, stupor, seizures, coma.
Psychological & Social Emergencies
 Separation Anxiety
 Child Safety
 Lack of Communication and
Comprehension Skills