Injuries and accidents in pediatrics presentation by kajal of mbbs batch 2012(adesh university)

1. INJURIES AND
ACCIDENTS IN
PEDIATRICS
KAJAL
60

2. Injury versus Accident
• Accident (WHO): an event independent of human willpower,
caused by an external force, acts rapidly and results in bodily
or mental damage
• Injury: refers to the damage resulting from acute exposure to
physical and chemical agents
• Accident is the event while injuries the consequences
• Accidents are random, chance, uncontrollable events but
injuries are describable, epidemiologic conditions that can be
controlled and prevented

3. Interactive Model of Injuries
VICTIM
(HOST)
AGENT
HUMAN
ENVIRONMENT
PHYSICAL
ENVIRONMENT

4. Primary Factors in Pediatric Accidents
Increased vulnerability
and/or risk situation
Psychosocial
(endogenous)
Predisposing Factors
Environmental
(exogenous)
Predisposing Factors
Accident
Precipitating
Factors
Precipitating
Factors

5. Classification of Injuries
Unintentional Injuries:
(Road traffic injuries,
Poisoning,
Falls,
Fire and burn injuries,
Drowning)
Intentional Injuries:

6. Mechanism of injuryMechanism of injury
• Massage in newbornsMassage in newborns
• Fall while walking/running/sports/heightFall while walking/running/sports/height
• Vehicular accident: pedestrian/ in vehicleVehicular accident: pedestrian/ in vehicle
• Crush injury: door, heavy objectCrush injury: door, heavy object
• Sharp object : impalement/ bitesSharp object : impalement/ bites
• Large object falling on child: chest /Large object falling on child: chest /
abdomenabdomen

7. Site of InjurySite of Injury
• Head injuryHead injury
• Face , neck, mouth injuryFace , neck, mouth injury
• Chest injuryChest injury
• Abdominal injuryAbdominal injury
• Limb injuryLimb injury

8. Breast abscess following massageBreast abscess following massage

9. OVERVIEW OF COMMON
ACCIDENTAL INGESTION
INGESTIONINGESTION CLINICALCLINICAL
MANIFESTATIOMANIFESTATIO
NN
NURSINGNURSING
TREATMENTTREATMENT
INTERVENTIONSINTERVENTIONS
Salicylate (Aspirin)Salicylate (Aspirin)
TinnitusTinnitus
HyperpyrexiaHyperpyrexia
SeizuresSeizures
BleedingBleeding
HyperventilationHyperventilation
EmesisEmesis
HydrationHydration
Vitamin KVitamin K
Activated charcoalActivated charcoal
AnticipatoryAnticipatory
guidanceguidance
BleedingBleeding
precautionsprecautions
Counseling if suicideCounseling if suicide
attemptattempt
AcetaminophenAcetaminophen
(Tylenol)(Tylenol)
Liver necrosis in 2-5Liver necrosis in 2-5
days; nausea;days; nausea;
vomiting; pain in Rvomiting; pain in R
upper quadrant;upper quadrant;
jaundice;jaundice;
coagulation;coagulation;
abnormalities,abnormalities,
hepatoxichepatoxic
-EmesisEmesis
MucomystMucomyst
(antidote)(antidote)
-Counseling if-Counseling if
suicide attemptsuicide attempt
- Liver assessment- Liver assessment

10. Lead (paint, also inLead (paint, also in
soil near heavilysoil near heavily
trafficked roadways,trafficked roadways,
household dust)household dust)
-Developmental-Developmental
regressionregression
-Impaired growth-Impaired growth
(encelophalopathy)(encelophalopathy)
-Irritability-Irritability
-Increased-Increased
clumsinessclumsiness
-Chelation therapyChelation therapy
-EDTAEDTA
-BalBal
-Child must be wellChild must be well
hydratedhydrated
-Neuro assessmentNeuro assessment
-Diet high in calcium,Diet high in calcium,
ironiron
-Educate parents toEducate parents to
wash chuld’s hands,wash chuld’s hands,
toys frequently totoys frequently to
remove lead dustremove lead dust
-Lead abatementLead abatement
HydrocarbonsHydrocarbons
(kerosene,(kerosene,
turpentine, gasoline)turpentine, gasoline)
-Burning in mouthBurning in mouth
- choking andchoking and
gagginggagging
-CNS depressionCNS depression
-DO NOT INDUCEDO NOT INDUCE
EMESISEMESIS
-Activated charcoalActivated charcoal
-Gastric lavageGastric lavage
If vomiting, reduceIf vomiting, reduce
aspirationaspiration
Corrosives (drain orCorrosives (drain or
oven cleanser,oven cleanser,
chlorine bleach,chlorine bleach,
battery acid)battery acid)
-Burning in mouth-Burning in mouth
-White swollenWhite swollen
mucous membranesmucous membranes
-Violent vomitingViolent vomiting
- DO NOT INDUCE- DO NOT INDUCE
EMESISEMESIS
-Dilute toxin withDilute toxin with
waterwater
-Activated charcoalActivated charcoal
Keep warm andKeep warm and
inactiveinactive

11. MANAGEMENT OF
INGESTION
• Ingestions
– General information
• Emergency care: ABCs
• Identify substance, save evidence of poison
• Call poison control center for treatment advice
• Removal of substance
• syrup of ipecac
• Emetic
• 15 cc with 200-300 cc of water
• Save emesis
• Contraindications
– Unconscious
– Convulsing
– Ingested hydrocarbon, lye, strychnine

12. • Activated charcoal
• Gastric lavage
• Administer specific antidote
• Provide supportive therapy
• Educate parents about childproof environment
• Provide anticipatory guidance
• Infants and toddlers: at risk because everything goes
into the mouth
• Adolescents: at risk for intentional ingestion

13. BURNS
• 1. Characteristics of burns in children
• Due to the difference in proportions of
head, trunk and limbs, burn percentages are
rated differently for children
• Due to the high percentage of extracellular
fluids in the child, fluid loss can quickly
leas to hypovolemic shock.

14. • 2. Treatment
• similar to adult
• Children are likely to resist eating enough calories to
sustain healing and growth needs. Parenteral or
enteral feedings are usually necessary.
• 3. Rehabilitation
• Incorporate play into the PT and OT regimens for
improved success.
• Consider psychosocial needs of the child
• Adjustment and transition back to school may be very
difficult for the child who has sustained at disfiguring
burn

15. FRACTURES
• 1. Characteristics of fractures in children
• Due to immaturity of bones and incomplete ossification,
greenstick (incomplete) fractures are commonly seen
• Fractures to the epiphysis (growth plate) are of greater
concern as growth in limb can be stunted depending on the
amount of injury
• 2. Treatment
• Similar to adult, although pediatric fractures often have
shorter healing times
• May use cast (plaster or more commonly, fiberglass) soft
splint, traction or bracing

16. COMPLICATION OF
FRACTURES IN CHILDREN
• MALALIGNEMENT
• PHYSEAL ARREST
• OVERGROWTH
• REFRACTURE CAUSED BY RAPID
FRACTURE HEALING
• SHORTENING OF LIMB
• MALUNION,NONUNION FAT
EMBOLISM

17. MUSCULOSKELETAL
DISORDERS
• Scoliosis
• Lateral curvature of the spine
• Most common form is idiopathic seen (predominately) in
adolescent females; unknown etiology
• Acquired scoliosis associated with deformity resulting
from other neuromuscular disorders
• Diagnosis
• 1) Classic signs: truneal asymmetry; especially noted in
hips and shoulders, posture
• 2) Screening exam in school: child flexes at waist; one
scapula more prominent
• 3) Spinal x-ray

18. • e. Treatment
• 1) Mild scoliosis (20˚ curvature): observation,
encourage physical exercise
• 2) Moderate scoliosis (20˚-40˚curvature):
Milwaukee brace (pelvis to neck), Boston
brace (body jacket/TLSO brace)
• a) Goal is to prevent worsening of curve
• b) NURSING INTERVENTIONS
– Risk for noncompliance: difficult for adolescent due to
body image concerns; must wear 23 hours a day (one
hour off hygiene care); wears T-shirt under brace
– Body image disturbance: Boston brace better accepted (can
be completely hidden under clothing)

19. • 3) Severe scoliosis (40˚ curvature): surgery
• a) Spinal fusion with instrumentation
• b) Requires prolonged immobilization in cast,
brace or body jacket
• c) NURSING INTERVENTIONS
• (1) High risk for injury related to spinal
manipulation: log roll first 24 hours; neurovascular
checks; advance activity as ordered; observe for
paralytic ileus
• (2) Pain: adolescent good candidate for PCA pump

20. Children and drowning
Drowning refers to an event in which a child’s
airway is submerged in liquid, leading to an
impairment to breathing. The outcome can
be fatal or non-fatal, with some non-fatal
drowning events leading to significant
neurological damage.

21. Places where children drown
• Sea, lakes, streams
• Swimmingpools
• Wells, cisterns
• Buckets
• Bathtubs,Gardenponds

22. RISK FACTORS
• children under the age of five are at greatest risk of drowning,
although adolescents (15–19 years of age) also have high rates.
• Boys are almost twice as likely as girls to drown
• Drowning is strongly associated with poverty, particularly with regard
to parents’ educational level, number of children in the family and
ethnicity
• Populations most at risk are those living in low-income countries of
densely populated communities with high exposure to open water
• Other risk factors for drowning include: lack of available and
accessible safety equipment (e.g. life jacket), travel on unsafe water
transport (e.g. overcrowded ferries)

23. MANAGEMENT
• Rapidly assess airway, breathing, circulation and
conscious state.
• If child is in cardiorespiratory arrest proceed immediately
with Resuscitation guidelines.
• Airway and breathing (protect cervical spine if any
possibility of injury)
• If spontaneously breathing administer 100% oxygen by face
mask.
• Intubate and ventilate if:
– inadequate respiration
– falling arterial oxygen concentration despite increased
inspired oxygen
– persisting depressed conscious state.
• Perform chest X-ray.

24. Circulation
Assess pulse rate and volume, blood pressure and capillary
return.
Insert intravenous line.
Perform FBE, serum glucose, electrolytes and creatinine.
If circulation is inadequate give fluid bolus of 20 ml/kg.

25. Cerebral support
• Avoid any further episodes of hypoxia and hypercarbia.
• Optimise circulation as best possible.
• Once shock is reversed fluid restrict to 75% maintenance.
• Monitoring and control of intracranial pressure is
occasionally required.
Temperature
• Actively rewarm children slowly to a core temperature of
34 degrees.
• Passively rewarm over 34 degrees
General
• Admit to appropriate inpatient unit.
• Administer penicillin for respiratory prophylaxis.
• Corticosteroids are not recommended.

26. Adverse prognostic factors
• Immersion time > 10 minutes.
• Rectal temperature < 30°C.
• Absence of any initial resuscitative efforts.
• Arrival in hospital with CPR in progress or in coma.
• Requirement of cardiopulmonary resuscitation.
• Initial serum pH < 7.0

27. INTENTIONAL INJURIES
• Homicides
• Sexual assaults
• Neglect and abandonment
• Maltreatment
• Suicides
• Collective violence (war)

28. PREVENTION OF INTENTIONAL INJURIES IN CHILDREN