TRAUMA PEDIATRIC in nursing management ppt

emergency

1. TRAUMA NURSING CARE FOR PEDIATRIC PATIENT GROUP D MAJ RIZWANA CAPT MEHWISH CAPT ULFAT CAPT FOUZIA CAPT NAILA CAPT TEHMINA CAPT CHANDA CAPT SADIA CAPT FARINA CAPT RUKHSANA

2. Scenario A previously healthy two year old boy is brought to the Pediatric ER with altered mental status after his mother found him limp and unresponsive in his room.His mother put him down for a nap about one hour after he ate lunch; when she went to check on him two hours later, he was laying on the floor and was unable to be aroused from sleep. She immediately called EMS for assistance. Upon your arrival, his initial vital signs are as follows: Heart Rate 120 Respiratory Rate 24 Blood Pressure 90/60 Oxygen Saturation:98 % on room air

3. Physical Exam Maintaining a patent airway, normal lung and cardiac exam •Responsive only to painful painful stimuli by pulling away from the painful stimulus • Occasionally moans but has no purposeful verbal communication • Eyes remain closed to verbal and tactile stimuli. When manually opened, pupils are 3mm, equal, and reactive to light bilaterally • Muscle tone is diminished throughout • No skin lesions, rashes, or external evidence of trauma • Remainder of physical exam is normal

4. Initial Treatment Goals Q. What are the initial treatment goals? Ensure airway patency Stabilize vital sign Access and maintain circulation Administer supplemental oxygen Protect cervical spine Assess neurological status Monitor and document

5. Additional Elements In History Q. What additional elements would you like to learn about his history? Secondary survey: Obtain AMPLE history A allergies M medication P past medical history L last meal E events leading to injury

6. Cont … Head and maxillofacial C- spine & neck Chest and abdomen GI & rectum Skin & extremities

7. Transportation Q. How would you prepare this patient for transport? Before transportation: Communicate and collaborate Check bed availability Brief description of child’s condition Necessary arrangements needs to be done in ICU

8. Cont … During transportation: Transport with doctor/RN along with two assistant. Secure airway, monitor vitals signs, establish IV. Immobilization if there is any suspicion of trauma, HEAD/SPINE.

9. Shifting Of Patient Q. To which facility would you want to take this patient? Preferably we’ll shift this case to Peads Surg ITC, under the care of Neurosurgeon. GCS is 7/15

10. Initial Treatment Management Q. Initial Treatment Goals • A, B, C’s of trauma management – rapidly use your pediatric assessment triangle and primary survey to determine if the patient is sick or not sick: • Airway • Breathing • Circulation • Disability • Exposure • Which interventions are appropriate in this patient?

11. Airway with Cervical Spine Protection Assessment • check airway patency • Rapidly assess for airway obstruction Management • Head Tilt and Chin Lift • Clear airway of foreign bodies • Insert oropharyngel or nasopharyngeal airway Maintain cervical spine in neutral position with manual immobilization as necessary when establishing airway • Reinstate immobilization of c-spine after establishing airway

12. Breathing: Ventilation and Oxygenation Assessment Expose neck and chest Assure immobilization of head and neck Determine depth and rate of respirations Inspect and palpate neck and chest for tracheal deviation Unilateral and bilateral chest movement, use of accessory muscles, any signs of injury Percuss chest for dullness or hyper-resonance Auscultate chest bilaterally

13. Breathing: Ventilation and Oxygenation Management • Administer high concentration oxygen • Alleviate tension pneumothorax • Seal open pneumothorax • Pulse oximetry

14. Circulation with Hemorrhage Control Assessment • Identify source of external and internal hemorrhage • Pulse (quality, rate, regularity, paradoxical) • Skin color Capillary Refill • Decrease in blood pressure is a late finding in pediatric shock

15. Circulation with Hemorrhage Control Management Apply direct pressure to external bleeding site Consider presence of internal hemorrhage and potential need for operative management Insert 2 large-wide bore IV cannulas IV hydration with warm RL/NS or blood replacement Prevent hypothermia

16. Disability ; Brief Neurologic Neurologic Examination Determine level of consciousness • AVPU method A= Alert at baseline V= Verbal stimuli P= Painful stimuli U= Unresponsive • GCS score (score ranges from3 to 15) • Severe (GCS ≤ 8) • Moderate (GCS9 – 12) • Minor (GCS≥ 13) • Assess pupils for size, quality, reactivity

17. Pediatric Glascocoma scale

18. Environment/ Exposure Environment/ Exposure • Completely undress patient • Prevent hypothermia • Secondary survey once all primary survey interventions are met, more detailed head to toe physical exam

19. Message Of The Day