paediatric emergency.pptx

Viji child health nursing

1. CONNECT IT

2. Pediatric emergencies

3. Introduction Accidents and paediatric emergencies are common threat for the survival of children . Medical emergencies in paediatric practice constitute a sizeable segment of illness among infants and children. Since emergencies do not often permit leisurely consultations with specialists. History taking may be difficult and examination of children also. So, every medical personnel must possess a sound practical knowledge of efficiently handling these emergencies, syndromes.

4. CARDIAC ARREST Cardiac arrest may occur without warning or as a terminal event in chronic disease processes. It may manifest in one of three ways. 1. Ventricular stanstill ( asystole ) 2. Ventricular fibrillation. 3. Cardio vascular collapse.

5. Diagnosis 1.Pallor 2.Verypoororalmostimpreceptiblepulse 3.Unrecordablebloodpressure. 4. Cessation of respiration. 5.Ineffectivecardiacaction. The diagnosis is confirmed by palpation of the carotid and femoral pulses. ECG

6. Treatment If the cardiac pulse is absent and no heart beat is heard, the use of a defibrillator And CPR. The patient must be put on a board or on the floor with the head lowered. The most important treatment is to maintain a clear air-way by tilting the head backward, cleaning the upper air passages. Administrations of oxygen with 100%.

7. CARDIAC TEMPONADE Cardiac temponade results from rapid accumulation of fluid within the Pericardium there by raising the intra pericardial pressure to the point where the venous flow and the diastolic filling of the heart are impeded. It occurs in sudden hemorrhage into the pericardium.

8. Clinical feature Distended jugular veins Paradoxical pulse Peripheral oedema Tachycardia Hepatomegally Shock. Diagnosis Muffled heart sounds. Enlarged area of cardiac dullness and the apex beat not being palpable. Fluoroscopy may demonstrate the absence of pulsation of cardiac border.

9. Treatment Immediate relief is given by evacuation of the fluid. Pericardiocentesis is done through one of the following sites depending on the individual situation.

10. DROWNING Drowning is one of the important causes of accidental death among children. Asphyxia with a matter of 1-2 minutes after complete submersion and cardiac arrest occurs in the next 2-5 minutes.

11. Clinical features Abdomen distension Reflex apneaHypoxia, hypercapnia, & acidosis Cardiac arrhythmias, hypotension and renal tubular necrosis HyponatrimiaVomiting and aspiration Terminal apnea More inhalation of water Pulmonary & cerebral oedema

12. Management The immediate treatment is to clear the air way and start mouth to mouth breathing, closed cardiac message and oxygen. The child should be moved to the hospital as quickly as possible Back blow is done .

13. ACUTE RESPIRATORY FAILURE Acute respiratory failure is a life threatening emergency which requires prompt treatment in some kind of situation when hypoxia is present along with hyper capnoea. A low partial pressure of oxygen in arterial blood PaO, 50 mm of Hg with or without elevated CO, in arterial blood PaCO, 50 mm of Hg, is as respiratory failure.

14. ETIOLOGY CNS Head injury Guillain Barre syndrome Polio myelitis Myasthenia gravis. Cardiovascular syste m Congenital heart disease Congestive heart failure. Respiratory system Asthma Emphysema Foreign body Croup- Pneumothorax Pleural effusion Pulmonary oedema Chest wall – Traumna Poisoning :- Narcotic poisioning

15. Treatment The oxygen administration (1-4 lit/minute). Assisted ventilation. Aminophylline for relief from branchospasm. Antibiotics, steroids, digitals and potassium chloride. Endotracheal tube intubation if condition is not improved.

16. COMA Disorders of consciousness (alteration of sensorium) may range from stupor to coma. Stupor is partial disturbance of consciousness from which the patient can be aroused, whereas coma is a complete obliteration of consciousness from which the patient cannot be aroused by even painful stimuli.

17. ETIOLOGY i ntracranial causes Trauma Raised intracranial pressure or tension Meningitis Intracranial tumors Degenerative disease Encephalitis Extra cranial causes: Shock Diabetic coma Hepatic coma Uremia Hypoglycemia Electrolytic imbalance Poisons Septicemia Hyper pyrexia Anaphylaxis

18. Diagnosis History of the child from parents. Complete physical examination including vital signs, neurological defects like (hemiplegia, cranial nerve paralysis) Laboratory investigation. Urine examination for sugar and acetone. Lumbar puncture. X-ray of skull and chest.

19. Treatment Emergency treatment Maintain the airway. Tracheostomy. Administration of oxygen. Supportive treatment : Administration of I.V. fluids. Nutrition through nasal tube feeding Frequently changes the position Catheterization for bladder care

20. SHOCK Shock is a syndrome which is characterized by a traid of findings are Hypotension Break of effective tissue perfusion. Profound protrusion producing wide-spread systematic effect .

21. Types of shock

22. Types Etiology Clinical features Diagnosis management Hypovolemic shock : The most common type of shock. It is characterized by decreased intravascular volume. it occurs when there is a reduction in intravascular volume of15% to 25%. Haemorrhage Bur n s Dehydration Intestinal obstruction Infection like peritonitis. Decreased blood pressure Low central venous pressure Tachycardia Whole blood is the ideal treatment for shock due to haemorrhagePlasma loss is combated by plasma if available. Isotonic fluids are indicated for all the type of dehydration .

23. Types Etiology Clinical features Diagnosis Management Frequently check the vital signs. Foot end elevation for improvement of blood circulation. CARDIOGENIC SHOCK Occurs when the heart's ability to contract and to pumping blood is impaired and the supply of oxygen is inadequate for the heart and tissues. Cardiac temponade due to pericardial effusion. Cardiac arrhythmias Myocarditis Cardiac arrhythmias Electrolyte disturbance like acidosis, hypocalcaemia Congestive heart failure. Increased venous pressure. Increased venous resistance. Tachypnoea , cyanosis, crackles Hypernatremia , Decreased urine output. Skin will be pallor,cool , clammy. Decreased bowel sounds, nausea/vomiting . Cardiac sound not heard during physical examination. Increased blood glucose level Electro cardiogram Chest X-ray. Removal of pericardial fluid. In early stages of shock,supplemental oxygen is given by nasal cannula at arate of 2 to 6 L/mint to achieve oxygen saturation. Controlling heart rate.Providing selective fluid support.

24. Types Etiology Clinical features Diagnosis Management If the patient experiences chestpain , morphine sulphate is given intravenously for pain relief. NEUROGENIC SHOCK OR PSYCHOGENIC SHOCK It is a hemodynamic phenomenon that occurs after a spinal cord injury at the fifth thoracic vertebra or above. Spinal cord injury Spinal anaesthesia Pain Drugs-especially vasodilators. Tachycardia Tremor Pallor Hypotension Decreased cerebral blood flow. Loss of reflex activity with bowel and bladder function . Restoring sympathetic tone either through the stabilization of a spinal or injury or in the instance of spinal anaesthesia . Positioning the patient properly. If hypoglycaemia (insulin shock) is the cause, glucose rapidly administered.

25. Types Etiology Clinical features Diagnosis Management SEPTIC OR BACTERIMIC SHOCK It is a systemic inflammatory response to a documented or suspected infection. Gram negative septicaemia Meningitis Peritonitis Other infection. Early Increasing and decreasing of body temperature Tachycardia Hypotension . Late Increased PCO, level and decreased PO, level. Respiratory acidosis. Pulmonary hypertension with crackles sounds. Decreased urine output. Skin hemorrhages . Hepato splenomegaly . Blood examination for WBC count. Platelet count. Positive blood culture. Urine examination for: Specific gravity Urine sodium level decreased. Broad spectrum antibiotics are started until culture and sensitivity reports arereceived . Cephalosporin agent plus an amino glycosides may be prescribed initially. Nutritional supplementation should be initiated within the first 24 hours of the onset of shock .

26. Types Etiology Clinical features Diagnosis Management ANAPHYLACTIC SHOCK It occurs as a result of an acute allergic reaction from exposure to a substance to which the child has been sensitized. The substance are drugs, chemical, vaccine, food or insect venom Urticaria Respiratory distress Bronchospasm Circulatory collapse Chest pain Swelling of lips and tongue Shortness of breath Edema of the larynx and epiglottis Wheezing, Rhinitis, Stridor Mental confusion Nausea, vomitting , diarrhoea etc. Removing the causative antigen. Epinephrine is given for its vasoconstrictive action. Diphenyl hydramine is administered to reverse the effects of histamine, Aminophylline is given to reverse histamine induced bronchospasm . If cardiac arrest have occurred, cardiopulmonary resuscitation is performed. Endotracheal intubation

27. HAEMORRHAGE Haemorrhage is a term applied to bleeding or a flow of blood, especially if it is veryprofuse. The haemorrhage may be external or internal. The latter form of haemorrhageis often serious and requires prompt diagnosis and treatment.

28. Cause of Haemorrhage 1. Gastro intestinal system Hematemesis Rectal bleeding 2. Respiratory System Epistaxis Hemoptysis Hemothorax 3) Renal System Hematuria

29. Management When gross haemorrhage occurs from areas which are obvious, a tourniquetmay help to control the hemorrhage. The torniquet is loosened every 15-20minutes for one or two minutes and re-applied till routine care can be instituted. Restoration of blood volume Supportive therapy includes oxygen, suction, gastric lavage and treatment ofcardiac arrest and temponade if hemorrhage is associated with trauma.

30. FOREIGN BODY ASPIRATION I nfancy is the oral phase, when infants explore everything by putting them in the mouth. If small objects are put in the mouth, they may get aspirated. Toddlers often aspirate foreign bodies such as peanut, almond, groundnut seeds, grains and pulses. Occasionally, small metallic coins may also be inhaled though, more often, these are swallowed. There is a sudden paroxysm of cough with congestion of the face and almost a sta t e of suffocation. If the foreign body fails to be coughed out, it may cause partial or complete obstruction of a main bronchus.

31. Diagnosis It is from the history of a sudden paroxysm of violent, clinical findings of pneumonia, collapse, emphysema, etc. bronchoscopy and radiology (provided if it is a metallic foreign body).

32. Management Precautions- The care should be taken not to leave any small objects in infants hand and within their reach. Toys should not have any small removable parts. Infants should never be fed solid foods which are difficult for them to chew, such as groundnuts. Management is aimed at removing the foreign body (in most cases by bronchoscopy ) and administration of appropriate antibiotics in care of infection.

33. POISONING The growth, characteristic of the normal child such as increased activity and oral exploration of objects in early life, naturally leads to such accidents. Transferring poison from its original container, careless misplacement from the usual place of storage and lack of storage space in low socio-economic groups.

34. TYPES OF POISONING Kerosene oil poisoning Ddt poisoning Datura poisoning Lead poisoning Mercury poisoning Chronic mercury poisoning

35. clinical features General Pyrexia Hypothermia in morphine, Phosphorus etc. Excessive salivation Organophosphorus - Odour in breath Kerosene Pallor- Lead, Benzene etc. Cardiovascular systems Tachycardia-Atropine, Digitalis etc. Bradycardia -Morphine, Digitalis Hypertension Hypotension-Sedatives, Largectil etc.

36. Respiratory system Tachycardia-Atropine, carbon - monoxide Bradypnoea -Morphine. Centeral Nervous system Convulsion-Antihistamine Neck rigidity spasm-Lead, magnesium Hyporeflexia .-Lead, magnesium

37. DIAGNOSIS The diagnosis of poisoning may not often be obvious and should be suspected in obscurely in patients. By the physical examination. Laboratory examination.

38. MANAGEMENT Emetics- Vomiting is induced by tickling the back of the throat or by the use of emetics such as large drinks of salt water or by syrupP ipecac 9-15 ml repeated after 15 minutes. Apomorphine hydrochloride 0.l mg/kg 1.V. or subcutaneously may be used to induce vomitting. Castric lavage-For the cleaning of the gastrointestinal tract and administration of antidotes. The fluid that are usetul in gastric lavage are Warm tap water. One % salt solution. Activated charcol 90 gm in 400 ml of water. Absorption Non-specific absorbants like activated charcol powder are very effective and may be used after gastric lavage. 10-15 gm administered for each gm poison. Symptomatic and supportive therapy Keep the patient warm. Administration of blood and isotonic fluids. Suctioning of the respiratory tract Antibiotics for prevention of complications

39. ROAD TRAFFIC ACCIDENTS Traffic accidents or vehicle accidents are major cause of mortality today. In metropolitan cities, these accidents are increasing day by days. As the road traffic increases, risk of accidents is also increased. Road traffic accident are more common till school age group.

40. CAUSES Advancement of play materials and riding methods like - cycles and small petrol bikes . Negligence of parents. Lack of supervision. Playing by children in colonies, streets and on roads. Allowing the bicycles and tricycles to ride by the children at road sides. Negligence of traffic rules Lack of first aid facilities vehicles.

41. MANAGEMENT Children must not be allowed to play in streets. Children should be taught how to safely cross the road as soon as they are old enough to understand. They should be careful not to be run over by a reversing car. They must not be allowed to stand in a car when in motion and never left alone in a care unless it has been ensured that the keys are not in. Children using bicycles and tricycles must be cautioned against ditches and manholes in the drive which may cause accidents.Implementation of Rules Traffic rules, such as compulsory wearing of crash helmets. Restriction of the speed to recommended limits.

42. Checking of blood alcohol level of drivers that Regular checking of vehicles. Seat belts should be also made compulsory. Regular caution needs to be exercised in issuing driving licences. A driving licence should bear the blood group of the owner. Children must not travel on the front seat of the car. Condition of roads must be up to the mark. Every crossing and every vehicles must have first aid facilities and every driver must be familiar with first-aid administration before being issued a license.

43. CONCLUSION: Pediatric emergency medicine is a medical subspecialty of both pediatrics and emergency medicine. It involves the care of undifferentiated, unscheduled children with acute illnesses or injuries that require immediate medical attention.

44. SUMMARY

45. Knowledge translation studies in paediatric emergency medicine: A systematic review of the literature Aim:  Systematic review of knowledge translation studies focused on paediatric emergency care to describe and assess the interventions used in emergency department settings. Methods:  Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies. Results:  From 1305 publications identified, 15 studies of varied design were included. Four were cluster-controlled trials, two patient-level randomised controlled trials, two interrupted time series, one descriptive study and six before and after intervention studies. Knowledge translation interventions were predominantly aimed at the treating clinician, with some targeting the organisation.

46. Studies assessed effectiveness of interventions over 6-12 months in before and after studies, and 3-28 months in cluster or patient level controlled trials. Changes in clinical practice were variable, with studies on single disease and single treatments in a single site showing greater improvement.

47. ASSIGNMENT: Write an assignment on mercury poisoning

48. BIBLIOGRAPHY: BOOK REFERENCE: Rimple Sharma,’’Essential Of Paediatric Nursing,’’2ndedition,Jaypeepublication Pg No:502-504. Parul Data ‘’Pediatric Nursing’’ 2ndedition(2009),Jaypee Brothersmedical Publication Pg No:483-485. Ghai, ‘’Essential Pediatrics’’7th Edition(2009),CbsPublisher Pg No:371-374 . NET REFERENCE: https://www.healthline.com/health/paediatric emergency https://journals.lww.com/clinorthop/fulltext/2009/05000/update_on_paediatric emegencies__etiology_and_treatment.5.aspx https://www.hopkinsmedicine.org/health/conditions-and- racing