ACCIDENTS 1.power point about all common accidents in chiren

Its all about the accidents in children

1. PEDIATRIC ACCIDENTS

2. COMMON PEDIATRIC ACCIDENTS
Head Trauma
Drowning/Near Drowning
Poisoning
Burns
Bodily Injury/Suicide

3. HEAD
TRAUMA


4. HEAD TRAUMA
MVA most common cause
Head injuries also caused by falls from swings,
bikes

5. NURSING CARE OF THE CHILD
WITH HEAD TRAUMA
Take an Accurate History
Any loss of consciousness
Temporary amnesia
Lethargy
Inability to recognize caregivers
Nausea or vomiting since the injury
Abnormal behavior for age

6. NURSING CARE OF THE CHILD
WITH HEAD TRAUMA
Assessment
Need immediate baseline
Respiratory system
Cardiovascular system
Neurological assessment
(Glasgow Coma Scale)
Look for physical signs of ICP
Assess at frequent intervals for
changes

7. GLASCOW COMA SCALE 
Neurological Assessment on eye movement, verbal
response and motor movement
Score out of 15, usually reported as 3 scores
Best eye response (E)
4-Eyes opening spontaneously.
3-Eye opening to speech.
2-Eye opening to pain/ pressure on the patient’s
fingernail, supraorbital or sternum
1- No eye opening.

8. GLASCOW COMA SCALE
Best verbal response (V)
5-Oriented.
4-Confused.
3-Inappropriate words. (Random or exclamatory
articulated speech, but no conversational
exchange).
2-Incomprehensible sounds. (Moaning but no
words.)
1- None.

9. BEST MOTOR RESPONSE (M)
6-Obeys commands.
5-Localizes to pain. (Purposeful movements towards changing painful
stimuli)
4-Withdraws from pain (pulls part of body away when pinched)
3-Flexion to pain (decorticate response)
2-Extension to pain (decerebrate response) adduction, internal
rotation of shoulder, pronation of forearm).
1-No motor response.
 

10. INFANT ADAPTATIONS TO GCS
Eye Opening
4- Spontaneous
3- To speech
2- To pain
1- No response
Verbal Response
5- coos, babbles
4- irritable, cries
3-cries to pain
2-moans, grunts
1-no response
Motor Response
6-Spontaneous
5-localizes pain
4-withdraws from pain
3-flexion
2-extension
1-no response

11. SEVERITY OF HEAD INJURIES BASED ON GLASGOW COMA SCALE
Mild (Score of 13-15)
-- Possible headache and cognitive deficits (especially affecting memory)
-- Possible stress intolerance
Moderate (Score of 9-12)
-- Headache, memory deficits, cognitive deficits
-- Difficulty with activities of daily living
-- Rarely but occasionally results in death

12. GLASGOW COMA SCALE
(CONT.)
Severe (Score of 3-8)
-- Post trauma syndromes and cognitive, emotional, motor,
and sensory deficits caused by irreversible brain injury
-- Long-term care or support in the community usually
needed
-- May result in death

13. INCREASED INTRACRANIAL PRESSURE
(ICP)
INFANT
Poor feeding or vomiting
Irritability or restlessness
Lethargy
Bulging fontanel
High-pitched cry
Increased head circumference
Separation of cranial sutures
Distended scalp veins
Eyes deviated downward
(“setting sun” sign)
Increased or decreased
response to pain
Child
•Headache
•Diplopia
•Mood swings
•Slurred speech
•Altered level of
consciousness
•Nausea and vomiting,
especially in the
morning

14. HEAD TRAUMA INTERVENTIONS
Spinal immobilization until x-ray is back
Monitor for ICP
Prepare for intubation, possible respirator
Evaluate neuro

15. MEDICATIONS
Anticonvulsants: seizure prevention
Osmotic and loop diuretics: deplete
water from intracellular and
interstitial compartments, decrease
cerebral fluid volume and ICP
Steroids: decrease inflammation

16. COMMON PEDIATRIC HEAD INJURIES
Skull fracture
Linear or depressed
Intra-cranial Hemorrhage
Subdural Hematoma
Epidural Hematoma
Concussion

17. SKULL FRACTURES
Linear/Depressed
Linear fracture are breaks in the bone that transverse the full thickness
of the skull from the outer to inner usually straight without any bone
displacement
 Depressed fracture Often associated with a direct blow from a solid
object
Leads to increased risk for infection and CSF leak
Fragments may require surgical removal to protect underlying cerebral
tissue and vasculature
Fracture of any bone that comprises the “base” of the skull is called
basilar fracture

18. SIGNS AND SYMPTOMS OF SKULL
FRACTURES
Headache
Decreased LOC
Otorrhea, Rhinorrhea that tests positive
for glucose
Unilateral hearing loss
Orbital or post-auricular ecchymosis

19. DIAGNOSIS OF SKULL FRACTURES
Confirmed by skull and spinal x-ray
CT, MRI if ICP is suspected
Accurate history of injury
Helps to determine the type of
injury and if child loss
consciousness

20. TREATMENT
Linear:
Observation
Analgesia
Repeat x-ray in about 3 weeks to confirm healing
Depressed:
Facilitate drainage of CSF (positioning)
Prophylactic ABX
Check skin integrity
Cough suppressant

21. INTRACRANIAL HEMORRHAGE
Subdural Hematoma
Collection of blood between the
duramater and cerebrum
Epidural Hematoma
Collection of blood between the skull
and the duramater

22. SUBDURAL HEMATOMA
Caused by trauma or violent shaking that cause neurons
bleed
Signs & symptoms:
LOC changes-Confusion, irritability, lethargy
Ipsilateral pupil dilatation
Seizures
Vomiting
Retinal hemorrhage

23. EPIDURAL HEMATOMA
Caused by severe blunt head trauma that ruptures the middle
meningeal artery
Signs & Symptoms
Can have a delayed onset of symptoms then rapid deterioration in
status
LOC changes- sleepy, lethargic
Unequal fixed dilated pupils
Contralateral paresis or paralysis
Seizures
Vomiting
Headache

24. DIAGNOSIS AND MANAGEMENT FOR BOTH
Diagnosis by CT Scan
Interventions
Surgical removal of the accumulated
blood (Crainotomy)
Cauterization or ligation of the torn
artery
*Early intervention is the key to
avoiding increased ICP & brain
anoxia

25. CONCUSSION
Closed head injury
Caused by a blow to the head or a rapid deceleration resulting
in transient neuro changes
Signs and Symptoms
N & V
Dizziness
Brief loss of consciousness

26. CONCUSSION MANAGEMENT
R/O skull fracture with x-ray, CT
 Observation for 24 hours to r/o trauma, edema,
laceration
If discharged teach parents to assess for LOC q 1-
2 hours, check pulse
If child’s behavior changes seek help

27. TBI –TRAUMATIC BRAIN INJURY
Trauma to head causing permanent disability
Range on deficits
Cognitive defects
Emotional and behavioral problems
Physical disability
Self care deficits
Long term rehabilitation is treatment

28. DROWNING/NEAR
DROWNING

29. Drowning
Death within 24 hours due to
suffocation from submersion in liquid.
(alveoli blocked)
3500 children die annually; toddlers
and preschoolers most frequent victims
Near Drowning/Hypoxic Injury
A submersion injury which requires
emergency treatment in where the
child survives the first 24 hours.

30. HYPOXIC INJURY
Fluid is swallowed (aspiration)
Causes Layrngospasm
Leads to hypoxia
Child becomes unconscious
Laryngospasm relaxes
Gag reflex is lost
Swallows more water
Hypothermia as body cools

31. NEAR DROWNING-HYPOXIC BRAIN INJURY
Management:
Immediate mouth to mouth resuscitation; CPR if
necessary
Goal: to increase child’s oxygen and carbon dioxide
exchange capacity; mechanical ventilation
Gradual warming of body temperature
21% of near drowning have neurologic damage

32. POISONING
Chemical injury to a body system
Physical emergency for child
Emotional crisis for parents
Important to calm and support parents
Explore circumstances of injury
Prevention of recurrence
Unintentional vs. intentional

33. MANAGEMENT OF POISONING
Initial Intervention:
Terminate Exposure!
empty mouth of pills, plants
flush eyes or skin
remove contaminated clothes

34. TRY TO IDENTIFY THE POISON
1 Take an accurate history
2. Physical Exam
Neuro
Resp
Cardiac
3. Obtain Labs

35. INTERVENTION
While waiting decision for intervention:
Maintain patent airway
Maintain effective breathing pattern
Maintain vital signs within normal range
Maintain body temperature

36. REMOVE POISON, AND PREVENT
ABSORPTION
Three ways of gastric
decontamination:
Syrup of Ipecac
Gastric Lavage
Activated Charcoal

37. SYRUP OF IPECAC
Induces emesis
Contra indicated in some poisons
On-going vomiting
Electrolyte disturbances
No longer recommended to have at home
It doesn't completely remove poison
Vomiting can lead to mistrust with other
treatments
Misuse by anorexic/bulimic adolescents

38. GASTRIC LAVAGE
Used in 1
st
1-2 hours after ingestion of
very toxic poison that is rapidly absorbed
50-100ml of saline flushed into NG tube,
aspirated until clear
Save first specimen for toxicology
analysis

39. ACTIVATED
CHARCOAL
odorless, tasteless, fine, black
powder
treatment of choice when posion
is unknown
absorbs many compounds
creating a stable complex
mixed with water or saline to
form a “slurry” (black mud)

40. ACETAMINOPHEN POISONING
Signs & Symptoms:
Anorexia, nausea, vomiting
Liver tenderness
Liver toxicity: usually occurs after 24h
(blood level of drug)
Assess liver function: Elevated AST, ALT

41. MANAGEMENT
Gastric Lavage if within the 1
st
hour of ingestion
Then Activated charcoal
Mucomyst is antidote, however…

42. IN ALL POISONING WHEN CHILD IS
STABLE…
Assess for contributing factors:
Inadequate support systems
Marital discord
Discipline techniques (behavior problems)
Institute anticipatory guidance: based on child’s
developmental level (child-proof home
May require home visit

43. THE HOME VISIT
Educate re: safe storage of toxins, return immediately
after use to safe storage
Offer strategies of effective discipline (limit setting)
Phone number of Poison Control by phone, have
babysitters aware
For all parents-teach to
Call Poison Control Center first in event of poisoning

44. INFORMATION THEY WILL NEED TO PROVIDE
age, weight
name of product
degree of exposure or amount swallowed
time of exposure
route of poisoning
symptoms
home management

45. LEAD POISONING
Usual source: paint chips from window sill, crib,
furniture
lead dust from home remodeling
folk remedies
ceramics (unglazed pottery)
cigarette butts and ashes
lead in soil and water from old lead pipes

46. SYMPTOMS OF LEAD POISONING
Often, no symptoms
Irritability
Headacshes
Fatigue
Abdominal pain
Cognitive and motor delays
Screening is essential.

47. DIAGNOSIS
Venous lead level: poisoning present when 2
successive blood levels > 10ug/dl
serum iron and serum iron binding capacity: iron
deficiency can enhance lead absorption and
toxicity
Abdominal flat plate: may show radiopaque
foreign materials that were ingested in the last
24-36 hours

48. EFFECTS OF LEAD ON THE BODY
SYSTEMS
Hematologic: anemia
Renal: kidney damage
Skeletal: lead deposits in bones
Neurologic:
•low level: hyperactivity, hearing impairment,
distractibility, mild intellectual deficits
•high level: Cognitive Impairment, paralysis,
blindness, seizures, coma, death

49. MANAGEMENT
lead level > 15: prevent further
lead exposure (nutritional
education, more frequent
screening)
lead level > 25: environmental
evaluation, remove child from
the environment
lead level > 30: chelation
therapy

50. CHELATION THERAPY
removes lead from soft tissue and bones
PO chelation for levels 30-69
IM chelation for levels above 70
edetate calcium disodium (EDTA): deep
IM injection (very painful), toxic to
kidneys

51. NURSING
MANAGEMENT
Monitor serum Ca levels, renal function
 I & O, BUN, creatinine, check
protein in urine
Assist families with making changes to protect
the child from further exposure
Children must be followed to evaluate
development and intelligence i.e. proper school
placement

52. REDUCING BLOOD LEAD
LEVELS
Wash & dry child’s hands & face frequently, especially
before meals
Wash toys & pacifiers
During remodeling keep children & pregnant women out
Don’t store foods in open containers, especially imported
Don’t use pottery for eating
Make sure child eats regular meals, lead is absorbed easier
on an empty stomach
Diet should contain iron and calcium

53. BURN INJURY
intravascular capillaries become
very permeable
large amounts of fluids, proteins,
& electrolytes shift to the
interstitial space
results in edema of the burned
area and a loss of circulatory
volume
This is called “third spacing”

54. OTHER EFFECTS
Heat loss: (larger body surface
area in relation to body weight)
Infection (tissue necrosis)
Inhalation injuries: (progressive
edema; airway obstruction)

55. FIVE METHODS OF BURN INJURIES
Inhalation: symptoms may not be seen for 24
hours after exposure
Thermal: dermal exposure to heat and/or flame
Electrical: contact with electric current
Chemical: dermal exposure to corrosives
Radiation: radiation therapy

56. NURSING ROLE
History:
When, where, how injury occurred
Type of burn
Past medical history
Treatment prior to arrival in ED
Signs and Symptoms:
vary & are related to the depth of injury, affected
surface area, and presence of inhalation injury

57. DEPTH OF INJURY
1st degree/(superficial partial thickness)
 epidermis; erythema, pain, appears dry
2nd degree/(deep partial thickness)
entire epidermis & dermis; moist, blisters, erythema, pain
3rd degree/(full thickness)
epidermis & dermis, adipose tissue, fascia, muscle & bone;
dry, leathery appearance, range in color (white to brown or
black), no sensation to pain

58. BODY SURFACE AREA
use age appropriate charts to determine the extent of
the burn
or by using the size of the child’s palm(approximately
1% of the tbsa)
add the number of times the child’s palm would fit
into the affected area will provide an estimation of
the extent of the burn surface area

59. LOCATION OF BURNS
DETERMINES INTERVENTION
Face and neck
Hands and feet
Perineum

60. INTERVENTION
Stop the burning process
Ensure a patent airway
Deliver oxygen/assisted
ventilation
Obtain two vascular access
with large bore catheter

61. IV FLUIDS- PARKLAND FORMULA
Warmed crystalloid solution (RL)
2-4ml x weight in kg x BSA = total amount of
fluids to be infused during the first 24h
Of this amount ½ should be given in the first 8
hours
remainder should be given equally over the next
16 hours.
Calculation of the 24 hours begins from the time
of the actual burn injury

62. EXAMPLE:
Child weight 70 lbs
Burned TBSA 20%
MD orders: Administer 1300ml of RL in 24 hours
Time of injury 0800 am
Time of MD order 1100 am
Drop factor 15 gtt/ml

63. Is this order safe?
How should this be administered?

64. OBJECTIVES OF IVF
Compensate for water and sodium loss
Restore circulatory volume
Provide profusion
Improve renal function

65. THERAPY
Open tx
Closed tx
Silvadene cream: drug of choice
Escharotomy
Debridement
Grafting

66. Whirlpool/hydrotherapy
Analgesia
Strict I+O
Isolation
When stable
Nutrition

67. SUICIDE
Third leading cause of
death during the teenage
years.

68. MOTIVES
Desire to influence others
Gain attention
Communicate love or anger
Escape a difficult situation

69. RISK FACTORS FOR SUICIDE

Suicidal clues
-- Cryptic verbal messages
-- Giving away personal items
-- Changes in expected patterns of behavior

Specific statements about suicide

Preoccupation with death, interest in death
themes in literature and art

70. RISK FACTORS FOR SUICIDE

Frequent risk-taking or self-abusive behavior

Use of alcohol or drugs to cope

Overwhelming sense of guilt or shame

Obsessional self-doubt
Signs of mental illness such as delusions or
hallucinations

71. RISK FACTORS FOR SUICIDE
Significant change/major life event that is internally
disruptive

History of physical or sexual abuse
Homosexuality, especially if teen discovers gender
orientation early in adolescence, or experiences
violence or rejection because of sexual orientation
Early detection is key to prevention

72. THREATS OF SUICIDE
A suicide gesture or threat should never be
ignored
Nurse must determine whether the child has a
plan and whether the plan is lethal
A qualified health care professional should
provide help

73. NURSING CONSIDERATIONS
A history of a previous suicide attempt is a serious
indicator for possible suicide completion in the
future
Discuss with the parents of at-risk teenagers to
remove firearms, weapons, alcohol, medications
from the home

74. CASE STUDY
A preschool teacher has asked the nurse to
develop and present a program on safety for
toddlers for interested parents.
Devise a topical outline for this program.
Under each topic, list at least three specific
suggestions to offer parents.

75. MOTOR VEHICLE ACCIDENTS
Drowning
Burns
Poisoning
Falls
Choking
Bodily Injury

76. PRACTICE QUESTIONS!

77. When caring for a child diagnosed with severe
lead poisoning, the primary goal is to:
a.Assess for pica
b.Promote excretion of lead via chelating agents
c.Correct the anemia
d.Reverse the neurological effect

78. If observed in a home with a 2-year-old child, which
action would the nurse identify as an INEFFECTIVE
safety measure?
a. Keeping the poison control number by the phone
b. Installing safety latches on bathroom cabinets used for
medication
c. Keeping poisonous items in a locked cabinet
d. Keeping all substances in their original containers

79. A 10-year-old boy is struck on his head with a
hard baseball and was taken to the ER. If the
child were to develop an subdural hematoma,
he would most likely display symptoms:
a.Upon arriving to the ER
b.In the PICU later that day
c.After discharge home
d.Over the next two months

80. In which type of poisonings should the nurse
question orders to induce vomiting?
a.Aspirin
b.Acetaminophen
c.Iron tablets
d.Drain cleaner

81. The nurse is providing discharge instructions for a child
who has suffered a head injury within the last four
hours. The nurse determines there is a need for
additional teaching when the mother states:
a. I will call my doctor immediately if the child starts
vomiting
b. I won’t give my child anything stronger than Tylenol
for a headache
c. My child should sleep for at least 8-12 hours without
arousing him after we get home
d. I recognize that continued amnesia about the injury is
not uncommon

82. When performing a health screening on an
adolescent in the health clinic, the nurse determines
the adolescent is at a higher risk of suicide than
other adolescents of the same age based on the
following disclosure. The adolescent states that he:
a.Sleeps late on the weekends
b.Only has a small group of close friends
c.Is attracted to same sex individuals
d.Often skips meals and does not worry about
nutrition

83. The community health nurse is planning a program to
prevent MVA in toddlers. Parents attending the program
have indicated their children weigh between 20-40 lbs.
Which care safety seat should the nurse bring to
demonstrate proper instruction?
1. Rear facing 5-point harness
2. Forward facing 5 point-harness
3. Booster seat with lap and shoulder belt
4. No seat as seat belt alone in back seat is
ok

84. FILL IN THE BLANK
The nurse is assessing a child who was unrestrained
in a car and sustained a crash. The child was
transported to the ER and is presently in the
positioning below:
The nurse records this as a _____ on the motor response
section of the GSC