Pediatric Emergency Care amnesia

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Pediatric Emergency Care amnesia Powered By Docstoc
					Pediatric Emergency
Lawrence D. Beem, D.C., FICPA
Cleveland Chiropractic College at
        and the
of Emergency Procedures
       Topics to be Covered
 Safety
 Primary Assessment
 Goals of Emergency Procedures
 Legal Issues
 Trauma to the Head
 Trauma to the Neck
 Thermal Injuries
 Shock
               Safety First
 Always   survey the scene for hazards and
  be sure it is safe for You and others who
  may be around the scene.
 If not, do not attempt to respond until it is
  safe and secured.
 This prevents you and others from
  becoming another victim.
 Always assess the nature of the
  emergency or the Mechanism of Injury.
           Safety (Continued)
 Observation:
     The Nature of the Emergency or the
      Mechanism of Injury:
     Patient location (address of the emergency)
     Number of victims
     Are there others who may be able to assist
            Safety (Continued)
 Take   Charge
     Usually people freeze
     Someone needs to take charge and tell them
      what to do

 Assign   duties:
     You go call 9-1-1
     Help that person there and etc.
        Primary Assessment
 Always   begin by determining if the victim
  is conscious
 Airway: Check for clear open airway
 Breathing: Look, Listen and Feel
 Circulation: Check for Carotid or Brachial
 Disability: Mental Alertness
 Expose: Check for Bleeding
         Goals of Emergency

 TO
   Legal Issues in Emergency
 Good  Samaritan
 Duty to Act
 Negligence
 Standards of Care
 Abandonment
 Patient’s Rights
 Consent
          Good Samaritan
 “When  citizens respond to an emergency
 and act as a reasonable and prudent
 person would under the same conditions,
 Good Samaritan immunity generally
 prevails. This legal immunity protects you,
 as a rescuer, from being sued and found
 financially responsible for the victim’s
          Good Samaritan
A  good Samaritan is a person willing to
 provide emergency care without accepting
 anything in return, and is required to use
 common sense and a reasonable degree
 of skill, not to exceed the scope of their
 training in emergency situation.
            Good Samaritan
   Reasonable and Prudent Person;
     Move a victim only if the victim’s life was

     Ask a conscious victim for permission

      before giving care.
     Check the victim for life-threatening

      emergencies before providing further care.
     Summon professional help to the scene by

      calling the local emergency number or the
     Continue to provide care until more highly

      trained personnel arrive.
             Duty to Act
 In most states Chiropractors are
  required to have a CPR certification and
  in some more formal EMS training.
 Most laws were written to take into
  consideration the level of training and
  emergency care skills
 As a healthcare professional, in some
  states, you are required to ACT.
  Chiropractors are considered Primary
  Care Providers in most states, and
  Failure to Act can make you liable.
 The  commission of an act that a prudent
  person would not have done or the
  omission of a duty that a prudent person
  would have fulfilled resulting in injury or
  harm to another person.
 Failure of duty to act
     Failure to provide needed standard of care
     Care that renders harm to a patient
            Standards of Care
 Minimal acceptable care based on local
 protocol and training of the provider.

 Once aid has started, leaving the patient
 before completing care or transferring care
 to someone who has less training.
  Patient’s Right of Consent
 ToProvide care you must have consent
 from the patient:
     Expressed Consent is usually oral.
     Patient must be conscious and competent.
     Patient must be making an informed

     This information allows the patient to
      provide you with Informed Consent. If you
      do not secure permission to help, you
      could be charged with assault and battery.
    Patient’s Right of Consent
 Implied Consent: When a person is
  unconscious, confused or so severely
  injured a clear decision cannot be made
  you have the right to provide care.
 The law assumes that if the patient were
  able to make a decision they would want
  care or treatment.
     Patient’s Right of Consent

A child or mentally incompetent adult are
 not legally allowed to provide consent or
 refuse care. When the parents or a
 guardian are not present and cannot be
 reached the law assumes that they would
 want care provided to this patient.
      Patient’s Right of Consent
 The law recognizes the right of a patient to
 refuse care when:
     When adults are mentally and physically
      capable to make judgments are assumed to
      be competent, and cannot be forced to accept
      emergency care.
     When refusal is given after the patient knows
      the recommended treatment an care is
     This refusal may occur by holding up hands in
      the universal sign to stop or shakes head no.
        Pediatric Emergencies
 Injury is the leading cause of death in
  children in the U.S.

 The  6 most common types of childhood
  injuries are
     Why Kids Always Get Hurt
A  child’s body proportions are different
 from adult’s:
    children have a higher center of gravity
    a child’s head is quite large and heavy
     compared with the rest of the body
    children’s eyesight and hearing take time to
     fully develop
    weaker more immature neck muscles
   Signals of Pediatric Head
     and/or Neck Injuries
 Changes    in consciousness
 Severe pain or pressure in the head,
  neck, or back
 Tingling or loss of sensation in the
  hands, fingers, feet, and toes
 Partial or complete loss of movement of
  any body part
 Unusual bumps or depressions on the
  head or over the spine
Signals of Pediatric Head and/or
          Neck Injuries
   Blood or other fluids in the ears or nose
   Heavy external bleeding of the head, neck, or
   Seizures
   Impaired breathing or vision as a result of
   Nausea or Vomiting
   Persistent headache
   Loss of balance
   Bruising of the head, especially around the
    eyes and behind the ears
        Pediatric Head Injuries
 Mechanism    of Injury
     Compressive
     Tensile
     Shearing
 Types   of Brain Injuries
     Coup
     Countre-coup
        Pediatric Head Injuries
 Types   of skull fracture
     Linear
     Depressed
     Basal
     Comminuted

      injuries occur in proportion to the
 Brain
 degree the brain is accelerated.
         Pediatric Head Injuries
 The   most common head injury is a
 Until just a few years ago, losing
  consciousness was part of the definition of a
 Today, any head injury that makes you
  confused or dizzy for a few minutes is
  considered a concussion.
 There are 3 grading scales for concussions in
       Grade 1   Mild
       Grade 2   Moderate
       Grade 3   Severe
       Grade 1 Concussion

 Noloss of consciousness
 Momentary period of post-traumatic
 Confusion without amnesia
          Grade 2 Concussion

 Briefloss of consciousness
 A period of post-traumatic amnesia
 Confusion
     Grade 3 Concussion

A  loss of consciousness
 A period of post-traumatic Amnesia
   Confusion
      Evaluation of Concussion
 Mental    Status Testing
     Orientation: Time, place, person and
     Concentration: Digits backward, months of
      year backward
     Memory: Names (own name, parent’s
      name, 3 words and 3 objects
     Neurological Testing:
       • Pupils: symmetry and reaction
       • Coordination: finger-nose, finger to finger
       • Sensation: finger prick, pinch
      Evaluation of Concussion
 External   Provocative Testing
     5 knee bends
     5 sit-ups
     5 push-ups
     40 yard sprint
                Punch Drunk
   Fatuous or Euphoric dementia
   Emotional liability
   Mood swings
   Progressively slower speech and thought
   Deteriorating memory
   Tremor
   Dysarthria
   Bradykinesia
    Post-concussion Syndrome
 Headache
 Dizziness
 Fatigue
 Irritability
 Impaired       memory and concentration
  Four Types of Hemorrhages
  Possible in every Head Injury
 Epidural or Extradural Hematoma
 Subdural Hematoma
 Intracerebral Hematoma
 Subarachnoid Hemorrhage
Malignant Brain Edema Syndrome
  (Adult 2nd. Impact Syndrome)
 Hyperemia of the brain
 Athletes with symptoms from previous head
  injury who sustain a second acceleration head
 Rapid progression to coma
            Cervical Spine Injuries
   Cervical sprain is the most common neck injury
      It is caused by damage to the musculotendon units

      The associated pain and irritation will remove the

       athlete from competition at least for the event.
   Spinal Cord Concussion involves the cord itself:
      Concussion is from a single violent impact to the

       vertebral column and it effects spinal cord function.
      These effects are transient and with some of motor or

       sensory cord function below the level of injury
      The symptoms may last from seconds to minutes and

       by definition they must to have cleared within 24
      Symptoms that last beyond 24 hours indicate a more

       serious injury.
Cervical Spine Injuries (Continued)
   Spinal Cord Contusion
       Contusion can cause varying degrees of permanent
        cord injury
   Central Cord Syndrome
       Indicates spinal cord injury with disproportionate
        greater loss of motor and sensory function in the
        upper extremities as compared with the lower
       Central Cord Syndrome is usually caused by a
        hyperextension injury.
Cervical Spine Injuries (Continued)
   Burning Hand Syndrome is named for its
       Predominately painful dysesthesias that appear in the
        hands more than in the lower extremities.
       Is a variant of the central cord syndrome.
   Lateral Pinch or Burners Syndrome is so called
    because of similar burning sensations.
       Characterized by pain and burning paresthesia that
        radiate from the neck down one arm often to the base
        of the thumb lasting several minutes or less.
           Cervical Spine Injuries
 Torticollis is a condition that causes the neck to
  involuntarily twist to one side secondary to
  contraction of the neck muscles.
 The ear is tilted toward the contracted muscle
  and the chin is facing the opposite direction.
 Some of the more common causes include:
       Congenital problems
       Trauma
       Infections
         Cervical Spine Injuries
         (Torticollis Continued)
 Congenital    Muscular Torticollis
     Is a common Condition
     Usually discovered in the first 6 to 8 weeks of
     The contracture usually occurs on the right
     20% of the children with congenital muscular
      torticollis also have developmental dysplasia
      of the hip
         Cervical Spine Injuries
         (Torticollis Continued)
 Non-muscular      Torticollis: Traumatic
     Most cases of torticollis in children have a
      sudden onset which may follow trauma or
      strenuous activity.
     Torticollis commonly follows an injury to the
      C1/C2 articulation.
         Cervical Spine Injuries
         (Torticollis Continued)
 Non-muscular       torticollis: Infections
     A major cause of torticollis in older children is
      bacterial or viral pharyngitis with involvement
      of the cervical nodes.
     Spontaneous atlantoaxial rotatory subluxation
      can occur following acute pharyngitis.
    Cervical Spine Injuries (Erb’s
   Erb’s Palsy or Upper Brachial Plexus Injuries:
       Brachial Plexus Injury is a weakness of the arm that
        occurs in newborn babies.
       It is caused when the nerves that control the are are
        stretched during the birth process or may be due to a
       Infants with Erb’s Palsy (BPI) hold the affected arm at
        the side, with the forearm turned inward and the wrist
  Cervical Spine Injuries (Erb’s
 Erb’s   Palsy or Brachial Plexus Injuries:
     Appearance: Drooping, wasted shoulder,
      pronated and extended limb (“waiter’s tip
         Cervical Spine Injuries
          (Klumpke’s Palsy)
 Klumpke’s     Palsy or Lower Brachial Plexus
     Much rarer than Erb’s Palsy
     Loss of C8 and T1 which results in major
      motor deficits in the muscles working the
      hand: (“claw hand”).
     Loss of sensation to the medial aspect of the
      upper extremity.